QUALITY TOOLS & TECHNIQUES

Quality Enhancement Cell

So many things to handle!

Why QC tools
To find that our process/activity is fulfilling requirements To have a pictorial view of process/data so that: We can find good elements of the process To find the problematic areas Their causes The major causes The solutions to problematic things Verifying the effectiveness of solutions To reduce costs To improve quality of work and product

Where to use :
In KPI Reports In Corrective Action Requests In Routine Analytical Reports In finding solution to work problems

Quality Tools & Techniques

Incomplete Records Processing Team 04/18/01
x4905 gets calls for ROI Charts not locked on wards

Supplies

Methods
Delinquent physician list is inaccurate to COS office (more than 24-48 hours old) Filing of information that is already in CPRS Access issue, signing from CU/ UNMC New process with Inaccurate CPRS reports of chart incompletions to physician Chart not assembled correctly

CPRS= Delete loose filing

Transfer missing current clinical volume

Data Base Integration, 419/ Error Reports Notification in a timely manner of transfer discharges by social worker

Current volume may be unavailable Physician access

New records are made without old volume available, OP chart missing

Transfers to file room L/GI patients

Cross coverage between IRR staff

Timeliness & Accuracy Effects

Timely dictation Charge & recharge issues Charts appear on MR walls & are not charged to Delays in Incomplete receiving Records Room, charts (for people don't dictation) recharge them Release of Information & coding function Lack of physici an privacy, noise # 9: Quiet work area, lack of space, noisy, crowded, air flow problems, staff has 10-11 staff, plus physicians (were 4 staff before), copier issues, no patient privacy PC printers needed More VistA printers needed

Lack of response to delinquency letters by physicians

More WUC staff needed

Coders have other duties

Physician notification & education & orientation & reponsibilities for medical records

Medical Records staff need their own copier Need 1 PC for File Room with Outlook

Interruptions

People

Space for 3 more needed: volunteer, file staff, new supervisor

Environment

Confidentiality & security of records/ area, open area & shelves, 2 entrances

Equipment

Bar Graph
A bar graph can be used to display and compare data The columns are positioned over a label that represents a categorical variable

Double Bar Graph

90 80 70 60 50 40 30 20 10 0 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Can be used to compare two related sets of data

Histogram
Histogram is a bar graph that shows the frequency of data within equal intervals. There is no space in between the bars. They show how many observations on a given variable have a particular attribute

DIFFERENCE BETWEEN BAR CHARTS AND HISTOGRAMS

With bar charts, each column represents a group defined by a categorical variable; With histograms, each column represents a group defined by a quantitative variable.

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When to Use a Histogram

When the data are numerical. When you want to see the shape of the datas distribution, especially when determining whether the output of a process is distributed approximately normally. When analyzing whether a process can meet the requirements. When seeing whether a process change has occurred from one time period to another. When determining whether the outputs of two or more processes are different. When you wish to communicate the distribution of data quickly and easily to others.

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Step 1
Number of Frequency hours of TV

1 2 3 4 5

Number of hours of TV II 6 III IIII 7 IIII - IIII IIII - IIII 8 III IIII - I 9 IIII IIII - III

1-3 4-6 7-9

15 17 16

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Step 2
Choose an appropriate scale and interval for the vertical axis. The greatest value on the scale should be at least as great as the greatest frequency.

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Number of Frequency hours of TV

16 12 8 4 0 1-3 4-6 7-9

1-3 4-6 7-9

15 17 16

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Step 3
Draw a bar for each interval. The height of the bar is the frequency for that interval. Bars must touch but not overlap. Label the axes and give the graph title

Hours of Television Watched

20
Number of students

16 12 8 4 0 1-3 4-6 7-9

Hours

Number of hours of TV

Frequency

1-3 4-6 7-9

15 17 16

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Cause & Effect/Fishbone/ Ishikawa Diagram

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Cause & Effect Diagram

Also known as a fishbone diagram (looks like a fish spine) & as the Ishikawa diagram (Japanese designer of this tool) Used to identify the potential causes for an effect (problem) in the process Identifies and organizes potential areas for improvement activities

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ROOT CAUSE ANALYSIS

Define the problem or describe the event factually. Include the qualitative and quantitative attributes (properties) of the harmful outcomes. Gather data and evidence, classifying that along a timeline of events to the final failure or crisis. Ask "why" and identify the causes associated with each stwards the defined problem or event. " Identify solutions that effective, Implement the recommended root cause correction(s). Ensure effectiveness by observing the implemented recommendation solutions.

Scatter Plots

Scatter Plot

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Scatter Plot
A scatter plot is a graph of a collection of ordered pairs (x,y). The graph looks like a bunch of dots, but some of the graphs are a general shape or move in a general direction.

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Positive Correlation
If the x-coordinates and the y-coordinates both increase, then it is POSITIVE CORRELATION. This means that both are going up, and they are related.

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Positive Correlation
If you look at the age of a child and the childs height, you will find that as the child gets older, the child gets taller. Because both are going up, it is positive correlation.

Age 1 Height 25

2 3 31 34

4 36

5 40

6 41

7 47

8 55

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Negative Correlation
If the x-coordinates and the ycoordinates have one increasing and one decreasing, then it is NEGATIVE CORRELATION. This means that 1 is going up and 1 is going down, making a downhill graph. This means the two are related as opposites.

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Negative Correlation
If you look at the age of your familys car and its value, you will find as the car gets older, the car is worth less. This is negative correlation.

Age 1 of car Value $30,000

$27,00 $23,50 $18,70 $15,35 0 0 0 0

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No Correlation
If there seems to be no pattern, and the points looked scattered, then it is no correlation.

This means the two are not related.

Scatterplots Which scatterplots below show a linear trend?

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a)

c)

Negative Correlation

e)
Positive Correlation

b)

d)

f)
Constant Correlation

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References:
www.lemars.k12.ia.us/webfiles/ccollins/.../Scatterplots%5B1%5D.ppt Princess C. Barcega APG School, Manama, Bahrain, www.world of teaching.com Cause and effect diagram and Pareto charts, Marvin J. Bittner MD MSc http://en.wikipedia.org/wiki/Root_cause_analysis

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Thank you.!