Qi Plan Part II - Managing and Improving Quality

QI Plan Part II Managing and Improving Quality

Nicole Rinaldi

HCS 588

March 14, 2016

Cynthia Hughes

QI Plan Part II Managing and Improving Quality

Introduction

Health care systems are organizations created to meet the health needs of an intended population. A "health care system" refers to a country's structure of delivering services for the prevention and treatment of disease and for the promotion of physical and mental well-being. One particular interest to a health care system is how medical care is organized, financed, and delivered. Health care systems, like medical knowledge and medical practice, are not fixed but are continually evolving. Health care systems reflect the ever-changing scientific and technologic nature of medical practice. A country's health care system varies considerably and also reflects on the culture and values of that society. This paper analyzes the quality and managing improvement of the “runback” process at “Davis Medical Center” pathology department.

Review of Runbacks Process

An aspect within the Pathology Department at Davis that needs improvement is the amount of runbacks. “Runback” is a specimen that contains too much fatty tissue to be regularly processed through histology machinery that then requires reprocessing after pathology assistant interventions -delay of at least 24 hours can occur and specimen may be irreparably damaged. The Runback process is as follows: delivery to pathology or frozen section, accessioning, grossing, and processing through histology (machine, embed, cut, slide). On the machine, the tissue will not process if the sample is too fatty. If that occurs, the tissue is returned to the gross room to be trimmed and reprocessed (continue steps above). If a specimen is “runback” it can delay the case for at least 24 hours.

Quality Improvement Methodologies

        The TOYOTA method is a Japanese based ideology created to reduce waste and improve efficiency. Waste (muda) is identified as a loss of over production, time on hand, transportation, processing itself, stock at hand, movement or making defective products. The elimination of these “muda” is achieved by implementing small ideas for improvement in a rapid manner until improvement is seen and waste decreases. Once this is achieved, the success is measured and maintained with data collection.

        The Six Sigma method is a variety of the TOYOTA method that involves the same principles of improvement with “process, speed, agility and flow” but also incorporates “Quality, statistical process, data and control”. It entails improving, designing and monitoring process to reduce or remove excess while achieving stratification and strengthening financial constancy. (Hughes, 2008) One element of Six Sigma utilizes a five-stage practice of define, measure, analyze, improve and control (DMAIC) approach. To begin, the project is identified, historical data are reviewed, and the scope of expectations is defined. Next, continuous total quality performance standards are selected, performance objectives are defined, and sources of variability are defined.  Additionally, while Six Sigma focuses on waste, the primary focus is typically on the financial aspect of lost resources, which is commonly referred to as the location of “sleeping dollars”.