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Unit 2: Measuring Quality
Lori Seargeant, MS,RHIA
 Read
Chapters 3, 4 and 5
 Discussion Post
 Quiz with two essay questions
 Case Study 5 Assignment
What are the components of
Donabedian’s quality matrix, and
how do they compare to industrial
models of process and process
quality?
 Aspects



Structure
Process
Outcome
 Quality
-
-
of Care
Dimensions
Access
Technical Management
Management of Interpersonal Relationships
Continuity of Care
Structure
Process
Outcome
Accessibility
Technical
Management
Management of
Interpersonal
Relationships
Continuity
Figure 3-1 Donabedian’s Matrix for the classification of quality
measures (McLaughlin and Kalunzy, 2006, p 68)
Structure
Process
Outcome
Accessibility
Integrated
delivery model
Coordinated
scheduling and
referral
management
Timely access and
treatment
Technical
Management
Infection control
team
Improved hand
washing
techniques
Decreased
infection rates
Management of
Interpersonal
Relationships
Use of survey
data to improve
care
HCAHPS
Overall rating of
care
Continuity
Arrangement for
follow up care
Timely
communication of
information
Decreased
readmissions
Figure 3-1 Donabedian’s Matrix for the classification of quality measures (McLaughlin and
Kalunzy, 2006, p 68)
Project
 Annotated
Selection (Unit 3)
Bibliography (Unit 4)
 Process Tools Application (Unit 4)
 Detailed Project Outline (Unit 5)
 Progress Report (Unit 7)
 Final Project (Unit 9)
PLAN
DO
CHECK
ACT
 What
could be the most important
accomplishment of the team?
 What changes do we desire?
 What data is available?
 Are new observations needed?
 If yes, plan or change a test.
 Decide how you will use the observations
 Analyze
an existing process to find
opportunity

Define processes and identify sources of variation
using tools such as:







Cause and effect diagram
Histogram
Pareto chart
Check sheet
Control chart
Bar graph
Scatter diagram
Figure 4-6 Flow Chart of Medication Administration Process
medication
ordered
is medication
in unit stock?
no
request from
pharmacy
yes
administered
to patient
documented in
patient’s record
observe
patient status
dispensed by
pharmacy
Example: The desired change is to improve TAT of
chemistry tests.

First we flowchart the steps from order to results
 Enter into the computer/order entry system


What is the process in all of the respective areas?
Draw the specimen


Delivery of the specimen to the lab


Where is it delivered?
Analytical stage


What methods are used, how long does it take?
Receipt of specimen in the Lab


What is the time frame from order to draw?
Are processes standard? Equipment adequate?
Results

Where are they going, and is there anyone there to
receive them?
Figure 4-9 Cause- and- Effect Diagram - Medication
Errors
Procedures
People
Unable to read order
due to illegible writing
Wrong drug selected for
patient condition
Lack of knowledge
Unfamiliar with
patient population
Reliance on memory
Policies not followed
Equipment malfunction
patient
distractions in work
environment
Manual systems
similar packaging for
different drugs
Plant & Equipment
Problem: Adverse
Drug Event
lack of training
drug
dose
route
time
Policies
lack of adverse event reporting
8
7
6
5
4
3
2
1
0
Lack of training Unable to read
Equipment
Packaging