In today’s challenging health care environment, health care organizations are faced with improving patient outcomes, redesigning business processes, and executing quality and risk management initiatives. Health Care Quality Management offers an introduction to the field and practice of quality management and reveals the best practices and strategies health care organizations can adopt to improve patient outcomes and program quality.

• Filled with illustrative case studies that show how business processes can be restructured to achieve improvements in quality, risk reduction, and other key business results and outcomes
• Clearly demonstrates how to effectively use process analysis tools to identify issues and causes, select corrective actions, and monitor implemented solutions
• Includes vital information on the use of statistical process control to monitor system performance (variables) and outcomes (attributes)
• Also contains multiple data sets that can be used to practice the skills and tools discussed and reviews examples of where and how the tools have been applied in health care
• Provides information on root cause analysis and failure mode effects analysis and offers, as discussion, the clinical tools and applications that are used to improve patient care

Figures and Tables  xi

Preface  xix

The Author xxvi

Part 1: The State of Quality Management in Health Care

Chapter 1 Quality in Health Care 3

Introduction  3

The Goal of Quality Management  5

Quality Pioneers in Health Care 12

Requisite Skills for Improving Health Care 19

Quality Control in Industry 23

System Thinking 27

Summary  33

References  35

Chapter 2 Error and Variation 37

Introduction  37

The Medical Decision-Making Process 37

Human Error and James Reason 40

Small Area Variations and John Wennberg 43

Practice Guidelines and Brent James 49

The Structure-Process-Outcome Paradigm 50

The Three Faces of Quality 51

Underuse, Overuse, and Misuse 55

Controlling Variation and Improving Outcomes 57

Summary  58

References  60

Chapter 3 Regulating the Quality and Quantity of Health Care 63

Introduction   63

Licensure, Accreditation, and Credentialing 65

Malpractice   71

The Economics of Health Care Markets 73

A Brief History of Health Care Financing in the United States 88

Pay for Performance and the CMS Quality Initiative 102

Summary  105

References  108

Part 2: Quality Management Tools

Chapter 4 Process Analysis Tools 113

Introduction 113

Tools to Identify Problems 116

Tools to Identify Causes 137

Tools to Identify Solutions 146

Tool to Monitor Progress 152

Summary  155

References  159

Chapter 5 Root Cause Analysis 161

Introduction 161

Root Cause Analysis 162

Single-Event Analysis 178

Multiple-Event Analysis 189

Prevention and Recovery 199

Cases and Applications 205

Summary  212

References  214

Chapter 6 Statistical Process Control for Monitoring System Performance  217

Introduction  217

Statistics Review 220

Types of Variation 226

Setting Performance Targets 228

Statistical Process Control for Continuous Data: X − and R Charts 231

Tinkering  255

Cases and Applications 257

Summary  261

References  264

Chapter 7 Statistical Process Control for Monitoring Failure Rates  265

Introduction  265

Statistical Process Control for Binomial Data: p and np Charts 266

Establishing Valid Control Limits 282

Constant and Variable Control Limits 284

Rebasing Control Limits and Monitoring Changes over Time 287

Cases and Applications 290

Improving Performance Using SPC 295

Summary  296

References  299

Chapter 8 Statistical Process Control for Monitoring Nonconformities  301

Introduction  301

Statistical Process Control for Counts: c and u Charts  302

Medicare Hospital Quality Initiative Example 312

Cases and Applications 317

Selecting a Control Chart 321

Benefits of SPC  323

Inhibitors of the Use of SPC 325

Summary  329

References  332

Chapter 9 Exploring Quality Issues with Statistical Tools 333

Introduction 333

Chi-Square Analysis 335

Analysis of Variance 344

Analysis of Means 350

Regression Analysis354

Quality Improvement and Research 362

Summary  365

References  370

Chapter 10 Failure Mode and Effects Analysis 373

Introduction 373

General System Theory 374

The Value Chain 383

Failure Mode and Eff ects Analysis 386

Designing Better Systems 398

Summary  403

References  406

Part 3: Medical Practice Management

Chapter 11 Practice Policies 411

Introduction 411

Practice Policies  413

Computer Decision Support427

Cases and Applications 428

Summary  432

References  434

Chapter 12 Case, Disease, and Outcomes Management 437

Introduction 437

Case Management 440

Disease Management 449

Outcomes Management 463

Summary  468

References  470

Chapter 13 Profiling, Economic Credentialing, and Risk Adjustment  473

Introduction 473

Physician Profiling and Report Cards 476

Academic Detailing 485

Economic Credentialing 488

Risk Adjustment 490

Summary  505

References  507

Chapter 14 Benchmarking and Implementation 511

Introduction 511

Benchmarking and Best Practice 512

Balanced Scorecards 523

Dashboards 531

Implementation Strategies 537

Summary  542

References  544

Chapter 15 The Future of Quality Management in Health Care 547

Introduction 547

Bringing It All Together 549

Value and What an Employee (or Manager) Should Do 558

The Future of Health Care and Quality Management 561

Summary  564

References  566

Index  567