An Introduction to Clinical Quality Improvement

Brent C. James, MD, MStat
Length: 3 hours 46 minutes

Presentation Objectives:
  • Definition of processes.
  • Quality improvement as the science of process management.
  • Classes of outcomes: physical, service,cost.
  • Process management.

Three Methods

Brent C. James, MD, MStat
Length: 4 hours 12 minutes

Presentation Objectives:
  • Feedback of comparative data (QUE studies).
  • Practice guidelines/protocols (ARDS study).
  • Computerized decision support (Antibiotic Assistant Study).

Modeling Processes

Brent C. James, MD, MStat
Length: 3 hours 25 minutes

Presentation Objectives:
  • Use of conceptual and detailed flow diagrams.
  • Use of cause and effect diagrams, tally sheets and pareto charts in organizing and displaying information.
  • Formal team tools: brainstorming, multi-voting, nominal group technique (NGT Dephi methods).

Pragmatic Science

Brent C. James, MD, MStat
Length: 3 hours 40 minutes

Presentation Objectives:
  • Accelerated improvement efforts.
  • Goal: improvement vs. research.
  • Fundamental improvement questions.
  • Graphical display of data.
  • Adjusting for differences in inputs (severity, cohort formation).
  • Extracting medical evidence: synthesis/meta-analysis of data.

Understanding Variation

Brent C. James, MD, MStat
Length: 2 hours 49 minutes

Presentation Objectives:
  • Specification limits.
  • Process capability.
  • Methods for separating random from assignable variation (introduction to Statistical Process Control).
  • Methods to manage assignable variation: tracking to root causes.
  • Methods to manage random variation: Shewhart's PDCA cycle (the scientific method).
  • Frequency distributions: central limit theorem.
  • Tampering.

Data Types

Brent C. James, MD, MStat
Length: 2 hours 49 minutes

Presentation Objectives:
  • Four types of data nominal, ordinal, interval, ratio.
  • Correlation between SPC graphical analysis and data type.
  • Role of underlying distributions when constructing control charts.
  • Rules for collecting data.

Deployment: Clinical Integration

Brent C. James, MD, MStat
Length: 2 hours 29 minutes

Presentation Objectives:
  • Understand the structural considerations for replicating improvement across systems of care.
  • Describe Intermountain Healthcare's management structure designed to accomplish implementation.
  • Understand drill-down versus outcomes tracking approaches.

Designing Data Systems

Brent C. James, MD, MStat
Length: 2 hours 20 minutes

Presentation Objectives:
  • Concepts important when designing a data system.
  • Relationship between aim statement and data system design.
  • Components of self-coding data forms

Clinical Information Systems

Brent C. James, MD, MStat
Length: 1 hour 44 minutes

Presentation Objectives:
  • Core principles of clinical information systems.
  • Requirements of clinical information systems: central patient record, expert system, encoded data.
  • Issues of clinical information systems' implementation.

Quality Controls Cost & Tracking Health Care Costs

Brent C. James, MD, MStat
Length: 4 hours 16 minutes

Presentation Objectives:
  • Causal links between quality and cost.
  • Quality waste -- cost of poor quality.
  • Productivity/efficiency -- limited resource utilization.
  • Optimalist-maximalist argument -- implications of cost pressures for the health care system.
  • Reductionism and sub-optimization.
  • Fixed vs. variable costs.
  • Direct vs. indirect costs.
  • Activity based cost accounting.
  • Strategies to harvest quality savings.
  • The business case for quality.

Curing vs. Caring

Brent C. James, MD, MStat
Length: 3 hours 4 minutes

Presentation Objectives:
  • Definition of "customer".
  • Definition of "expectations".
  • A generic, functional definition of quality.
  • Methods of managing customer expectations.

Severity of Illness Adjustment

Brent C. James, MD, MStat
Length: 1 hour 30 minutes

Presentation Objectives:
  • Understand the conceptual implications of different severity measures.
  • Understand the impact of data on severity measurement.
  • Explore the impact of different severity measures on perceptions of outcomes.

Patient Safety

Brent C. James, MD, MStat
Length: 1 hour 45 minutes

Presentation Objectives:
  • Recognize how system failures create errors.
  • Determine patient safety clinical focus areas for their organizations.
  • Identify and make recommendations for local and national collaborations.