Quality Management in Health Care: Principles and Methods

by Lighter, Donald; Fair, Douglas C.

• ISBN13: 9780763732189
• ISBN10: 0763732184
• Edition: 2nd
• Format: Paperback
• Copyright: 2004-03-09
• Publisher: Jones & Bartlett Learning

Summary

Now in its second edition, Quality Management in Health Care: Principles and Methods addresses the mounting pressure on the health care industry to control costs while providing the highest quality care and services. In doing so, it provides students with a solid foundation in the implementation of quality improvement activities and the tools necessary to evaluate and improve their efforts toward quality of care. With an emphasis on general theory and practical applications, the text delineates the techniques that form the basis of quality management in medicine, such as group processes, process orientation, statistical process control, and statistical techniques. A clear and concise writing style and effective use of examples, illustrations, and case studies elucidate the complex topics presented in the text.

Author Biography

Donald E. Lighter, MD, MBA, FAAP Director of The Institute for Healthcare Quality Research and Education, Clinical Associate Professor, University of Tennessee Medical Center, Professor, College of Business Administration, University of Tennessee, Knoxville Douglas C. Fair Director of Statistical Applications, InfinityQS International, Inc., an SPC Software company Manassas, Virginia

Table of Contents

Contributors	vii
Foreword to the First Edition	ix
Foreword to the Second Edition	xi
Preface	xiii
Acknowledgments	xv
Chapter 1 The Rationale for Quality Improvement in Health Care	1	(12)
Donald E. Lighter and Curtis R McLaughlin
Introduction	1	(1)
Changing Health Care Environment	2	(2)
Growth of QI in Health Care	4	(3)
Transition to Integrated Health Care Delivery Systems	7	(1)
Delicate Balance Between Quality and Access	8	(2)
Next Level: Systemwide	10	(1)
Discussion Points	10	(3)
Chapter 2 Group Processes in Health Care Quality Improvement	13	(30)
Donald E. Lighter
Introduction	13	(1)
Teamwork Concepts	14	(3)
Use of Teams in Organizations	17	(10)
Group Process Techniques	27	(8)
Special Situations: Team-Building Approaches	35	(4)
Teamwork: The Key to Higher Quality	39	(1)
Discussion Points	40	(3)
Chapter 3 Process Orientation in Health Care	43	(60)
Donald E. Lighter
Introduction	43	(2)
Process-Analysis Tools	45	(39)
Failure Mode and Effects Analysis-Prospective Process Review	84	(4)
Root Cause Analysis-Retrospective Process Review	88	(1)
Continuous QI-Concurrent Process Review	89	(1)
Relationship of Quality Assurance Approaches	90	(1)
Data Requirements in Quality	91	(8)
Discussion Points	99	(4)
Chapter 4 Statistical Process Control: Basic Principles	103	(24)
Donald E. Lighter Introduction	103	(24)
Data Analysis Models	103	(3)
Process Problems and Statistical Process Control	106	(3)
Statistical Basis of SPC	109	(13)
Conclusion	122	(1)
Discussion Points	122	(2)
Appendix 4.A	124	(3)
Chapter 5 Statistical Process Control Approaches: Basic Theory and Use of Control Charts	127	(46)
Douglas C. Fair
Introduction	127	(1)
Overview of Data Types	127	(1)
Charts for Categorical Attributes	128	(7)
Charts for Counts Attributes	135	(9)
Analysis of Variables Data	144	(25)
Runs Testing in Control Charts	169	(1)
The Power of Control Charts	170	(1)
Discussion Points	170	(2)
Appendix 5.A	172	(1)
Chapter 6 Advanced Statistical Process Control	173	(66)
Douglas C. Fair
Introduction	173	(1)
Using the Control Chart Selection Diagram	173	(64)
Discussion Points	237	(2)
Chapter 7 Advanced Statistical Applications in Continuous Quality Improvement	239	(56)
Donald E. Lighter
Introduction	239	(1)
Discrete Contributions	239	(3)
Continuous Distributions	242	(6)
Statistical Inference	248	(1)
ANOVA	249	(13)
Regression Analysis	262	(13)
Analysis of Means	275	(7)
Design of Experiments	282	(5)
Sources of Data for QI	287	(5)
Discussion Points	292	(3)
Chapter 8 Clinical Processes: Clinical Practice Guidelines	295	(26)
Donald E. Lighter and Neda Lewis
Introduction	295	(1)
History of Clinical Practice Guidelines in Health Care	295	(2)
Use of CPGs in Health Care	297	(5)
Creation of CPGs	302	(15)
Discussion Points	317	(4)
Chapter 9 Strategies for Implementing Quality Improvement	321	(44)
Donald E. Lighter
Introduction	321	(1)
Deming's 14 Principles Applied to Health Care	321	(16)
Approaches to Implementation	337	(1)
Phases of Organizational Change	337	(16)
Institutionalization of Change	353	(1)
Balanced Scorecard Approach to QI	354	(8)
QI Implementation in Complex Organizations	362	(1)
Discussion Points	363	(2)
Chapter 10 Making Continuous Quality Improvement Work: Care Management	365	(64)
Donald E. Lighter
Introduction	365	(1)
Care Management: A Contemporary Approach	366	(1)
Care Management: Theoretical Framework	367	(2)
Key Elements of a Care Management Program	369	(5)
Development of a Care Management Program	374	(24)
Financial Analysis of Care Management Programs	398	(16)
Provider Involvement in Care Management	414	(2)
Partnerships Within the Industry	416	(3)
Future of Care Management	419	(1)
Discussion Points	420	(5)
Appendix 10.A: Quality Improvement and Health Statistics Data Sources	425	(4)
Chapter 11 Legal and Regulatory Issues in Quality Improvement	429	(112)
Donald E. Lighter and Sally A. Lighter
Introduction	429	(1)
Federal Legislation and Regulation	430	(7)
The NCQA	437	(8)
Utilization Review Accreditation Commission	445	(2)
Joint Commission on Accreditation of Healthcare Organizations	447	(2)
Foundation for Accountability	449	(3)
Malcolm Baldrige National Quality Award	452	(2)
International Organization for Standardization 9000	454	(4)
QI and Reducing Risk	458	(1)
Regulatory Agencies and the Growth of QI in Health Care	459	(1)
Discussion Points	459	(4)
Appendix 11.A: QISMC Domain 1	463	(28)
Appendix 11.B: QISMC Domain 2	491	(16)
Appendix 11.C: QISMC Domain 3	507	(30)
Appendix 11.D: QISMC Domain 4	537	(4)
Chapter 12 The Future of Continuous Quality Improvement in Health Care	541
Donald E. Lighter
Introduction	541	(1)
Quality Milestone 1: Improved Information Management	542	(6)
Quality Milestone 2: Health Care System Integration	548	(1)
Quality Milestone 3: Consumerism	549	(2)
Quality Milestone 4: Education	551	(1)
Quality Milestone 5: Federal and State Government Programs Emphasis on Quality	552	(2)
Quality Milestone 6: Adoption of the Quality Philosophy	554	(1)
QI Is the Answer	555	(1)
Discussion Points	556