+1(978)310-4246 credencewriters@gmail.com
  

Health Administration Press
Applying Quality
Management in Healthcare:
A Systems Approach
4th Edition
Chapter 8
Fostering a Culture of Collaboration and Teamwork
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Learning Objectives
After completing this chapter, you should be able to
• describe why a supportive culture, collaboration, and
teamwork are essential to quality health services delivery;
• recognize mental models about teams and the manager’s role
in team effectiveness;
• describe the importance of purposeful team design on
organizational results; and
• identify evidence-based strategies for improving collaboration
and teamwork.
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Collaboration and Teamwork
• To keep the silo syndrome from disrupting quality
improvement effects, healthcare leaders and
managers must adopt an organization-wide
collaborative culture that rewards teamwork.
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Creating a Supportive Culture
• Organizational culture: a consistent, observable pattern
of behavior in an organization; the way things get done
• Levers to encourage cross discipline teamwork:
–
–
–
–
–
–
Appealing to personal values
Inviting input on the vision
Celebrating change
Promoting psychological safety
Enabling knowledge sharing
Encouraging collaborative iteration
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Teams in Healthcare
• Work teams charged with accomplishing tasks in an
ongoing manner
• Parallel teams formed to address specific
challenges
• Projects teams responsible for time-limited
deliverables
• Management teams with oversight responsibilities
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
When Considering a Team Approach
Ask:
1. What is the purpose of the team?
2. What is the ideal, step-by-step process or
approach to achieve that purpose?
3. What is the most appropriate structure to support
and carry out that process?
4. How does the team define and measure success?
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Collaboration and Teamwork
Collaborative team: a group with “health care
professionals assuming complementary roles and
cooperatively working together, sharing
responsibility for problem-solving and making
decisions to formulate and carry out plans for patient
care”
(O’Daniel and Rosenstein 2008)
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Mental Models Affecting Team Design
• Mental models about authority can influence
communication in team settings and affect the quality
of clinical outcomes.
• A clinical microsystems mental model is useful for
overcoming traditional team design in healthcare
organizations.
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Mental Models About Work Team
Differences
• Diverse perspectives supply the essential elements of
creative tension that often result in innovations and
improvements
“Ideal” Employee Behaviors May
Not Promote Learning
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Tools for Effective Teams
• Human resource tools
• Collaborative team tools
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
TeamSTEPPS
• A training program that facilities can use to provide
healthcare workers with the necessary collaborative
teamwork strategies and tools to improve
performance
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Applying Quality
Management in Healthcare:
A Systems Approach
4th Edition
Chapter 9
Measuring Process and System Performance
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Learning Objectives
After completing this chapter, you should be able to
• describe how managers use measurement for performance
management purposes,
• distinguish types of measures and comprehensive
measurement sets,
• explain how performance measurement fits into the quality
continuum, and
• identify sources of comparative performance data for health
services organizations.
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Quality Measures and Their Uses
• Quality measure (or metric): “any type of
measurement used to gauge a quantifiable
component of performance”
(Spath 2013)
• Indicators: statistical measures that give an
indication of process or output quality
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Quality Measures and Their Uses
• Performance management measures are used to
better understand the system’s behavior.
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Performance Management Cycle
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Selecting Performance Measures
• Select performance indicators that are linked to
and aligned with the organizations’ goals, business
strategy, and customer and stakeholder
requirements.
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Internal and External Measures
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Choosing a Comprehensive Set of
Measures
Balanced score card: an organization-defined set of
measures that provides leaders with a concise but
comprehensive view of business performance
Kaplan and Norton (2005)
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Clinical Value Compass
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Pillars of Excellence
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Health Administration Press
Performance
Measures and the
Quality Continuum
Copyright 2017 Foundation of the American
College of Healthcare Executives. Not for sale.
Evaluate Quality
Performance
Supplemental Reading
Performance Assessment
Judging or evaluating measurement data
for the purpose of reaching a conclusion
Judge the
bowling
score data.
Any
conclusions?
Some conclusions:
• All scores varying
someone each
month.
• Hubert seems to
have the most
consistent score
each month.
• January was the
best month for
everyone.
The Assessment Step
Measurement
How are we
doing?
Yes
Assessment
Are we meeting
expectations?
No
Improvement
How can we improve
performance?
• Measurement results
are evaluated to
determine whether
processes are
performing as expected.
• Measurement results
are also assessed to
judge the impact of
improvements.
The assessment step follows
performance measurement. In this
step, the organization judges
whether its performance is
acceptable. If its performance is
acceptable, the organization
continues to measure
performance to ensure it doesn’t
deteriorate. If its performance is
not acceptable, the organization
advances to the improvement
step.
Assessment Activities
1. Display measurement data
2. Compare performance to expectations
3. Determine whether action is needed
Once measurement data
are collected and verified
for accuracy, assessment
can begin. The
assessment step involves
three activities
Display Measurement Data
• Factors to consider:
• Type of data to be reported
• Audience for the data
• Intended use of the information
The first step in analyzing performance data is
deciding how the information will be presented or
displayed. The data should be reported in a
format from which conclusions can be easily
drawn.
More important than the format in which
data
are displayed,
a preMore
important
than thehowever,
format in is
which
data are
displayed, however,action?
is a presentation that
provides accurate and reliable information to help
the audience answer the following questions:
What is current performance? Is there a trend in
the data? Should action be taken? What kind of
action?
Snapshot Reports
Display data from one period
Tabular Report
Pie Chart
SNAPSHOT REPORT
FORMATS Some performance
reports provide information that
represents only a snapshot of
time
More important than the
To create these reports, data are
format in which data are
gathered for a certain period and
displayed, however, is a presummarized for analysis.
action?
Common types of snapshot report
formats are tabular reports, pie
charts, scatter diagrams, bar
graphs, histograms, Pareto
charts, and radar charts.
Snapshot Reports
Scatter Diagram
Histogram
Bar Graph
Pareto Chart
Radar Chart
Trend Reports
Display data from several time periods
Tabular Report
TREND REPORT FORMATS
While a report of performance from an
interval of time can be helpful in some
situations, decision making often requires an
understanding of performance over time.
Quality is a dynamic attribute, so the ability
aCommon report formats used to
to recognize changes in performance trends
display performance results from
is important..
several periods are described in the
Common
report
formatsaction?
used
sections
that follow.to display performance results
from several periods are
described in the sections that
follow.
Trend Reports
Line Graph
Simplicity is the key to reporting performance
measurement data, whether for a single period or
many. An uncluttered tabular report or graph usually
conveys information more effectively. Several basic
principles should be observed when displaying
performance results:
•
Bar Graph
•
•
•
•
•
Make sure the data are accurate and no
relevant data are omitted.
Minimize the number of measures reported in
one table or graph.
Ensure that the report is self-explanatory.
Use clear and concise labels for the report
title, period, legends, and other explanatory
information.
Use legends or keys to explain data that may
be confusing or subject to misinterpretation.
Define abbreviations and symbols.
Compare Performance to Expectations
SETTING EXPECTATIONS Performance expectations should
be established for every measure. These expectations are
based in part on internal quality priorities, which are often
influenced by the needs of stakeholders (e.g., patients and
purchasers). Government regulations and accreditation
standards influence an organization’s desired performance
level.
• Establish performance expectations
• Consider “absolutes” found in external
regulations and accreditation standards.
• No external expectations? Set performance
targets on the basis of
• opinion,
• criteria, or
• performance comparisons.
Performance measures should be
tied to a predefined goal or
expectation. Interpretation of
measurement results is
meaningful only when they are
associated with goals.
Measurement without defined performance
expectations doesn’t contribute to quality
improvement.
Without performance expectations,
performance results cannot be evaluated
objectively.
The purpose of quality
management is to continuously
improve performance.
Compare Performance to Expectations
Opinion Performance targets may be derived from the opinion of those affected by the measure. A
determination is made regarding the acceptable or desired level of performance, which then becomes the
goal.
Criteria Performance targets should not be based solely on opinions if relevant, professionally de- fined
criteria are available. Professionally defined criteria are found in the standards, rules, and principles that
have been developed by authoritative groups, such as clinical practice guidelines (discussed in the
previous chapter), consensus statements, and position papers. Compliance with the criteria is usually
considered voluntary, but organizations are encouraged to consider them when establishing expected
levels of performance.
Performance Comparison Other organizations’ performance is the third influence on quality targets. The
use of comparative information to set performance goals is a relatively new phenomenon in healthcare.
When relevant comparison data are not publicly available, organizations collaborate to share pertinent
performance information. Another source of comparison data is the literature. Published research studies
often provide information about performance rates.
The term benchmarking is typically used to describe performance comparison (e.g., Benchmarking “we are
benchmarking against other hospitals”), but it involves more than simple com- Learning about the parison to
other organizations.
STATISTICAL PROCESS CONTROL
In addition to comparing performance to predefined goals, healthcare organizations are increasingly using
statistical process control (SPC) to assess performance. This technique is used to highlight variations in
performance that should be investigated. Variation in performance can sometimes be a bigger problem than
average performance.
Walter A. Shewhart
(Early 1920s, Bell Laboratories) Shewhart championed the use of statistical methods to evaluate the causes of variation
in performance results. Improvement strategies are affected by the cause of variation.
•
•
Some process variation is due to common causes.
Some process variation is due to special causes.
Process is stable (only common cause variation
is present).
• To reduce variation and improve
performance, process changes must be made
(common causes are inherent in the process).
Process is unstable (special cause variation is
present).
• Special causes are identified and eliminated.
• Process itself is not changed (special causes
are extrinsic to the process).
Determine Whether Action Is Needed
Measurement
How are we
doing?
Yes
Assessment
Are we meeting
expectations?
No
Improvement
How can we improve
performance?
Performance assessment is the
evaluation stage of quality
management.
• Measurement data are reported
and analyzed to determine
whether improvement
opportunities exist.
Signals of Need For Action to Improve
In the final phase of performance assessment, the need for further action is decided. At this point, the
measurement results have been reported and performance is evident. Any of the following situations might
signal the need to advance to the next step—performance improvement.
•
•
•
Performance does not meet expectations; there are no signs of specialcause variation.
Performance meets expectations; there are signs of special-cause
variation.
Performance does not meet expectations; there are signs of special-cause
variation.
Question 1.
Of the ground rules listed in your Ch. 9 supplemental reading, which three are most
important for a team to adopt, and why? When choosing the rules, consider your past
experiences working with a team or a decision-making group.
Learning Outcome
•
make decisions as part of a team.
Question 2.
Refer to text chapter 8, Exercise 8.1
. identify management behavior and effect of the patient experience in the context of
collaborative teamwork.
Question 3.
Write one full page of brief history about the founder, evolution, development, applications
of Statistical Process Control. Reference or cite your sources.
Google or research and answer the following questions.
a.How and where SPC (statistical process control) has been applied to healthcare? List
the top 5 areas or settings.
b.How and where SPC has applied: fields of healthcare? List the top 5 fields.
c.Give an example (case or situation) and explain where SPC can be applied to detect
the cause of variation (or the process is unstable).
Learning Outcome
.apply statistical process control in healthcare;
Question 4.
Refer to text chapter 9, Exercise 9.1
. successfully navigate the AHRQ and National Quality Measures Clearinghouse websites
to locate measurement resources.
Question 5.
1. Prepare a cause-and-effect diagram with several main and sub-factors (causes) to
address the problem.
2. Select one of the main factors from the diagram and explain how the factor can help
to address the problem.
Learning Outcome
•
•
creates a relevant cause-and-effect diagram.
explain how the diagram can help to address the problem.
Exercise
Exercise 9.1
Objective: To familiarize yourself with the measurement resources available on the AHRQ
National Quality Measures Clearinghouse website.
Instructions: Select a healthcare service setting that you are familiar with or would like to
become more familiar with. Using the search function on the National Quality Measures
Clearinghouse website (www.qualitymeasures.ahrq.gov), identify measures that could be
used in your chosen setting to evaluate performance in each of these quality domains: safe
care, effective care, patient-centered care, timely care, efficient care, and equitable care.
Identify at least one measure for each quality domain.
Companion Readings Agency for Healthcare Research and Quality. 2016. “Toolkit for Using
the AHRQ Quality Indicators.” Reviewed
July. www.ahrq.gov/professionals/systems/hospital/qitoolkit/index.html. Blumenthal, D., E.
Malphrus, and J. M. McGinnis (eds). 2015. Vital Signs: Core Met- rics for Health and Health
Care Progress. Washington, DC: National Acad- emies Press. Burstin, H., S. Leatherman,
and D. Goldman. 2016. “The Evolution of
Healthcare Quality Measurement in the United States.” Journal of Internal Medicine 279 (2):
154–59. Buying Value. 2016. “How to Build a Measure Set.” Robert Wood Johnson
Foun- dation. Accessed November 14. www.buyingvalue.org/resources/toolkit. Farquhar, M.
2008. “AHRQ Quality Indicators.” In Patient Safety and Quality: An EvidenceBased Handbook for Nurses, edited by R. G. Hughes. AHRQ. Pub- lished April. www.ncbi.nl
m.nih.gov/books/NBK2664. Healthy People 2020. 2016. “Leading Health Indicators.”
Accessed November 14. www.healthypeople.gov/2020/Leading-HealthIndicators. Lichiello, P. 2010. Guidebook for Performance Measurement. Turning Point.
Accessed October 12,
2016. ww.phf.org/resourcestools/documents/pmcguidebook.pdf. Neely, A., and M. A. Najjar.
2006. “Management Learning, Not Management
Con- trol: The True Role of Performance Measurement?” California Management Review 48
(3): 101–14.
Web Resources Agency for Healthcare Research and
Quality • National Quality Measures Clearinghouse: www.qualitymeasures.ahrq.gov • Qualit
y Indicators: www.qualityindicators.ahrq.gov CMS QualityNet: www.qualitynet.org Nationa
l Quality Forum: www.qualityforum.org

Purchase answer to see full
attachment

  
error: Content is protected !!