QUALITY RADIOLOGY. What is Quality, and how does it apply to Radiology. How is Quality defined in healthcare, specifically Radiology?

Transcription

1 QUALITY RADIOLOGY Daryl Chen, MD Harbor City/South Bay Medical Center What is Quality, and how does it apply to Radiology Quality Assurance Quality Control Total Quality Management Total Quality Leadership Total Quality Improvement Statistical Quality Control Continuous Quality Improvement How is Quality defined in healthcare, specifically Radiology? Not an easy task. Agreements do not exist. Is it success of the procedure or result of therapy? Is it the greatest amount of studies performed in a certain amount of time? Is it patient satisfaction regarding the amount of time spent in the department, outcome of the study, etc.? 1

2 Quality yadayadayada Is it all the same? Quality assurance = Quality control = Quality Improvement = Total Quality Management? Is it all the same bird under a different feather? 2

3 Quality Assurance Prevention of defects Activities that provide adequate confidence that radiology service renders consistent high quality images and services Quality Control Detection of defects An aspect of quality assurance that monitors technical equipment to maintain quality standards. 3

4 Total quality management focuses on needs and expectations of the customers and continuous improvement of product a business management strategy aimed at embedding awareness of quality in all organizational process. It includes planning, directing Define Quality Business has tried to define quality in a producer-consumer context, with the following variations: ISO 9000: "Degree to which a set of inherent characteristic fulfills requirements."[2] The standard defines requirement as need or expectation. Six Sigma: "Number of defects per million opportunities."[3] The metric is tied in with a methodology and a management system. Philip B. Crosby: "Conformance to requirements."[4][5] The difficulty with this is that the requirements may not fully represent customer expectations; Crosby treats this as a separate problem. Joseph M. Juran: "Fitness for use."[5] Fitness is defined by the customer. Noriaki Kano and others, presenting a two-dimensional model of quality: "must-be quality" and "attractive quality."[6] The former is near to the "fitness for use" and the latter is what the customer would love, but has not yet thought about. Supporters characterize this model more succinctly as: "Products and services that meet or exceed customers' expectations." Robert Pirsig: "The result of care."[7] Genichi Taguchi, with two definitions: a. "Uniformity around a target value."[8] The idea is to lower the standard deviation in outcomes, and to keep the range of outcomes to a certain number of standard deviations, with rare exceptions. b. "The loss a product imposes on society after it is shipped."[9] This definition of quality is based on a more comprehensive view of the production system. American Society for Quality: "a subjective term for which each person has his or her own definition. In technical usage, quality can have two meanings: a. the characteristics of a product or service that bear on its ability to satisfy stated or implied needs; b. a product or service free of deficiencies."[5] Peter Drucker: "Quality in a product or service is not what the supplier puts in. It is what the customer gets out and is willing to pay for."[10] The common element of the business definitions is that the quality of a product or service refers to the perception of the degree to which the product or service meets the customer's expectations. Quality has no specific meaning unless related to a specific function and/or object. Quality is a perceptual, conditional and somewhat subjective attribute. ^ The third meaning echoes Aristotle, who defined quality as that by virtue of which a thing is such and such. Cited by: Reese, William L. (1996). Dictionary of Philosophy and Religion. Prometheus Books. ISBN ^ TC 176/SC (2005). ISO 9000:2005, Quality management systems -- Fundamentals and vocabulary. International Organization for Standardization. ^ Motorola University. "What is Six Sigma?". Motorola, Inc.. Retrieved on ^ Crosby, Philip (1979). Quality is Free. New York: McGraw-Hill. ISBN ^ a b c American Society for Quality, Glossary - Entry: Quality, retrieved on 20 July 2008 ^ Kano, Noriaki ( ). "Attractive quality and must-be quality". The Journal of the Japanese Society for Quality Control: ^.Pirsig, Robert M. (1974). Zen and the art of motorcycle maintenance : an inquiry into values. New York, N.Y.: Morrow. ISBN Cited by: Jones, D.R. (September 1989). "Exploring quality: what Robert Pirsig's "Zen and the Art of Motorcycle Maintenance" can teach us about technical communication". IEEE Transactions on Professional Communication (IEEE) 32 (3): ^ Taguchi, G. (1992). Taguchi on Robust Technology Development. ASME Press. ISBN ^.Ealey, Lance A. (1988). Quality by design: Taguchi methods and U.S. industry. Dearborn, Mich.: ASI Press. ISBN Cited by: Sriraman, Vedaraman, A primer on the Taguchi system of quality engineering, retrieved on 20 July 2008 ^ Drucker, Peter (1985). Innovation and entrepreneurship. Harper & Row. ISBN

5 Applying a business model to people? Why the fuss over Quality In 2005, the U.S. spent 16% of its GDP on healthcare, and the projection will be 20% by The American Healthcare consumer is becoming much more intelligent and informed, and he/she is demanding more for the expense. Confidence in leaders of organized medicine has fallen from 73% in mid-1960 s to 33% in Vast majority feel increased cost is not justified, and that rising costs can be reduced by better organization and management, without cutting the quality of care. Consequences Rising public interest in mandated controls on cost has been transmitted to public policymakers who affect government-subsidized healthcare programs. Examples of public perception of poor quality: (1) Breast and Cervical Screening Mortality Prevention Act of 1990 certain standards in mammography and Pap smear screening. (2) Cancer Quality Improvement Act of 1992 requires all mammography sites to be certified. 5

6 Is this misdirected or the future? The Resource Based Relative Value Scale-assigns procedure performed by physician or medical provider a relative value, adjusted by geographic region, multiplied by a conversion factor which changes annually, thus coming up with the payment. Used by Medicare in the U.S. and nearly all HMO s. The RBRVS does not include adjustments for outcomes, quality of service, severity, or demand. Future of radiology practice not only told how much you will be paid, but how it is to be accomplish. UnitedHealthcare Extends Required Imaging Accreditation Deadline to Fourth Quarter 2009 UnitedHealthcare will now require all out-patient medical imaging providers to have completed and submitted an application to obtain accreditation from ACR or another accrediting body deemed appropriate by UnitedHealthcare, by the fourth quarter of 2009 in order to receive reimbursement for CT, MRI, PET, nuclear medicine, nuclear cardiology and echocardiography services. UnitedHealthcare originally intended to require accreditation as a condition for reimbursement beginning in the third quarter of However, the insurer adjusted its timeline based on feedback it received from physicians and other imaging stakeholders, which it says indicate that some communities may not have a sufficient number of accredited facilities to meet patient and physician needs. Another factor is the recent implementation of the Medicare Improvements for Patients and Providers Act (MIPPA) requiring providers of advanced imaging services to be accredited by January 1, Effective this date, accreditation will become a mandatory requirement in order to receive payment for the technical component of imaging services. In the meantime, UnitedHealthcare has indicated that it will continue to promote and encourage the use of accredited imaging facilities to referring physicians and to its members. U.S. Dept. of Veterans Affairs Selects ACR to Accredit All VA Radiation Oncology Facilities The American College of Radiology, the nation s oldest and most widely recognized radiation oncology and medical imaging accrediting body, has been awarded a three-year contract from the U.S. Department of Veterans Affairs to serve as the accrediting organization for all VA hospital radiation oncology facilities nationwide. The 33 VA facilities will go through the ACR accreditation process over the next three years. The ACR is extremely proud to do its part to help ensure that our nation s veterans receive the highest quality health care available. American servicemen and women have demonstrated their commitment to our country. The ACR is committed to ensuring that they receive consistent, quality care, said ACR Executive Director Harvey L. Neiman, M.D., FACR. 6

7 William Edwards Deming (October 14, 1900 December 20, 1993) an American statistician, college professor, author, lecturer, and consultant credited with improving production in the United States during World War II in Japan, from 1950 onward he taught top management how to improve design (and thus service), product quality, testing and sales (the last through global markets) through various methods, including the application of statistical methods such as analysis of variance (ANOVA) and hypothesis testing made a significant contribution to Japan's later renown for innovative high-quality products and its economic power Deming s 14 points applied to radiology 1. Create constancy of purpose toward improving product and service, to become competitive and to stay in business and provide jobs. 2. Adopt a new philosophy. 3. Cease dependence on mass inspection to achieve quality. Build quality into the product in the first place. Deming s 14 points 4. End practice of awarding on price alone. Minimize total cost. 5. Improve constantly and forever the system of production and service, to improve quality and productivity, thus reducing costs. 6. Institute training on the job. 7. Institute leadership to help do the job better. 7

8 Deming s 14 points 8. Drive out fear so everyone can work for the good of the organization. 9. Remove barriers between departments. 10. Eliminate slogans, exhortations, and targets for the group. 11. Eliminate quotas. 12. Eliminate merit rating systems. Deming s 14 points 13. Institute program of education and selfimprovement. 14. Involved everyone in the organization towards quality improvement. Structured problem solving Find a problem or process to improve Organize a team/group that knows the process Clarify the current knowledge/process Understand the problem or cause of variation Select method for process improvement 8

9 Structured problem solving Plan the new implementation and continue data collection Do improvements Check results Act to hold gains and continue improvement Where does quality start? Chief/Manager Assistant Manager Assistant Manager Assistant manager Others Others Others Others Others Others The traditional pyramidal structure Improvement effort must be driven by top management. Must receive support and resources necessary, along with active involvement. However, there needs to be a revision in the traditional structure. While structure/responsibility is important in any organization, the concept that only one group or person is the most important needs to change. 9

10 Quality is Interdependent Radiologist Transcription Fileroom Reception Quality Managers Clinicians Patients Technologist The TEAM concept Overall function of the radiology department is dependent on all people to fulfill their responsibilities in relationship to the other groups. Loss of any one group is significantly detrimental to quality improvement. 10

11 The Healthconnect to RISS quandary Physician orders Ultrasound pelvis, complete documentation on Healthconnect RISS produces request Ultrasound pelvis, transabdominal only US technologist performs as ordered Radiologist reads study, states limitation of transabdominal technique Physician/Patient upset 11

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