Ontrolling Related to Total or Continuous Quality Improvement

Instructions and overview

Document Preparation:
1. Journal Article Reviews:
The narrative of journal article reviews must be:
· Double spaced
· Standard 1 inch margins on all four sides of the paper
· Size 12 font for the narrative
· Page numbers
· Headings that stand out to break up the content.
· Your Name and Date
· Name of the topic of the paper (Example: Nurse Staffing in a Hospital)
· Article Reviewed and Source (journal, authors, month and year)
· Key Points of the Article (this is a practice in summarizing, interpreting and paraphrasing reading material in your own words (no cutting and pasting or bullet points); be concise but brief (limit this section to one half page)
· Critique of the Article (make this part the bulk of the paper since it carries the most grading weight) including:
-why the article is important/relevant to management in health care
-management issues related to key points made by the author(s); examples: cultural, political, legal, ethical or global issues
· -where the article author(s) and the textbook authors agree or disagree (this is usually the part most difficult for studentshow the article authors match or conflict with the required reading authors; this is also where citations are required from external sources, which may include but not be limited to the article and the textbook)
-conclusion(s) drawn from the article as a way to close the paper; answers the So, what were the lessons learned in the article?
· Bibliography (see instructions below about learning and using APA style)
· Caution: No Title Page

Journal Review subject: Controlling Related to Total or Continuous Quality Improvement

Some explanations on the subject:
CQI/TQM (Total or Continuous Quality Improvement) represents one way health care administrators exercise the management function of control (standards are set, measures of performance are taken and administrative actions are implemented to improve performance). The administrative action taken based on collected and analyzed data represents the controlling function (to control performance within acceptable standards or perimeters).

Compare the key points in the selected article to the required reading for the learning module to see where the authors agree or disagree.
For example: how do the contents of the selected article fit or not fit the work of Deming, Juran or Crosby?

Focus attention on management issues such as how the function of controlling might create conflicts with other cultural, ethical, legal, political or global healthcare issues.

Supplemental information on Deming, Juran or Crosby:

Deming offered practical and pragmatic approaches to the improvement of quality and productivity that relied heavily on his components of the  System of Profound Knowledge. He proposed fourteen quality principles 15 that led to the development of quality improvement approaches that changed the focus of enlightened managers from trying to change people to changing processes and systems to improve output and reduce cost through redesign and reengineering.

Crosby articulated four absolutes:
1. Conformance to requirements is the only definition of quality
2. What causes quality is prevention, not appraisal
3. Zero defects is the only acceptable performance standard
4. The price of nonconformance is how quality should be measured. 20

Juran teaches a project-by-project, problem-solving, team method of quality improvement in which all levels of management must be involved- Total Quality Management (TQM). Quality doesn t happen by accident; it must be planned. His key points involve: implementing organizational wide quality planning including identifying customers and their needs, establishing optimal quality goals, creating measurements of quality, planning processes capable of meeting those goals under operating conditions, and producing continuing results in improved market share, premium prices, and reduction of error rates. Dr. Juran was the first to incorporate the human aspect of quality management, embraced in TQM. 19

The article to review:

Testimony on Patient Safety
Supporting a Culture of Continuous Quality Improvement in Hospitals and Other Health Care Organizations
Carolyn M. Clancy, M.D., Director, AHRQ
Before the Senate Permanent Subcommittee on Investigations, Committee on Governmental Affairs, June 11, 2003

The IOM Report
Its a Systems Problem
Successful Examples
Obstacles to Overcome
Patient Safety Initiative
Good morning. I am very pleased to be here today to discuss the important issue of supporting hospitals and other health care organizations in their efforts to build and sustain a culture of continuous quality and patient safety improvement.
Hospitals and other health care delivery systems provide millions of Americans each year with important, frequently life-saving, care. But, as we all know, medical errors and patient safety issues represent a national problem of epidemic proportions. And as we have seen from recent news headlines, no institution is exempt, and everyone who uses the health care system is at risk.
However, there is good news. Our health care system is committed to improving the quality and safety of the care provided to our Nations citizens. That commitment has never been stronger as shown by the dedication of the health care organizations like those you have gathered here today.
This issue is a very high priority for HHS Secretary Tommy Thompson and for the Agency for Healthcare Research and Quality (AHRQ). Over the last 3 years, thanks to the vision of the U.S. Congress, AHRQ has dedicated $165 million to patient safety research. AHRQ is now the leading funder of patient safety research in the world.
As a clinician, as well as the head of a Federal agency, making sure that patients have safe, high quality health care is a personal priority for me. Like all clinicians, I have had personal experience with patient safety issues in my own practice.
Return to Contents
The IOM Report
It is important to note that the issue of improving patient safety is not new to the health care system. The landmark 1999 Institute of Medicine report, To Err is Human, was preceded by a body of research largely funded by AHRQ.
Also, segments of the health care system began to recognize where improvement was needed and came together to improve patient safety. For example, anesthesiology had an error rate in the 1960s and 70s of 25 to 50 per million patients. After a concerted effort, that rate has been reduced nearly seven-fold, to 5.4 per million.
In the mid-1990s, the American Medical Association launched the National Patient Safety Foundation, an organization committed to improving safety and reducing errors in medicine.
To Err Is Human galvanized fears and served as a further catalyst to efforts to improve safety and reduce errors. The reports estimates that 44,000 to 98,000 people die in hospitals each year due to medical errors shocked our Nation and all of us involved in health care. Media attention was high at the release of the report and continues with each high-profile case that makes news.
With all of this attention before and after the release of the IOM report, it would be easy to assume that we could do something quickly to improve patient safety. Yes, we are making progress and beginning to use what we know works to improve safety. However, we have much more to do. It is imperative that we do what is right and what evidence shows will work. We need to make sure that the cure for medical errors does not make the epidemic worse.
Return to Contents
Its a Systems Problem
The key message of the IOM report and its sequel, Crossing the Quality Chasm, is that Its the system.Health care professionals are human, and humans are prone to mistakes. We need to make sure that health care professionals work in systems that are designed to prevent mistakes and catch problems before they cause