Modern Quality Control. Pierre Barker Jens Jensen Nirav Shah

Transcription

1 Modern Quality Control Pierre Barker Jens Jensen Nirav Shah

2 Deming and Berwick Cease dependence on inspection to achieve quality. Eliminate the need for inspection on a mass basis by building quality into the product in the first place - Out of the Crisis. W. Edwards Deming Those of era 2 believe in accountability, scrutiny, measurement, incentives, and markets. Era 2 has brought with it excessive measurement, much of which is useless but nonetheless mandated.

3 Dr. Joseph M. Juran s Trilogy 3 QUALITY PLANNING QUALITY IMPROVEMENT QUALITY CONTROL

4 Juran Trilogy: All three elements are needed 4 Sporadic spike Chronic waste (opportunity for improvement) PERFORMANCE SHIFT Source: Juran J, Godfrey AB, eds. Juran s Quality Handbook: Fifth Edition. New York: McGraw-Hill, 1999.

5 Juran Trilogy: All three elements are needed 5 Sporadic spike Chronic waste (opportunity for improvement) PERFORMANCE SHIFT Source: Juran J, Godfrey AB, eds. Juran s Quality Handbook: Fifth Edition. New York: McGraw-Hill, 1999.

6 Juran Trilogy: All three elements are needed 6 Sporadic spike Chronic waste (opportunity for improvement) PERFORMANCE SHIFT How do we measure and who measures? Source: Juran J, Godfrey AB, eds. Juran s Quality Handbook: Fifth Edition. New York: McGraw-Hill, 1999.

7 Components of quality: planning, quality control and quality improvement 7 Leadership and Management Priorities, structures (e.g. Quality Directorate), data systems, learning system, sense making, strategic deployment, building capability Quality Planning New Designs, re-designs Innovations, new tools in response to customer needs and experience Quality Control Internal monitoring continuous measurement External Inspection intermittent inspection Internal and external regulations IMPROVED OUTCOMES Quality Improvement Motivation/Leadership Efficient Systems Reflective Data Context-sensitive learning

8 Jens Winther Jensen, MD, Steering Committee Chairman The Danish Clinical Registries Senior Fellow Institute for Healthcare Improvement

9 Welcome to Denmark

10 Challenges Economy New treatments Expectations and demand Variation in outcomes Patients are hurt Patientens wishes often not in line with physicians Inequalities in health

11 Hamster Wheel 11 Structual activity Focus in productivity an economy Much attention on defining the whats right in the clininic Employees express they run too fast

12 April 2015: Denmark to stop hospital accreditation

13 Bent Hansen, President of Danish Regions 'Quality work must be simplified and focused. The time has come to strengthen it by putting the patient at the centre, rather than focusing on compliance with a variety of standards. Accreditation has been justified and useful, but we move on. We need a few national targets to be met locally with strong commitment from the staff and with room for local solutions.'

14 Grand, J. Le. (2010). Knights and Knaves Return: Public Service Motivation and the Delivery of Public Services. International Public Management Journal, 13(1),

15 Mental Models of Governance Public service motivation and the delivery of public services LeGrand s Categories Choice Voice Mistrust Trust Derek s Translation Competition Patient co-production Command and control Collaboration Grand, J. Le. (2010). Knights and Knaves Return: Public Service Motivation and the Delivery of Public Services. International Public Management Journal, 13(1),

16 A new balance Health Care system units Quality improvement Control Supervision Innovation Unacceptable quality Excellent quality Control and command Cooperation and trust Users voice Competetion Steering paradigms

17 Governance review of hospitals Suggestions for procedures and rules simplification, Maj 2015

18 Review An excess of generalised and standardised procedure- and monitoring demands Employees use a lot of time on tasks which are questioned by employees and their leaders Implementation overload not the specific standard or monitoring but the overall burden and trend Fear of not being accredited has produced a large number of local quality standards and guidelines Reduced local room for leadership Quality problems and standards are defined externally Leadership role reduced to implementation

19 New Danish Quality Program - current components National quality targets Learning and quality teams Leadership development program New extended role of clinical registries

20 Quality Control Routine everyday monitoring part of your management practice Role of intermitted external inspection? Whose responsibility is it? Government Healthcare Regions Hospitals Administrators Profession

21 Measurement for improvement, research and accountability