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 https://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

xiDetai led Contents

Chapter 7. Setting Improvement Goals in Complex Systems ………..107 Learning Objectives ………………………………………………107 Relationship Between Goals and Results ……………………109 Setting Improvement Goals in Complex Systems ………..111 Types of Goal Statements ……………………………………….114 Critiquing Goal Statements …………………………………….115 SMART Goals and Complex Systems………………………..119 Corollaries to Purpose and Goals ……………………………..120 Summary …………………………………………………………….121 Companion Readings …………………………………………….123 Web Resources ……………………………………………………..123 References ……………………………………………………………123

Chapter 8. Fostering a Culture of Collaboration and Teamwork ……125 Learning Objectives ………………………………………………125 Creating a Supportive Culture …………………………………126 Teams in Healthcare ………………………………………………128 Collaboration and Teamwork ………………………………….129 Mental Models Affecting Team Design ……………………..129 Mental Models About Work Team Differences……………131 Tools for Effective Teams ……………………………………….134 Summary …………………………………………………………….137 Companion Readings …………………………………………….141 Web Resources ……………………………………………………..142 References

 

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