Also contains multiple data se
Table of Contents
Figures and Tables xi
Preface xix
The Author xxvi
Part 1: The State of Quality Management in Health Care
Chapter 1 Quality in Health Care 3
Introduction 3
The Goal of Quality Management 5
Quality Pioneers in Health Care 12
Requisite Skills for Improving Health Care 19
Quality Control in Industry 23
System Thinking 27
Summary 33
References 35
Chapter 2 Error and Variation 37
Introduction 37
The Medical Decision-Making Process 37
Human Error and James Reason 40
Small Area Variations and John Wennberg 43
Practice Guidelines and Brent James 49
The Structure-Process-Outcome Paradigm 50
The Three Faces of Quality 51
Underuse, Overuse, and Misuse 55
Controlling Variation and Improving Outcomes 57
Summary 58
References 60
Chapter 3 Regulating the Quality and Quantity of Health Care 63
Introduction 63
Licensure, Accreditation, and Credentialing 65
Malpractice 71
The Economics of Health Care Markets 73
A Brief History of Health Care Financing in the United States 88
Pay for Performance and the CMS Quality Initiative 102
Summary 105
References 108
Part 2: Quality Management Tools
Chapter 4 Process Analysis Tools 113
Introduction 113
Tools to Identify Problems 116
Tools to Identify Causes 137
Tools to Identify Solutions 146
Tool to Monitor Progress 152
Summary 155
References 159
Chapter 5 Root Cause Analysis 161
Introduction 161
Root Cause Analysis 162
Single-Event Analysis 178
Multiple-Event Analysis 189
Prevention and Recovery 199
Cases and Applications 205
Summary 212
References 214
Chapter 6 Statistical Process Control for Monitoring System Performance 217
Introduction 217
Statistics Review 220
Types of Variation 226
Setting Performance Targets 228
Statistical Process Control for Continuous Data: x̄ and R Charts 231
Tinkering 255
Cases and Applications 257
Summary 261
References 264
Chapter 7 Statistical Process Control for Monitoring Failure Rates 265
Introduction 265
Statistical Process Control for Binomial Data: p and np Charts 266
Establishing Valid Control Limits 282
Constant and Variable Control Limits 284
Rebasing Control Limits and Monitoring Changes over Time 287
Cases and Applications 290
Improving Performance Using SPC 295
Summary 296
References 299
Chapter 8 Statistical Process Control for Monitoring Nonconformities 301
Introduction 301
Statistical Process Control for Counts: c and u Charts 302
Medicare Hospital Quality Initiative Example 312
Cases and Applications 317
Selecting a Control Chart 321
Benefits of SPC 323
Inhibitors of the Use of SPC 325
Summary 329
References 332
Chapter 9 Exploring Quality Issues with Statistical Tools 333
Introduction 333
Chi-Square Analysis 335
Analysis of Variance 344
Analysis of Means 350
Regression Analysis 354
Quality Improvement and Research 362
Summary 365
References 370
Chapter 10 Failure Mode and Effects Analysis 373
Introduction 373
General System Theory 374
The Value Chain 383
Failure Mode and Effects Analysis 386
Designing Better Systems 398
Summary 403
References 406
Part 3: Medical Practice Management
Chapter 11 Practice Policies 411
Introduction 411
Practice Policies 413
Computer Decision Support 427
Cases and Applications 428
Summary 432
References 434
Chapter 12 Case, Disease, and Outcomes Management 437
Introduction 437
Case Management 440
Disease Management 449
Outcomes Management 463
Summary 468
References 470
Chapter 13 Profiling, Economic Credentialing, and Risk Adjustment 473
Introduction 473
Physician Profiling and Report Cards 476
Academic Detailing 485
Economic Credentialing 488
Risk Adjustment 490
Summary 505
References 507
Chapter 14 Benchmarking and Implementation 511
Introduction 511
Benchmarking and Best Practice 512
Balanced Scorecards 523
Dashboards 531
Implementation Strategies 537
Summary 542
References 544
Chapter 15 The Future of Quality Management in Health Care 547
Introduction 547
Bringing It All Together 549
Value and What an Employee (or Manager) Should Do 558
The Future of Health Care and Quality Management 561
Summary 564
References 566
Index 567
