Title Page
Copyright
Dedication
List of Figures and Tables Preface
Preface
Acknowledgments
About the Author
Introduction
Part I: Quality Management Fundamentals
1. Chapter 1: Foundations of Health Care Quality
  1. Defining Quality
  2. Contributions of Quality Theorists—Nothing New under the Sun
  3. Quality Management Methodologies
  4. Organizations Making an Impact on Quality and Safety Standards
  5. Centers for Medicare and Medicaid Services
  6. Institute for Healthcare Improvement
  7. Agency for Health Research and Quality
  8. National Quality Forum
  9. The Leapfrog Group
  10. Data: The Foundation of Quality Management
  11. Summary
  12. Key Terms
  13. Quality Concepts in Action
  14. References
  15. Suggestions for Further Reading
  16. Useful Websites
2. Chapter 2: Understanding the Impact of Health Care Reform
  1. The Affordable Care Act
  2. New Models of Payment
  3. New Models of Providing Care
  4. New Models for Collecting Data
  5. Improving Interpersonal Communication
  6. Summary
  7. Key Terms
  8. Quality Concepts in Action
  9. References
  10. Suggestions for Further Reading
  11. Useful Websites
3. Chapter 3: Making the Case for Change
  1. What Is Involved in Change?
  2. Managing and Measuring Quality in the Reform Environment
  3. Who Is Involved in Change?
  4. Changing Communication
  5. The Role of Data in Promoting Change
  6. Summary
  7. Key Terms
  8. Quality Concepts in Action
  9. References
  10. Suggestion for Further Reading
  11. Useful Websites
4. Chapter 4: New Challenges for Health Care Professionals
  1. Meeting Statistical Expectations for Standards of Care
  2. Meeting Patient Expectations
  3. Role of Dashboards
  4. Role of Data Analysis
  5. Understanding Different Kinds of Data
  6. Managing Care for Chronic Illness across the Continuum
  7. Managing Aggregated Patient Care Issues
  8. Improving Communication
  9. Summary
  10. Key Terms
  11. Quality Concepts in Action
  12. References
  13. Suggestions for Further Reading
  14. Useful Websites
5. Chapter 5: Improving Patient Safety
  1. Understanding Medical Errors and Adverse Events
  2. High-Reliability Organizations
  3. The Role of Quality Management in Promoting a Safety Culture
  4. Prioritizing Improvements
  5. Expanding Data Sources: Partnerships to Develop Best Practice
  6. Leading Organizational Improvements
  7. The Role of Nursing Leaders in Promoting Safety
  8. The Role of the Medical Staff in Promoting Safety
  9. Promoting Safety through Effective Communication
  10. Summary
  11. Key Terms
  12. Quality Concepts in Action
  13. References
  14. Suggestions for Further Reading
  15. Useful Websites
Part II: Applying Quality Tools and Techniques
1. Chapter 6: Working with Quality Tools and Methods
  1. Identifying a Problem
  2. Describing Information
  3. Variability
  4. Making Use of Data
  5. Using Quality Tools and Techniques to Improve Safety
  6. Clinical Pathways or Care Maps
  7. Improving Performance: Plan-Do-Study-Act
  8. Summary
  9. Key Terms
  10. Quality Concepts in Action
  11. Suggestions for Further Reading
  12. Useful Websites
2. Chapter 7: Working with Quality Data
  1. Working with Measurements
  2. Understanding Issues in Data Collection
  3. Using Data to Understand Appropriateness of Care
  4. The Value of Aggregated Data in Performance Improvement
  5. The Role of Data in Managing Chronic Disease
  6. Using Data to Monitor Variability
  7. Publicly Reported Data
  8. Interpreting and Making Use of Data
  9. Quality Management in the Future
  10. Summary
  11. Key Terms
  12. Quality Concepts in Action
  13. References
  14. Suggestions for Further Reading
  15. Useful Websites
3. Chapter 8: Working with Quality and Safety Measures
  1. Commitment to Quality
  2. Using Measures to Understand Care
  3. Defining the Measure
  4. Process Measures
  5. Pay for Performance
  6. Patient Satisfaction Measures
  7. Monitoring Measures
  8. Safety and Environment of Care Measures
  9. Summary
  10. Key Terms
  11. Quality Concepts in Action
  12. References
  13. Suggestions for Further Reading
  14. Useful Websites
4. Chapter 9: Translating Information into Action
  1. Maximizing Efficiency
  2. Determining Appropriate Levels of Care
  3. End-of-Life Care/Advanced Illness
  4. Understanding Mortality
  5. Improving ICU Care
  6. Analyzing Readmission
  7. Using Data for Improvements
  8. Patient-Centered Care
  9. Delivering the Message
  10. Summary
  11. Key Terms
  12. Quality Concepts in Action
  13. References
  14. Suggestions for Further Reading
  15. Useful Websites
5. Chapter 10: Preparing for the Future
  1. The New Quality Management
  2. The Business of Health Care
  3. Measurements Are the Nuts and Bolts of Quality
  4. Getting Everyone on Board
  5. Challenges for the Future
  6. Summary
  7. Key Terms
  8. Quality Concepts in Action
  9. Suggestions for Further Reading
  10. Useful Websites
Index
End User License Agreement

List of Illustrations

Chapter 1: Foundations of Health Care Quality
1. Figure 1.1: Causes of Patient Mortality Pie Chart
2. Figure 1.2: Causes of Patient Mortality Histogram
3. Figure 1.3: Medication Error Rate Pareto Chart, January 2011–June 2011
4. Figure 1.4: Hospital Compare Webpage for Unplanned Readmissions
5. Figure 1.5: Hospital Compare for Waiting Times
6. Figure 1.6: Quality Indicator
Chapter 2: Understanding the Impact of Health Care Reform
1. Figure 2.1: Value‐Based Performance at a Community Hospital
2. Figure 2.2: Value‐Based Performance at a Tertiary Hospital
Chapter 3: Making the Case for Change
1. Figure 3.1: Screening Tool to Identify Advanced Illness
2. Figure 3.2: Dimensions of Care
3. Figure 3.3: Lines of Communication
4. Figure 3.4: JCPAC Communication
Chapter 4: New Challenges for Health Care Professionals
1. Figure 4.1: Inpatient Likelihood to Recommend
2. Figure 4.2: Quality and Safety Vector of Measures Dashboard
3. Figure 4.3: Hospital Comparison Dashboard
4. Figure 4.4: Raw Heart Failure Readmission Rate
5. Figure 4.5: Tactics and Team Responsibilities
6. Figure 4.6: Patient Friendly Care Map for Hip Replacement Surgery
7. Figure 4.7: Preoperative Continuum of Care
8. Figure 4.8: Postoperative Continuum of Care
Chapter 5: Improving Patient Safety
1. Figure 5.1: Falls with Injury
2. Figure 5.2: Analytics and Interpretation
3. Figure 5.3: Monthly Emergency Department Data
4. Figure 5.4: Raw Sepsis and Severe Sepsis/Septic Shock Mortality Rate, January 2008–September 2014
5. Figure 5.5: Discharge Follow‐up Information Heart Failure
6. Figure 5.6: Prioritization Matrix
7. Figure 5.7: Serum Lactate Order to Result within 90 Minutes for Severe Sepsis/Septic Shock in the Emergency Department
8. Figure 5.8: Integrating Data/Generating Reports
9. Figure 5.9: Patient Outcome Monitoring Tool
10. Figure 5.10: Communication across the Care Continuum
Chapter 6: Working with Quality Tools and Methods
1. Figure 6.1: Falls Cause‐and‐Effect Diagram
2. Figure 6.2: Flowchart
3. Figure 6.3: Time‐Out Checklist
4. Figure 6.4: Newborn Deliveries Run Chart
5. Figure 6.5: Waiting Time for Emergency Department Triage
6. Figure 6.6: Standard Deviation Formula
7. Figure 6.7: Blood Pressure Bell Curve
8. Figure 6.8: Comparing RCA and FMEA
9. Figure 6.9: Transfusion Flowchart
10. Figure 6.10: Hip Replacement Care Map
11. Figure 6.11: Variance Analysis: CAP Chart
12. Figure 6.12: Variance Analysis: CAP Outcome Bar Chart
13. Figure 6.13: Quality Improvement through Care Pathways
14. Figure 6.14: Improved Efficiency and Throughput
15. Figure 6.15: Clinical Guidelines Creation Methodology
16. Figure 6.16: PDSA Cycle
Chapter 7: Working with Quality Data
1. Figure 7.1: Hospital‐Acquired Pressure Injury Index
2. Figure 7.2: Mortality Surveillance Tool Summary Report
3. Figure 7.3: Kidney Transplant Data Input
4. Figure 7.4: Wound Infection Rate
5. Figure 7.5: 30-Day Observed Readmission Rate for Heart Failure Analysis
6. Figure 7.6: Heart Failure Readmission by Age
7. Figure 7.7: Heart Failure Readmission Analysis: HF Discharges by Discharge Disposition
8. Figure 7.8: Know Your Heart Failure Zones
9. Figure 7.9: Control Chart of Clostridium difficile
10. Figure 7.10: Hospital Compare Benchmark Report: Inpatient Clinical Measures—Inpatient Surgical Infection Prevention
11. Figure 7.11: Timely Heart Attack Care
Chapter 8: Working with Quality and Safety Measures
1. Figure 8.1: Hospital Medication Administration Process
2. Figure 8.2: Medication Error Measures
3. Figure 8.3: Executive Summary Medication Measures
4. Figure 8.4: Medication Safety Alert
5. Figure 8.5: Mammography Rate
6. Figure 8.6: Independent Variables
7. Figure 8.7: Non‐ICU Central Line–Associated BSI Control Chart
8. Figure 8.8: Public Reporting Scores
9. Figure 8.9: Executive Summary
10. Figure 8.10: Risk‐Adjusted Mortality Index
11. Figure 8.11: Non‐ICU Central Line‐Associated BSI Index
12. Figure 8.12: Non‐ICU Central Line‐Associated BSI Index Pivot View
13. Figure 8.13: Safety Services Quarterly Report
Chapter 9: Translating Information into Action
1. Figure 9.1: Throughput
2. Figure 9.2: Ambulatory Surgery Log Tracking
3. Figure 9.3: Advanced Illness
4. Figure 9.4: APACHE Reports
5. Figure 9.5: Bariatric Preoperative Checklist
6. Figure 9.6: SF‐36 Physical and Mental Health Component Analysis by Time Point
Chapter 10: Preparing for the Future
1. Figure 10.1: Data Overload

INTRODUCTION TO
HEALTH CARE QUALITY

Theory, Methods, and Tools

Yosef D. Dlugacz

PART ONE
QUALITY MANAGEMENT FUNDAMENTALS

PART TWO
APPLYING QUALITY TOOLS AND TECHNIQUES