Quality Management in Health Care : Principles and Methods

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