Quality Health Care: A Guide to Developing and Using Indicators / Edition 2

by Robert Lloyd

Overview

Written by an internationally-recognized expert in the field of quality management, this text is an essential guide for understanding how to plan and implement a successful quality measurement program in your healthcare facility. It begins by presenting an overview of the context for quality measurement, the forces influencing the demand for quality reform, how to listen to the voice of the customer, and the characteristics of quality that customers value most. Students will also learn how to select and define indicators to collect data and how to organize data into a dashboard that can provide feedback on progress toward quality measurement. Finally, this book explores how to analyze the data by detailing how variation lives in your data, and whether this variation is acceptable. Case studies are provided to demonstrate how quality measurement can be applied to clinical as well as operational aspects of healthcare delivery.

Product Details

ISBN-13:	9781284023077
Publisher:	Jones & Bartlett Learning
Publication date:	09/01/2017
Pages:	368
Product dimensions:	6.90(w) x 8.90(h) x 1.00(d)

About the Author

Dr. Robert Lloyd, Ph.D.,is Vice Presidentfor the Institute for Healthcare Improvement (IHI). Dr. Lloyd provides leadership in the areas of performance improvement strategies, statistical process control methods, performance improvement indicators, strategic dashboard development and performance improvement training. He also serves as faculty for various IHI initiatives. Before joining the IHI, Dr. Lloyd served as the Corporate Director of Quality Resource Services for Advocate Health Care (Oak Brook, IL). He also served as director of Quality Measurement for Lutheran General Hospital and directed the American Hospital Association's Quality Measurement and Management (QMMP) project. The Pennsylvania State University awarded all three of Dr. Lloyd’s degrees. His undergraduate degree is in sociology, his master’s degree is in regional planning and his doctorate is in rural sociology. Dr. Lloyd has addressed over 370 national meetings of professional groups and associations, and has had over 22,000 participants from this country and abroad attend his classes and presentations on CQI. He has served as faculty for the American College of Healthcare Executives, the American Society for Quality (ASQ), the University of Wisconsin's graduate program in Administrative Medicine, the Healthcare Forum, the International Quality and Productivity Center, the American Health Information Management Association, the JCAHO, the Group Practice Improvement Network, the Ontario Hospital Association, the Vancouver BC Quality Forum, the Medical Group Management Association and numerous QIOs around the country. Dr. Lloyd has also presented his two-day seminar on statistical thinking to physicians and administrators from the Federation of County Councils in Stockholm, Sweden. He has published articles and reports on a wide range of topics including CQI theory and implementation, clinical outcomes, customer satisfaction, information systems and parish nursing. He also serves as a Regional Councilor for the Health Care Division of ASQ. Dr. Lloyd is co-author of the internationally acclaimed book, Measuring Quality Improvement in Healthcare: A Guide to Statistical Process Control Applications (American Society for Quality Press, 2001, 5th printing). His most recent book, Quality Health Care: A Guide to Developing and Using Indicators was published in March of 2004 by Jones and Bartlett Publishers(Sudbury, MA).

Table of Contents

Acknowledgments ix

Foreword xi

Introduction to the Second Edition xiv

About the Author xvii

Chapter 1 Setting the Context for Measurement 1

The Growing Demand for Transparency 2

The Growing Focus on Patient-Centered Care and Service 12

The Quality Funnel 19

References 24

Chapter 2 Why Are You Measuring? 25

Connecting the Dots! 25

Types of Studies 28

Research for Efficacy, Efficiency, and Effectiveness 30

The Three Faces of Performance Measurement 33

Case Study #1 Being a Translator 39

References 44

Chapter 3 Measuring the Voice of the Customer 45

It All Starts with Listening 45

Creating a Service Excellence Culture 46

Who Are Your Customers? 55

Defining Key Quality Characteristics 57

Listening Three Times 60

Understanding VOC Tools 61

Focus Groups 64

Observation 64

Personal Interviews 65

Leadership Walk-Rounds 65

Unsolicited Feedback 65

High-Tech Tools 66

The Experiential Shopper 66

Surveys 67

References 91

Chapter 4 Milestones in the Quality Measurement Journey 93

Developing a Measurement Philosophy 93

Measurement Roadblocks 95

Milestones in the Quality Measurement Journey 99

Selecting a Specific Indicator 104

Developing Operational Definitions 109

Developing Data Collection Plans 113

Probability Sampling 117

Nonprobability Sampling 120

The Indicator Development Worksheet 127

Case Study #1 Transcription Turnaround Time 132

References 141

Chapter 5 Organizing Indicators into a Strategic Dashboard 143

Evolution of the Strategic Dashboard 144

Focusing on the Vital Few 151

Case Study #1 East London National Health Service (NHS) Foundation Trust's Strategic Dashboard 152

The Role of Benchmarking 155

References 158

Chapter 6 Tapping the Knowledge That Hides in Data 159

Data Versus Information 159

Static Versus Dynamic Approaches to Data Analysis 163

Case Study #1 The Monday Morning Dilemma 168

References 169

Chapter 7 Overcoming Numerical Illiteracy 171

Understanding Variation Conceptually 171

Distinguishing Common from Special Causes of Variation 179

Making the Appropriate Responses to Common and Special Causes of Variation 182

References 185

Chapter 8 Understanding Variation with Run Charts 187

What Is a Run Chart? 187

How Do I Construct a Run Chart? 188

How Do I Analyze a Run Chart? 190

Case Study #1 Hand Hygiene Compliance 199

A Few Closing Thoughts on Using Run Charts 202

References 209

Chapter 9 Understanding Variation with Shewhart Charts 211

Run Charts Versus Shewhart Charts 211

What Is a Shewhart Chart? 211

Key Questions About Shewhart Charts 214

Deciding Whether a Special Cause Is Present 219

Deciding Which Shewhart Chart

Is Most Appropriate 225

Types of Data 226

Types of Shewhart Charts 229

Defining the Key Terms 230

You Make the Call 242

Additional Shewhart Charts 247

Using Shewhart Charts Effectively 249

References 257

Chapter 10 Applying Quality Measurement Principles 259

Case Study #1 Predictinga Cardiovascular Event 259

Case Study #2 Sampling Central Line Infections 265

Case Study #3 Sampling Medicare Insurance Audits 267

Case Study #4 Tracking Patient Falls 268

Case Study #5 Pressure Ulcer Prevention 272

Case Study #6 Evaluating Staffing Effectiveness 275

Case Study #7 To Flash or Not to Flash-That Is the Question 283

Case Study #8 Clarifying the Operational Definition of Readmission 286

Case Study #9 Managing a Breast Cancer Patient's Clotting Levels 287

Case Study #10 Group B Streptococcus in Pregnant Women 290

Case Study #11 Emergency Department Fast Track 293

Case Study #12 Tracking Patient Complaints 296

Case Study #13 Reducing Ventilator-Associated Pneumonia 300

Case Study #14 Pain Management for Hip and Knee Replacement Patients 306

Case Study #15 Hospice/911 Paramedic System Partnership to Improve Care 315

Case Study #16 Improving Access to Community Services for Mental Health and Community Health Patients 317

References 329

Chapter 11 Connecting the Dots 331

Adopting Quality as a Business Strategy 332

Developing a Learning System to Support Improvement 336

Linking Measurement to Improvement 339

Building Capacity and Capability for Improvement 346

References 360

Index 363

Editorial Reviews

Reviewer: Jill P Massengale, DNP (James A. Haley Veterans' Hospital)
Description: This update of a guide to planning and implementing a quality measurement program in a healthcare facility builds upon the foundation established in the 2004 edition. Just as healthcare quality has evolved, so has the direction the author provides.
Purpose: The purpose is to help readers understand what to measure and how to collect the correct data to answer their quality questions. This gives deeper meaning to the statistical processes laid out in the first edition.
Audience: The audience is healthcare professionals, who often lack the business knowledge required to support healthcare. The author's expertise has been developed over decades.
Features: Quality measures are frequently defined by accrediting bodies. However, healthcare facilities may use slightly different definitions when capturing data. This book seeks to clarify what to measure, when to measure it, and how to accurately collect and report the data. The author superbly focuses on measurement that healthcare professionals understand.
Assessment: This second edition builds upon the previous work and provides unsurpassed information for healthcare professionals who may find themselves supporting the business of healthcare.

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