The how of a design, for health care quality improvement, made simple, would help constructing bridges for and effectively acceptable template for a better performance.

1. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
How ToHow To DesignDesign a Health Carea Health Care
QualityQuality ImprovementImprovement
ProgramProgram

2. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
LearningLearning series on quality improvementseries on quality improvement
planningplanning
FocusFocus on implementationon implementation
RoadmapRoadmap for getting therefor getting there
Create a QICreate a QI infrastructureinfrastructure
SeekSeek resourcesresources and technicaland technical
assistanceassistance
Third-partyThird-party quality recognitionquality recognition
Build onBuild on partnershipspartnerships with thewith the
national cooperative agreementsnational cooperative agreements

3. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
% entered prenatal care in the first trimester
% of children received all recommended
immunizations by 2nd
birthday
Hypertensive Patients with Blood Pressure<=
140/90
% Diabetic Patients with HbA1c <= 8
Total Cost per Patient
Cost per Medical Visit

4. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Improve Access to Quality Health Care and
Services
Community/new site development
Expansion planning
Patient-centered medical/health home
development
Strengthen the Health Workforce
recruitment and retention
Build Healthy Communities and Improve
Health Equity

5. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Develop and enhance access points
Transform care delivery system
Recruit, develop, retain skilled workforce
Integrate Health Center into local health
systems - Specialists, ER
Public Health
Align policies and programs where possible

6. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Performance Profile (National/State) -- Number & Percent
of Health Centers
Meet Meaningful Use Standards
Achieve National Quality Recognition
Exceed Healthy People Goals (Core Clinical Measures)
Increase in Cost/Patient Less than National
Increase in Patients
Going Concern Issues
Claims/Visit
60 or 30 Day Progressive Actions
1 year Project Periods

7. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Ongoing QI/QAOngoing QI/QA Plan encompassing
management and clinical services
maintaining.
ConfidentialityConfidentiality of patient records.
FocusedFocused responsibility for QI.
Periodic assessmentsPeriodic assessments of
appropriate service use and quality.

8. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Roadmap for HC organization
(1)Leadership, focus, & prioritization.
(2)Efficient coordination of staff &
resources.
(3)Better outcomes.
(4)Satisfy external requirements.
(5)CBAHI, State.
(6)Third-party quality.
(7)accreditation and recognition.

9. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
OK Great!!
So how do we actually do this when we are:
Short staffed.
Busy with lots of complicated patients.
Short on resources (shouldn’t all our money
go for patient care?).
Lacking QI skills (not covered well in medical
school, nursing school, business school).

10. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Depends onDepends on wherewhere you are,you are, whowho you are,you are,
whenwhen you began,you began, how bighow big you are…you are…
One site 3 providers rural-Urban 2,000 usersOne site 3 providers rural-Urban 2,000 users
12 sites Khobar providers 100,000 users12 sites Khobar providers 100,000 users
history of organization,history of organization,
fully implemented EHR for 4 yearsfully implemented EHR for 4 years
New start 2010 paper medical recordsNew start 2010 paper medical records

11. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
The Steps
(1)(1)Design the Basic Structures.Design the Basic Structures.
(2)(2)Evaluate & Determine Priorities.Evaluate & Determine Priorities.
(3)(3)Select Performance Measures.Select Performance Measures.
(4)(4)Collect Data/Determine aCollect Data/Determine a
Baseline.Baseline.
(5)(5)Analyze Data/EvaluateAnalyze Data/Evaluate
Performance.Performance.
(6)(6)Plan & Implement Changes forPlan & Implement Changes for
Improvement.Improvement.
(7)(7)Monitor Performance Over Time.Monitor Performance Over Time.

12. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Quality as an integral part of the
organization’s “culture”
Buy-in at all levels.
Board, management, staff and
patients.
Resources—staff time, meetings,
information systems.
Provide education.

13. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
QI Committee
QI Plan & Health care plan
QI calendar
Clinical practice guidelines
Policies & procedures
Peer review
Chart audits
Patient satisfaction surveys
Tracking systems
Credentialing and privileging
Data sources

14. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Set goals for measuresSet goals for measures
A SMART goal is a goal that is
Specific,
Measurable,
Attainable,
Relevant and
Time based.
In other words,a goal that is veryIn other words,a goal that is very
clear& easily understood.clear& easily understood.

15. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Define measurement population and
delineate eligibility criteria.
Create a data collection plan to
include:
Sampling strategy.
Determine method of data collection,
i.e. chart abstraction, interviews.

16. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Create data collection toolsCreate data collection tools
Design instructions for data collection
tools.
Train personnel who will collect data.
Conduct pilot test of tool.
Establish process of communicating with
staff about measurement process.
Collect data.

17. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
i.Analyze data and review the results.
ii.Identify areas where additional data is
required.
iii.If historical data are available,
compare for trends.
iv.Display and distribute data to
communicate findings and results.
v.Identify areas for improvement and
select a quality improvement project.

18. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

19. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
i.i.Develop a time line or calendarDevelop a time line or calendar
of activities for the year.of activities for the year.
ii.ii.Select a QI approach,Select a QI approach,
iii.iii. such as the Chronic Care Model.such as the Chronic Care Model.
iv.iv.Clarify QI responsibilities ofClarify QI responsibilities of
staff.staff.

20. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Identify potential solutions to make
improvement to the systems of care.
Recognize quick fixes and longer term
solutions.
Try a small test of change and analyze results.
Refine improvement plan.
Develop timeline for implementation of plan.
Delineate team responsibilities.
Implement changes.
Track changes and improvement actions

21. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
i.Determine interval for re-measurement.
ii.Remeasure indicator after change has
been implemented.
iii.Look for incremental improvement.
iv.Communicate results to team, staff and
leadership.
v.Develop a plan for sustained
improvement.

22. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Processes
(1)Chronic Diseases Care being
implemented
(2)Staff training.
(3)Patient education.
(4)Plan to institute new consent form
(5) specific for women’s health and policy
to ensure its use.

23. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Implementing your QI plan
(1) How to choose specific strategies.
(2) How to evaluate.
(3) Connection to risk management, peer
review accreditation.
(4) How to use the collected data,
to fuel your QI process.
(5) Setting goals and performance metrics.
(6) Increasing data reliability.