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Managing Outcomes Utilizing an Organizational Performance Improvement Model

Managing Outcomes Utilizing an Organizational Performance Improvement Model

Managing Outcomes Utilizing an Organizational Performance Improvement Model

Out line

Out line  Defining Quality of Care  History of Quality  Quality Principles  Categories

Defining Quality of Care History of Quality Quality Principles Categories of Performance Outcomes Who Are the Customers in Health Care? Defining Customer Needs Patient Satisfaction Data Performance Improvement Concepts QUALITY DIMENSIONS Quality Improvement Process Quality control tools (Charts)

Objectives

Objectives         Upon completion of this Presentation , the

Upon completion of this Presentation , the Participant should be able to:

Know what is the Quality Care Identify the Customer and Customer Needs Know Performance Improvement Concepts Explain PI Process Methodologies Explain QUALITY DIMENSIONS

Know Quality control tools (Charts) DO Performance Improvement Project

Defining Quality of Care

Defining Quality of Care  “Quality of care is the degree to which health services for

“Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”.

- Institute of Medicine, USA

History of Quality :

History of Quality :  Quality assurance (QA) emerged in health care in the 1950s as

Quality assurance (QA) emerged in health care in the 1950s as an inspection approach to ensure that minimum standards of care existed in health care institutions.

With its emphasis on “doing it right,” some thought that QA was very punitive and did little to sustain change or proactively identify problems before they occurred.

: History of Quality

: History of Quality  Total quality management (TQM) began in the manufacturing industry, when W.

Total quality management (TQM) began in the manufacturing industry, when W. Edwards Deming and Joseph Juran consulted with Japanese corporations in the 1950s.

The end result of this method was to satisfy customers rather than just “doing it right.”

This approach became integrated in the health care industry in the 1980s.

Quality Principles

Quality Principles Continuous Empowerment Improvement Customer QUALITY Orientation Performance Measures Work Process Focus
Continuous Empowerment Improvement Customer QUALITY Orientation Performance Measures Work Process Focus
Continuous
Empowerment
Improvement
Customer
QUALITY
Orientation
Performance
Measures
Work Process
Focus
Categories of Performance Outcomes

Categories of Performance Outcomes

Categories of Performance Outcomes

Categories of Performance Outcomes A. Doing the Wrong Things Right  System Design is poor 

A. Doing the Wrong Things Right System Design is poor Staff performance is acceptable

- revisit the design step.make sure staff members are trained to carry out any changes in design

Categories of Performance Outcomes

Categories of Performance Outcomes B. Doing The Wrong Things Wrong  System design is poor 

B. Doing The Wrong Things Wrong System design is poor Staff performance is not acceptable

-Entire approach needs to be revisited (all five steps)

Categories of Performance Outcomes

Categories of Performance Outcomes C.Doing The Right Things Right  System design is good  Staff

C.Doing The Right Things Right System design is good Staff Performance is good

Make sure you find out what makes it work so you can repeat it

Categories of Performance Outcomes

Categories of Performance Outcomes D. Doing The Right Things Wrong  System design is good 

D. Doing The Right Things Wrong System design is good Staff performance is not acceptable

Find out why staff are not able to carry out the program as designed. Make necessary improvements.

Who Are the Customers in Health Care?

Who Are the Customers in Health Care?  A customer is anyone who receives the output

A customer is anyone who receives the output of your efforts.

Customers can be internal, within the organization. Customers can be external, outside the organization.

Defining Customer Needs

Defining Customer Needs  Who are my cust cust om om er er s s ?

Who are my cust customomererss?

What do they need need from me?

What is my ser servvicicee to meet their needs?

What are my customers’ eexxppeecta ctatiotionsns?

What is my prprooccess ess for meeting their needs?

Does my service mmeeeett oorr exexceceeded their needs and

expectations?

Do all the activities in the process add vvalue

alue to the

customer?

Empowerment of Everyone in the Organization

Empowerment of Everyone in the Organization  Each person must feel that he or she participates

Each person must feel that he or she participates.

Each takes responsibility for the success or

failure of an organization.

Each takes an active part in developing new ways

of doing business and securing new customers.

Each trusts that his or her efforts are valued.

Who Participates in the Improvement Process?

Who Participates in the Improvement Process?  All staff members should be encouraged to participate. 

All staff members should be encouraged to participate.

All those involved with or affected by a goal or

process should participate.

Staff can participate on individual, unit, or

organizational levels.

Participants should include point-of-service staff, i.e.,

those workers on the front line who do the direct work

involved in the process being changed.

Improvement of the Health Care Process

Improvement of the Health Care Process  A process is a set of causes and conditions

A process is a set of causes and conditions that

repeatedly come together in a series of steps to

transfer inputs into outcomes.

All processes have inputs, steps, and outputs.

Improvement of the System

Improvement of the System  A system is an interdependent group of items, people, or processes

A system is an interdependent group of items, people,

or processes with a common purpose.

Outcomes in a system can be improved by examining

not only processes, but also the relationships

between processes.

Correct gathering and interpretation of data is an

essential component of continuous improvement.

Shewart cycle: Shewart developed the concept that

improvement is a cycle; it is continuous because it is

linked to customer needs and judgments.

Implications for Client Care

Implications for Client Care  Quality improvement for patient care can be measured by the overall

Quality improvement for patient care can be measured

by the overall value of care.

Value is determined by outcomes and cost.

Outcomes can be clinical/functional or related to

patient satisfaction.

Cost can be direct or indirect.

Goal: increase quality outcomes, reduce cost.

Improving Organization Performance

Improving Organization Performance The Organization’s approach to improving its performance must include the following processes: 

The Organization’s approach to improving its

performance must include the following processes:

Designing Processes,

Monitoring Performance through data collection,

Analyzing current performance,

Improving and sustaining improved performance

Patient Satisfaction Data

Patient Satisfaction Data  Accumulated through questionnaires, focus groups, and post care interviews  Helpful if

Accumulated through questionnaires, focus groups,

and post care interviews

Helpful if data can be compared/benchmarked against

data of similar organizations

Time series data

Allows a quality improvement team to see change in quality over time

Time series chart used to look for trends, shifts, and unusual data

QUALITY IMPROVEMENT

QUALITY IMPROVEMENT  Collaboratively select existing processes & outcomes for chronic problems in governance, management, clinical

Collaboratively select existing processes & outcomes

for chronic problems in governance, management,

clinical & support activities.

Analyzing causes of chronic process failure

Systematically develop optimal solutions to chronic

problems

Analyzing data for “better or best practice”

End by quality control/measuring to holds the gains.

PERFORMANCE IMPROVEMENTS

PERFORMANCE

IMPROVEMENTS

Performance Improvement Concepts

Performance Improvement Concepts  Performance is what is done & how well it is done to

Performance is what is done & how well it is done to provide health care.

Level of performance:

What is done, measured by DEGREE to which care is:

Efficacious

Appropriate

How it is done, measured by DEGREE to which care is:

Safe Available Timely delivered Efficient Effective Coordinated among care givers Respect & Caring to patient

QUALITY DIMENSIONS

QUALITY DIMENSIONS  3 A: 3A 2P 4C 1D 2E 1R 1S 1T  Accessibility, Amenities,

16

3 A:

3A
3A
2P
2P
4C
4C
1D
1D
2E
2E
1R
1R
1S
1S
1T
1T

Accessibility, Amenities, Appropriateness 2 P Prevention/Early detection, Preparedness 4 C:

Caring, Communication, Competency, Continuity 1 D:

Durability/reliability 2 E:

Effectiveness, Efficiency, Efficacy 1 R:

Respect 1 S:

Safety 1 T:

Timeliness

ACCESSIBILITY

ACCESSIBILITY Availability, Affordability, Acceptability  Physical, Financial, Intellectual Access.  Intellectual (Perception) Access = Care Communication

Availability, Affordability, Acceptability

Physical, Financial, Intellectual Access.

Intellectual (Perception) Access = Care Communication in Customer’s Culture, Beliefs & Education

With No Acceptability, Customer will not seek for the care even if it is available & affordable.

AMENITIES

AMENITIES  Esthetical Acceptable Environment of Care Provision  Pay Attention to Minute Details of Customer

Esthetical Acceptable Environment of Care Provision

Pay Attention to Minute Details of Customer Comfort & Wellbeing

E.g. Cleanliness, Decoration.

APPROPRIATENESS

APPROPRIATENESS  Care Provision in Relation to:  Customer Requirements (needs & expectations).  Current State

Care Provision in Relation to:

Customer Requirements (needs & expectations).

Current State of Knowledge

Correct and Suitable Resource Utilization

PREVENTION / EARLY DETECTION

PREVENTION / EARLY DETECTION  Risk Factors Detection  Health Status Promotion  Disease Prevention.

Risk Factors Detection Health Status Promotion Disease Prevention.

CARING

CARING  Individual Involvement in his/her Own Care & Service Decisions.

Individual Involvement in his/her Own Care & Service Decisions.

CONTINUITY

CONTINUITY  It is “Managed” Care.  Coherent Unbroken Succession of Services Provision. Health Care 

It is “Managed” Care.

Coherent Unbroken Succession of

Services Provision.

Health Care

Coordination of Needed Health Care Services for

Patients or specific population over time among:

All Practitioners Across All Involved Organizations

Continue!

CONTINUITY

Continue! CONTINUITY  Initiation, Rendering, Evaluation, Improvement & Continuous Monitoring of Care Provision Even After Patient

Initiation, Rendering, Evaluation, Improvement &

Continuous Monitoring of Care Provision Even After

Patient cure from his present Illness.

Extension of Care to Wellness, Health promotion &

Disease Prevention.

COMPETENCY

COMPETENCY  Practitioner Adherence to Profession &/or Organization Standards of Care & Practice.  Practitioner Ability

Practitioner Adherence to Profession &/or

Organization Standards of Care & Practice.

Practitioner Ability to Achieve both health &

satisfaction of customers.

Competency Needs Ongoing Education & Training.

COMMUNICATION

COMMUNICATION  Interpersonal Relations for Personal Interaction & Teamwork Practice among Professionals are Effective Communication Tool

Interpersonal Relations for Personal Interaction & Teamwork Practice among Professionals are Effective Communication Tool for Holistic Positive Care Outcome.

DURABILITY & RELIABILITY

DURABILITY & RELIABILITY  Consistency of Performance & Care Provision.  Useful Life of health Care

Consistency of Performance & Care Provision. Useful Life of health Care Service.

EFFECTIVENESS

EFFECTIVENESS  Doing the Right Thing Right  Provision of Care:  In Correct Manner 

Doing the Right Thing Right

Provision of Care:

In Correct Manner According to current state of knowledge To Achieve Desired/Projected Outcomes

Performance is Equivalent to Stated requirement &

agreed standards.

Positive Results of Care.

EFFICIENCY

EFFICIENCY  Combination of Skillfulness & Economy in provision of care, i.e. Elimination of Redundancy, Duplication

Combination of Skillfulness & Economy in provision

of care, i.e. Elimination of Redundancy, Duplication

& Rework.

Delivery of maximum number of “units” of health

care for a given “unit” of resources.

Relationship between Outputs (services provided) &

Inputs (resources used to produce these services).

EFFICACY

EFFICACY  Potential, Capacity, or Capability to produce Desired Outcome as already shown e.g. through scientific

Potential, Capacity, or Capability to produce Desired Outcome as already shown e.g. through scientific research (evidence-based) findings. Power of a procedure to improve health status.

RESPECT

RESPECT  Sensitivity & Care about Customer’s Requirements (needs, expectations) & Individual Differences during Provision of

Sensitivity & Care about Customer’s Requirements (needs, expectations) & Individual Differences during Provision of Care & Services.

SAFETY

SAFETY  Health Care Intervention reduces Risks of Adverse Outcomes for Both Patient & Providers. 

Health Care Intervention reduces Risks of Adverse Outcomes for Both Patient & Providers.

Organizational Environment is Free from Hazard or Danger for Both Patient & Providers.

TIMELINESS

TIMELINESS  Performance & Service Provision are in accordance with customer perception of promptness.  Provision

Performance & Service Provision are in accordance

with customer perception of promptness.

Provision of Health Care Services is at the most

Beneficial or Necessary Time for Patients.

Quality Improvement Process

Quality Improvement Process  A series of steps to think about & work through from initial

A series of steps to think about & work through from initial improvement challenge to successful completion of the effort.

These steps help to:

Ask questions Gather information Take actions efficiently & effectively

It has many benefits:

Prevent from skipping important steps along the way. Help a group work together & communicate to others Can be used by any one from frontline to executive level.

QI Process Methodologies

QI Process Methodologies  TEN Steps QI Process  FOCUS-PDCA  Six Sigma “3.4/million defects” 

TEN Steps QI Process

FOCUS-PDCA

Six Sigma “3.4/million defects”

Lean QI Process “No waste”

Kizen QI Process “Zero Defect”

The FOCUS-PDCA Problem-Solving Approach

The FOCUS-PDCA Problem-Solving Approach FOCUS  F ind a process to improve  O rganize team

FOCUS

Find a process to improve Organize team that knows the process. Clarify current knowledge of the process Understand causes of process variation Select the process improvement

F.O.C.U.S.

F .O.C.U.S. F ind an improvement project (initiative):  Review related standards & documents  Analysis

Find an improvement project (initiative):

Review related standards & documents

Analysis of collected data

Identify problems & desired outcomes

Identify Problem

Identify

Problem

How To Identify the Problem

How To Identify the Problem  Is it a real problem?  Do we have enough

Is it a real problem?

Do we have enough reliable data to prove that it is a

problem?

What is the scope of the problem?

Who are the Stakeholders?

What is the impact of this problem on Patient Care?

Is the solution within the scope of the team?

How To Write A Problem Statement

How To Write A Problem Statement A good problem statement  Should be:  specific 

A good problem statement Should be:

specific measurable supported by data objective

And should not:

include any causes or solutions or blame anybody

F.O.C.U.S.

F. O .C.U.S. O rganize (task force) team:  Identify & involve stakeholders (e.g. physicians, nurses,

Organize (task force) team:

Identify & involve stakeholders (e.g. physicians,

nurses, administrative …etc)

Cover all related departments to the improvement

initiative

Select team members who best do or know the

process to be improved

Team Responsibility

Team Responsibility  Accept or identify improvement projects  Investigate the cost of poor quality 

Accept or identify improvement projects

Investigate the cost of poor quality

Describe the specific problems/opportunities

Gather and analyze data

Identify root causes

Develop alternative processes

Apply alternative processes and track results

Recommend replication

Feedback helpful experiences (lessons , learned)

Team Leader

Team Leader  Role  Guide team to reach established goal (s)  Provides direction and

Role

Guide team to reach established goal (s) Provides direction and support to Team

Key Responsibilities

Coordinates & conducts Team meetings Encourages member participation Interacts with CQI Council on Team issues/programs Functions as an equal Team Member

Team Facilitator

Team Facilitator  Role  Promotes effective team dynamics  Serves as consultant/coach to the Team

Role

Promotes effective team dynamics Serves as consultant/coach to the Team

Key Responsibilities

Provide training in QI concepts & methods Assist team members in building strengths Assist Team Leader in team process

Team Facilitator (Cont.)

Team Facilitator  Not a member of the team,  Keep the team focused  Seek

Not a member of the team, Keep the team focused Seek opinions of all team members Coordinate ideas and test for consensus Assist team in applying Ql tools and techniques Summarize key points Provide feedback to the team

Team Member

Team Member  Role  Shares knowledge & expertise of process/issues  Key Responsibilities  Active

Role

Shares knowledge & expertise of process/issues

Key Responsibilities

Active participant in team process Performs assignments Represents/communicates with the work group

F.O.C.U.S.

F.O. C .U.S. C larify current process & desired outcomes:  Fully understand the current process

Clarify current process & desired outcomes:

Fully understand the current process by all team

member

Draw flow chart to clarify the process

variation/problem

Collect data from all affected areas relevant to process

& desired outcomes

F.O.C.U.S.

F.O.C. U .S. U nderstand Process Variation, Root Causes & Desired Outcomes:  Identify tools needed

Understand Process Variation, Root Causes &

Desired Outcomes:

Identify tools needed to describe & analyze process

variation, root causes & desired outcomes

Obtain Information from benchmark, best practice

..etc

Identify all possible solutions to achieve the desired

outcome

F.O.C.U.S.

F.O.C.U. S . S elect the best practice procedure:  Analyze alternative solutions related to process

Select the best practice procedure:

Analyze alternative solutions related to process

improvement

Choose the best solution that will achieve desired

outcome

Develop approval with a summary of required

information about expected outcomes, resources

needed, time-frame, responsibilities

..

etc

P.D.C.A.

P .D.C.A. P lan for improvement project (initiative):  Assign tasks with agreed criteria checklist &

Plan for improvement project (initiative):

Assign tasks with agreed criteria checklist & set time

frame

Allocate resources, determine responsibilities & gain

support from all who will be affected by

implementation.

Establish monitoring system to collect necessary data

to keep project on the track

P.D.C.A.

P. D . C.A. D o the improvement project:  Implement the best solution stated in

Do the improvement project:

Implement the best solution stated in FOCUS process.

Empower all people involved by training, education &

moral support.

Collect data & update checklist

P.D.C.A.

P.D. C .A. C heck the results  If the desired outcome is obtained & lead

Check the results

If the desired outcome is obtained & lead expected

improvement.

Compare data collected from FOCUS process with

that during DO

Check for any unexpected, undesired consequences or

outcomes

P.D.C.A.

P.D.C. A . A ct to hold gains or re-adjust FOCUS-PDC  If improvement initiative is

Act to hold gains or re-adjust FOCUS-PDC

If improvement initiative is reaches; standardize the process, adjust documents & empower people

If improvement initiative is not reached, repeat FOCUS-PDCA cycle

For both situations, continue to monitor the process to identify further improvement.

Quality control tools (Charts)

Quality control tools (Charts)  Flow Chart  Fishbone charts  Pareto  Pie charts

Flow Chart Fishbone charts Pareto Pie charts

Flowchart

Flowchart • A flowchart graphically represents the steps of a process or the steps that users

• A flowchart graphically represents the steps of a process or the steps that users have to take to use a service.

• It is a good technique to use for describing activities, identifying problems and their causes, detecting bottlenecks, unnecessary steps, repetitions and other obstacles and for defining indicators.

• A flowchart can use numerous different symbols to indicate different types of actions in the process.

Three major ones are:

Beginning or end of process

Step in the process (activity)

A decision point

Flowchart • A flowchart graphically represents the steps of a process or the steps that users
Flowchart • A flowchart graphically represents the steps of a process or the steps that users
Flowchart • A flowchart graphically represents the steps of a process or the steps that users

Fishbone Diagram

Fishbone Diagram • Also called Cause-and-Effect Diagram or Ishikawa Diagram. • A graphical technique for grouping

• Also called Cause-and-Effect Diagram or Ishikawa Diagram.

• A graphical technique for grouping ideas about the causes of a problem or effect.

How to do it

How to do it • Agree a problem statement . • Write it at the centre

• Agree a problem statement.

• Write it at the centre right of a flipchart and draw a box (fish head) around it and draw a horizontal

arrow running to the box. This arrow is the backbone or spine of the ‘fish’.

• The direction of the arrow shows that the items that feed into it might cause the problem described in the head.

Brainstorm the major categories or causes of the problem. • Some generic examples for categories would be:

Methods – Machines – Manpower – Materials – Measurement

• Write the categories of causes as branches (large bones) from the main arrow.

How to do it

How to do it Now brainstorm all the possible causes of the problem. • As each

Now brainstorm all the possible causes of the problem.

• As each idea is raised, write it as a branch from the appropriate category.

• Causes can be written in several places if they relate to several categories.

Keep asking ‘Why?’ about each cause. • Write sub-causes branching off the causes. • Layers of branches indicate causal relationships.

!!! Exercise

!!! Exercise  There is a high rate of Delay and cancel in Operation Theater. Group

There is a high rate of Delay and cancel in Operation Theater.

Group 1….…. Find a process to improve

……….…….

Organize team that knows the process.

Group 2……. Clarify current knowledge of the process ( use flow Chart)

Group 3……. Understand causes of process variation ( use fish bone)

………..…….

Select the process improvement

F ind a process to improve Since the delay and cancellation of surgical procedures was found

Find a process to improve

Since the delay and cancellation of surgical procedures

was found to be high ( during three weeks 21% for

canceled cases, and 30% for delay cases) a process to

reduce this rate was proposed . This process starts from

reservation till the time of the procedure itself started

The Opportunity Is Important Because It Will Lead To:

Effective use of staff time & operating rooms Improve arrangement of work flow according to the schedule. Reduce waiting time of the patients and increase patients satisfaction

Organize team to work on improvement (Team Building):

O rganize team to work on improvement (Team Building):  ??????/ Team leader.  ??????? /Team

??????/ Team leader. ??????? /Team Facilitator. ?????? /Team member. ??????? /Team member ???????? /Team member ???????? /Team member.

C larify current knowledge of the process Detailed Flowchart Of Patient Ready For Surgery

Patient arrives at admission office
Patient arrives at
admission office
Yes Bed ?Available No Delay or canceling
Yes
Bed
?Available
No
Delay or
canceling

Yes

C larify current knowledge of the process Detailed Flowchart Of Patient Ready For Surgery Patient arrives

No

canceled
canceled
C larify current knowledge of the process Detailed Flowchart Of Patient Ready For Surgery Patient arrives
Patient admitted to floor
Patient admitted
to floor
Patient fit for surgery No canceled
Patient fit
for surgery
No
canceled
Patient Yes prepared on time No Delay or canceling
Patient
Yes
prepared on
time
No
Delay or
canceling
Yes Surgeon Available No Delay Operation room ready No D el ay
Yes
Surgeon
Available
No
Delay
Operation
room ready
No
D
el ay

Yes

Patient ready for surgery
Patient ready for surgery

Yes

C larify current knowledge of the process Detailed Flowchart Of Patient Ready For Surgery Patient arrives

U nderstanding process variations Causes of Delay And Canceling

U nderstanding process variations Causes of Delay And Canceling Problem Underlying causes Bed availability -1 Admitted

Problem

Underlying causes

Bed availability -1

Admitted Emergency cases in I.C.U Full Capacity

-

-

Patient fitness-2

Low platelet at the time of procedure

-

Low immunity

–High B/P - on Warfarin

-

Incomplete pre-op -3 preparations

incomplete consent form- incomplete per-op preparation checklist-

 

Documentation &

Availability of lab investigation- Surgeon evaluation- Anesthesia evaluation-

Readiness of Operation -4 Room

Not clean- Previous case not finished-

Delay of surgeons-5

Part time surgeons

-Involvement in other activities

-

Understanding process variations

Using Fish bone (cause &effect )

U nderstanding process variations Using Fish bone (cause &effect ) Personal Communication Documentation Delay of surgeon
Personal
Personal

Communication

Documentation

U nderstanding process variations Using Fish bone (cause &effect ) Personal Communication Documentation Delay of surgeon
U nderstanding process variations Using Fish bone (cause &effect ) Personal Communication Documentation Delay of surgeon

Delay of surgeon

Doctor notes
Doctor notes

Booking mistake

Cleaner Consent form Short of nursing Delay And Cancel Missing Elevator s Not arrives Not Fit
Cleaner
Consent form
Short of nursing
Delay And
Cancel
Missing
Elevator s
Not arrives
Not Fit
Not Ready
Patient

Equipment

U nderstanding process variations Using Fish bone (cause &effect ) Personal Communication Documentation Delay of surgeon

Operation setup

U nderstanding process variations Using Fish bone (cause &effect ) Personal Communication Documentation Delay of surgeon

Environment

Select the process Improvement

S elect the process Improvement  Statistics During JAN/2009 -Total no. of cases: 224 -Total no.

Statistics During JAN/2009 -Total no. of cases: 224

-Total no. of delay cases:68 -Percentage of delay cases:30% Delay Cases Analysis

Statistics During Nov/2006 -Total no. of cases 224 -Total no. of canceled cases: 47

-Percentage of canceling cases: 21% Cancellation Cases Analysis

Causes

Quanti

Percentage

ty

Delay of surgeons

9

13%

Incomplete

  • 15 22%

 

preparations

Operation room not ready

  • 19 28%

 

Booking mistakes

  • 11 16%

 

X-ray not available

  • 10 15%

 

Time for platelet Transfusion

4

6%

Cause

Quantity

Percentage

postponed

  • 8 17%

 

Pt. not come

  • 9 19%

 

Pt. not fit

  • 12 26%

 

Patient refuse surgery

  • 11 23%

 

Incomplete

7

15%

preparation

Delay

CasesUsing Pareto chart

Delay Cases Using Pareto chart 50 F E B D A C NumberCases 10 20 30
50 F E B D A C NumberCases 10 20 30 40 90% 60 0 0%
50
F
E
B
D
A
C
NumberCases
10
20
30
40
90%
60
0
0%
10%
20%
30%
40%
50%
60%
70%
80%

Delay cases

Operation room not ready Incomplete preparations Booking mistakes

Delay of surgeons X-ray not available

Time for platelet Transfusion

19 27.9% 15 50.0% 11 66.2% 9 79.4% 10 94.1% 100.0 4 %
19
27.9%
15
50.0%
11
66.2%
9
79.4%
10
94.1%
100.0
4
%

Cancel Cases Using Pareto chart

Cancel Cases Using Pareto chart 40 E B D A C No of Case 10 15
40 E B D A C No of Case 10 15 20 25 30 35 90%
40
E
B
D
A
C
No of Case
10
15
20
25
30
35
90%
45
0
5
0%
10%
20%
30%
40%
50%
60%
70%
80%

Cancel cases

Pt. not fit D Patient refuse surgery A Pt. not come B postponed C E Incomplete
Pt. not fit
D
Patient refuse surgery
A
Pt. not come
B
postponed
C
E
Incomplete preparation
 

25.5%

12

 

48.9%

11

 

68.1%

9

 

85.1%

8

7

100.0%

P.D.C.A.

P. D .C. A . Act Plan C heck D o
Act Plan
Act
Plan
P. D .C. A . Act Plan C heck D o
P. D .C. A . Act Plan C heck D o

C heck

P. D .C. A . Act Plan C heck D o

Do

Month Weeks or

Resources

Responsibility

Objectives

ACTION PLAN

Month or Resources Responsibility Objectives ACTION PLAN Goal:…………………………………. 1- 2- 3- 12 3 4 5 6

Goal:………………………………….

1-

2-

3-

12 3 4 5 6 7 8 9 10
12 3 4
5 6 7 8 9 10

Outcomes

Outcomes  Outcomes are a measurement of the patient response to structure and process.  Outcomes:

Outcomes are a measurement of the patient

response to structure and process.

Outcomes:

Measure actual clinical progress Can be short-term or long-term

Outcome data can be helpful in identifying

opportunities for improvement.