Read Chapter 8 Answer Question
Patrice L. Spath Diane L. Kelly
FOURTH EDITION
Applying Quality Management IN HEALTHCARE
A SYSTEMS APPROACH
AUPHA/HAP Editorial Board for Graduate Studies
Nir Menachemi, PhD, Chairman Indiana University
LTC Lee W. Bewley, PhD, FACHE University of Louisville
Jan Clement, PhD Virginia Commonwealth University
Michael Counte, PhD St. Louis University
Joseph F. Crosby Jr., PhD Armstrong Atlantic State University
Mark L. Diana, PhD Tulane University
Peter D. Jacobson, JD University of Michigan
Brian J. Nickerson, PhD Icahn School of Medicine at Mount Sinai
Mark A. Norrell, FACHE Indiana University
Maia Platt, PhD University of Detroit Mercy
Debra Scammon, PhD University of Utah
Tina Smith University of Toronto
Carla Stebbins, PhD Des Moines University
Cynda M. Tipple, FACHE Marymount University
Health Administration Press, Chicago, Illinois
Association of University Programs in Health Administration, Washington, DC
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Copyright © 2017 by the Foundation of the American College of Healthcare Executives. Printed in the United States of America. All rights reserved. This book or parts thereof may not be reproduced in any form without written permission of the publisher.
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Library of Congress Cataloging-in-Publication Data
Names: Spath, Patrice L., author. | Kelly, Diane L., author. Title: Applying quality management in healthcare : a systems approach / Patrice L. Spath, Diane L. Kelly. Description: Fourth edition. | Chicago, Illinois : Health Administration Press ; Washington, DC : Association of University Programs in Health Administration, [2017] | Revision of: Applying quality management in healthcare / Diane L. Kelly. | Includes bibliographical references and index. Identifiers: LCCN 2016055038 (print) | LCCN 2017001695 (ebook) | ISBN 9781567938814 (print : alk. paper) | ISBN 9781567938821 (Ebook) | ISBN 9781567938838 (Xml) | ISBN 9781567938845 ( Epub) | ISBN 9781567938852 (Mobi) Subjects: LCSH: Medical care—Quality control. | Health services administration. | Total quality management. Classification: LCC RA399.A1 K455 2017 (print) | LCC RA399.A1 (ebook) | DDC 362.1068—dc23 LC record available at /orders/lccn.loc.gov/2016055038
The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI Z39.48-1984. ∞ ™
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To my lifelong friend and companion, my husband Robert O. Brown. —P. S.
To Isabella. —D. K.
vii
BRIEF CONTENTS
A Note from Diane L. Kelly ……………………………………………………………..xv Preface ……………………………………………………………………………………….xvii Acknowledgments ………………………………………………………………………….xxi
Section 1 Quality Management: A Systems Approach ………………………….. 1
Chapter 1. Quality Management Fundamentals ………………………….. 3 Chapter 2. Role of Policy in Advancing Quality ………………………… 17 Chapter 3. Characteristics of Complex Systems ………………………… 33 Chapter 4. Understanding System Behavior …………………………….. 49 Chapter 5. Visualizing System Relationships …………………………….. 65
Section 2 Setting the Stage for Success ……………………………………………81
Chapter 6. Establishing System Direction ………………………………… 83 Chapter 7. Setting Improvement Goals in Complex Systems …….. 107 Chapter 8. Fostering a Culture of Collaboration and Teamwork … 125
Section 3 Achieving Quality Results in Complex Systems …………………. 147
Chapter 9. Measuring Process and System Performance …………… 149 Chapter 10. Using Data Analytics Techniques to
Evaluate Performance …………………………………….. 167 Chapter 11. Designing and Implementing Improvements …………. 203 Chapter 12. Using Improvement Teams and Tools ……………………. 229 Chapter 13. Making Healthcare Safer for Patients …………………….. 253
Section 4 Practice Lab …………………………………………………………………. 283 Practice Exercise 1. Reflective Journal …………………………………..285 Practice Exercise 2. The Manager’s Role ………………………………..287 Practice Exercise 3. Dynamic Complexity ……………………………….289 Practice Exercise 4. System Relationships ……………………………….291 Practice Exercise 5. Meeting Customer Expectations ………………..293
viii Brief Contents
Practice Exercise 6. Organizational Self-Assessment ………………….295 Practice Exercise 7. Improving a Performance Gap
in Your Organization …………………………..301 Practice Exercise 8. Teamwork and Patient Safety …………………….309 Practice Exercise 9. Improvement Case Study …………………………313 Practice Exercise 10. Systems Error Case Study and Analysis ……….319 Practice Exercise 11. Failure Mode and Effects Analysis………………321
Glossary …………………………………………………………………………………….325 Index ………………………………………………………………………………………..335 About the Authors ………………………………………………………………………..353 About the Contributor ………………………………………………………………….355
ix
DETAILED CONTENTS
A Note from Diane L. Kelly ……………………………………………………………..xv Preface ……………………………………………………………………………………….xvii Acknowledgments ………………………………………………………………………….xxi
Section 1 Quality Management: A Systems Approach ………………………….. 1
Chapter 1. Quality Management Fundamentals …………………………… 3 Learning Objectives …………………………………………………3 Why Focus on Managing Systems? ……………………………….4 What Are Quality and Safety? ……………………………………..5 Creating a Common Understanding of Quality Methods …7 Three Principles of Total Quality …………………………………9 Quality Continuum for Organizations ………………………..12 Summary ………………………………………………………………14 Companion Readings ………………………………………………15 Web Resources ……………………………………………………….15 References ……………………………………………………………..15
Chapter 2. Role of Policy in Advancing Quality ………………………….. 17 Learning Objectives ………………………………………………..17 External Stakeholders Affecting Quality ……………………..18 Federal Health Policies and Oversight ………………………..20 Private Health Policies and Oversight …………………………26 Summary ………………………………………………………………28 Companion Readings ………………………………………………29 Web Resources ……………………………………………………….29 References ……………………………………………………………..31
Chapter 3. Characteristics of Complex Systems …………………………… 33 Learning Objectives ………………………………………………..33 Systems Thinking ……………………………………………………35 Dynamic Complexity ……………………………………………….37
x Detai led Contents
Summary ………………………………………………………………44 Companion Readings ……………………………………………..45 Web Resources ……………………………………………………….46 References ……………………………………………………………..46
Chapter 4. Understanding System Behavior ………………………………..49 Learning Objectives ………………………………………………..49 A Systems Metaphor for Organizations ……………………….49 Lessons for Healthcare Managers ……………………………….52 Going Below the Waterline ……………………………………….56 Summary ………………………………………………………………61 Companion Readings ………………………………………………62 Web Resources ……………………………………………………….62 References ……………………………………………………………..63
Chapter 5. Visualizing System Relationships ……………………………….65 Learning Objectives ………………………………………………..65 Interconnected Systems Model ………………………………….67 Three Core Process Model ……………………………………….68 Baldrige Performance Excellence Program
Framework ……………………………………………………….71 Socioecological Framework ………………………………………74 Summary ………………………………………………………………76 Companion Readings ………………………………………………78 Web Resource ………………………………………………………..78 References ……………………………………………………………..78
Section 2 Setting the Stage for Success ……………………………………………81
Chapter 6. Establishing System Direction …………………………………..83 Learning Objectives ………………………………………………..83 Purpose …………………………………………………………………84 The Purpose Principle ……………………………………………..90 Vision …………………………………………………………………..96 Context …………………………………………………………………99 Summary …………………………………………………………….102 Companion Readings …………………………………………….103 Web Resources ……………………………………………………..104 References ……………………………………………………………104
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