Management skills

for physiotherapists
8th lecture: Healthcare Quality Management
Quality management
• Quality does not develop on its own.

• For quality to be achieved, a

systematic evaluation and
improvement process must be
implemented. Called Quality
Management.
 Definition:
• A philosophy that defines a healthcare
culture emphasizing customer satisfaction,
innovation, and employee involvement.
Quality
management • The administration of systems design,
policies, and processes that minimize, if not
eliminate, harm while optimizing patient
care and outcomes
Quality management
Quality management aim to eliminate overuse, underuse, and misuse of services to achieve maximum customer
service in healthcare.

• Overuse occurs when a service is provided even though no evidence indicates it will help the patient.

• Underuse occurs when a service that would have been medically beneficial to the patient is not provided.

• Misuse occurs when a service is not carried out properly.

QUALITY MANAGEMENT
ACTIVITIES

• Quality management involves a cycle of

measurement, assessment, and
improvement.
 • Healthcare organizations track performance through
various measurement activities to gather information
about the quality of patient care and support functions.

• Results are evaluated in the assessment step by

comparing measurement data with performance
QUALITY expectations.

MANAGEMENT • If expectations are met, organizations continue to

ACTIVITIES measure and assess performance.

• If expectations are not met, they proceed to the

improvement phase to investigate reasons for the
performance gap and implement changes on the basis
of their findings.
QUALITY
MANAGEMENT
ACTIVITIES
Case study (Patient
satisfaction)
• Measurement: how are we doing?
• Feedback form about the clinic (environment, prices, interventions, etc.)

• Assessment: are we meeting expectations from measurement?

• e.g., Patients wait time data shows longer waiting times Mondays as well as larger number of
patients on that day. Whereas, Wednesday has the lower number of patients.

• Improvement: how can we improve performance?

• The previous assessment indicated the improvements areas. Therefore, new appointments
should make consideration to not overload the clinic on specific day.
Question?

How and Why exams used as

quality management?
Answer
• Measure the quality of
education.
• Measure the performance of
professors/ teachers.
• Monitoring the organization
objectives.
• Assuring that graduates skills are
parallel to work requirements.
Quality management activities:

1. Measuring performance
 • Organizations measure costs,
quality, productivity, efficiency,
customer satisfaction to
Measuring understand current performance
to identify where improvement is
performance needed and evaluate how changes
in work processes affect
performance.
MEASUREMENT
CHARACTERISTICS

• Performance measures or
Quality indicators: a
number or statistic, used
to monitor the quality of
some aspect of healthcare
services.
MEASUREMENT CHARACTERISTICS (cont.)
The correctness of the numbers and the validity of the measure (measuring what it is
Accurate: intended to).

The relevance of information to the aim (it must tell people something they want to
Usefulness: know).

Ease of Use graph, summaries and avoid listing unnecessary information (make it easier for the
Interpretation: reader).

Consistent It must be uniformly reported to make meaningful comparisons between the results
reporting: from one period and the results from another period
 MEASUREMENT CATEGORIES

Structure measures Process measures Outcome measures

 Structure:
• The structure of healthcare refers to resources
(inputs) used in the provision of care.
• It includes:
• Human resources:
• characteristics and qualification of the
individuals who provide care and of the
MEASUREMENT settings where the care is delivered.
• These characteristics include the
CATEGORIES education, training, and certification of
professionals who provide care and the
adequacy of the facility’s staffing.
• Physical resources:
• Equipment, drugs, space.
• Administrative elements:
• job descriptions, organizational chart,
procedure manuals.
 Process:
• The process of healthcare is measured to evaluate whether
activities performed during the delivery of health-care
services are delivered satisfactorily.

• Process is the series of events that takes place during the

delivery of care, also can be a basis for evaluating the quality
of care. During:
MEASUREMENT • Patient assessment
• Test ordering and interpretation
CATEGORIES • Medication administration
• Discharge plan

• The quality of the process can vary on three aspects:

• appropriateness, whether the right actions were taken.
• skill—the proficiency with which actions were carried
out.
• the timeliness of the care
 Outcome:
• Healthcare outcomes are measured to evaluate the
results of healthcare services and whether
healthcare goals were achieved, which can be
affected by structure and process measures.

• It is the end result of care in terms of health and

MEASUREMENT satisfaction.

CATEGORIES
• Outcomes may refer to indicators of health status,
such as whether a patient’s pain subsided, or
condition cleared up or whether the patient
regained full function

• Reflects all components of care by all members of

the medical care team
MEASUREMENT
CATEGORIES (cont.)
MEASUREMENT CATEGORIES (cont.)

• For example, if a manager of outpatient physical rehabilitation services

wants to measure each characteristic of the unit’s performance, he
might ask the following questions:

• Structure: Is the unit staffed with a sufficient number of registered

physical therapists?
• Process: How consistently do therapists measure and document
patients’ level of pain?
• Outcome: What is the rate of patient pain reduction following
therapy?
 • To gain an understanding of current
MEASUREMENT performance, healthcare organizations must
CATEGORIES measure the three categories: structure,
(cont.) process, and outcome.
 • Healthcare organizations use two tiers of measures
to evaluate performance: system–level measures
and activity-level measures.
SELECTING • System–level: measure is a snapshot of overall
PERFORMANCE clinic performance.
• Activity-level: measure the exact activity of
MEASURES people.
SELECTING PERFORMANCE MEASURES
(cont.)
• Healthcare organizations measures many aspects of performance.

• Some of the measures are mandated by external regulatory, licensing, and accreditation groups.

• Some are chosen to evaluate performance issues important to the organization.

• Some measures serve both purposes; the measure is required by an external group and provides
performance information important to the organization.
MEASURES OF • Many performance measures that healthcare
organizations use for quality management purposes are
CLINICAL DECISION similar to those found in other service industries.

MAKING • One aspect of healthcare not found in most service

industries is the clinical decision-making process.

• Which must be evaluated with performance measures

derived from clinical practice guidelines developed by
medical professional groups.

• These measures are referred to as evidence- based

measures.
MEASURES OF • Guidelines are important to healthcare quality
improvement because they can reduce variations in
CLINICAL DECISION practice and change physician behaviour to promote use
of interventions supported by the best evidence available.
MAKING
 • Measurement is the starting point of all quality management
activities and an integral part of the quality management cycle.

• Measurement results, usually numbers or statistics, are used by

decision makers to evaluate the performance of patient care
processes.

Summary • To be effective for quality management purposes, measurement

results must be accurate, useful, easy to interpret, and
consistently reported.

• Healthcare organizations use a combination of system- and

activity-level measures to evaluate three dimensions of service:
structure, process, and outcome.
 • Measurement information alone
does not improve quality, the
second step of the quality
management cycle—assessment—
Summary in which information must be
(cont.) analysed to determine whether
performance is acceptable and to
identify areas needing
improvement.
 • For any healthcare activity, three
performance factors can be
measured: structure, process, and
outcome. Identify one structure
Discussion measure, one process measure,
and one outcome measure that
could be used to evaluate the
following hospital admission
process:
Discussion (cont.)
• Upon arrival, the patient reports to the hospital registration or admitting area. The
patient completes paperwork and provides an insurance identification card, if insured.
Often, patients register before the date of hospital admission to facilitate the
registration process. An identification bracelet, including the patient’s name and
doctor’s name, is placed around the patient’s wrist. Before any procedure is performed
or any form of medical care is provided, the patient is asked to sign a consent form. If
the patient is not feeling well, a family member or caregiver can help the patient
complete the admission process.

• Discuss in the next lecture

Thank you for
listening