elements for quality management implementation in primary health care pedro j. saturno profesor de...

ELEMENTS FOR QUALITY MANAGEMENT IMPLEMENTATION

IN PRIMARY HEALTH CARE

Pedro J. SaturnoPedro J. Saturno

Profesor de Salud Pública,Universidad de Murcia, EspañaProfesor de Salud Pública,Universidad de Murcia, España

Visiting Lecturer in Quality Management,Visiting Lecturer in Quality Management,

Harvard School of Public Health, USAHarvard School of Public Health, USA

European Health Forum, Gastein, September 2002European Health Forum, Gastein, September 2002Universidad de Universidad de

Murcia,Murcia,EspañaEspaña

© PJ Saturno© PJ Saturno

Element for quality management implementation in Primary Health Care

I . LEADERSHIPI . LEADERSHIP

II. TRAININGII. TRAINING

III . INCENTIVESIII . INCENTIVES

IV . MANAGEMENT OF CHANGEIV . MANAGEMENT OF CHANGE

V. MYTHS, TRAPS AND TRICKS ON THE WAY TO QUALITY V. MYTHS, TRAPS AND TRICKS ON THE WAY TO QUALITY

MANAGEMENTMANAGEMENT

I . LEADERSHIPI . LEADERSHIP


III . INCENTIVESIII . INCENTIVES

IV . MANAGEMENT OF CHANGEIV . MANAGEMENT OF CHANGE

V. MYTHS, TRAPS AND TRICKS ON THE WAY TO QUALITY V. MYTHS, TRAPS AND TRICKS ON THE WAY TO QUALITY

MANAGEMENTMANAGEMENT

ELEMENTS FOR QUALITY MANAGEMENTE ELEMENTS FOR QUALITY MANAGEMENTE IMPLEMENTATION IN PRIMARY HEALTH CARE IMPLEMENTATION IN PRIMARY HEALTH CARE



Key activities: to influence, to guide.Key activities: to influence, to guide.

Emphasis in intangible elements (mission, values, motivation).Emphasis in intangible elements (mission, values, motivation).

Its target objective is people.Its target objective is people.

““Good managers know how to do things; good leaders know what things Good managers know how to do things; good leaders know what things

should be done”.”should be done”.”

I. LEADERSHIPI. LEADERSHIP



EffectiveEffective

WhithinWhithin appropriate appropriate context context

EfficientEfficient


Problem-Solving-orientedProblem-Solving-oriented

Fully adapted to HealthFully adapted to Health

Distance learning, Distance learning, guided in-service guided in-service self-learningself-learning



Intrinsic unlimited and with permanent effectIntrinsic unlimited and with permanent effect

Extrinsic limited and with short time effectExtrinsic limited and with short time effect

III. INCENTIVESIII. INCENTIVES



Intentionally planed and performedIntentionally planed and performed

Defined strategyDefined strategy

Defined structure for QMDefined structure for QM

Comprehensive vision for QM activitiesComprehensive vision for QM activities

ResourcesResources

IV. MANAGEMENT OF CHANGEIV. MANAGEMENT OF CHANGE






Comprehensive Comprehensive vision for QM activitiesvision for QM activities

ResourcesResources




SYSTEM LEVELS FOR SYSTEM LEVELS FOR QUALITYQUALITY

SYSTEM LEVELS FOR SYSTEM LEVELS FOR QUALITYQUALITY Population-based indicators, including all dimensions of quality Population-based indicators, including all dimensions of quality

and all institutions.and all institutions.

Focus on overall system strategies.Focus on overall system strategies.

Responsibility of high level managers and political authorities.Responsibility of high level managers and political authorities.

Indicators on the quality of the specific services for the specific Indicators on the quality of the specific services for the specific population served by the institution. population served by the institution.

Focus on optimizing resources and regulating processes Focus on optimizing resources and regulating processes Indicators on the quality of the organization.Indicators on the quality of the organization.

Responsibilty of the managers of the institution Responsibilty of the managers of the institution

Indicators on satisfaction, technical quality and effectiveness for Indicators on satisfaction, technical quality and effectiveness for specific conditions and type of patients.specific conditions and type of patients.

Focus on clinical quality on a broad sense.Focus on clinical quality on a broad sense.

Responsibility mostly of clinical personnel.Responsibility mostly of clinical personnel.

CHARACTERISTICS AND RESPONSABILITIESCHARACTERISTICS AND RESPONSABILITIESCHARACTERISTICS AND RESPONSABILITIESCHARACTERISTICS AND RESPONSABILITIES

Quality management through the health care systemQuality management through the health care system

HEALTH SYSTEM HEALTH SYSTEM QUALITYQUALITY

QUALITY OFQUALITY OF INDIVIDUALINDIVIDUAL

HEALTH CAREHEALTH CARE

INFORMATION

INFORMATION

SUPERVISION/INFORMATION


QUALITY OF AQUALITY OF A HEALTH CAREHEALTH CARE

INSTITUTION/CENTREINSTITUTION/CENTRE







ResourcesResources




MONITORINGMONITORING

QUALITY QUALITY PLANNING PLANNING

ORORDESIGNDESIGN

QUALITY QUALITY IMPROVEMENT IMPROVEMENT

CYCLESCYCLES

GROUPS OF ACTIVITIES FOR QUALITY IMPROVEMENT







ResourcesResources




A PERSONAL HISTORIC PERSPECTIVE:A PERSONAL HISTORIC PERSPECTIVE:

““from preaching to criticising”from preaching to criticising”

THREE FHASES:THREE FHASES:

Convincing first-line caregivers Convincing first-line caregivers (Iberian Program)(Iberian Program)

Facilitating implementation Facilitating implementation (EMCA Program).(EMCA Program).

Challenging managers Challenging managers (the real challenge for quality)(the real challenge for quality)

...... AND A SUMMARY STATEMENT:...... AND A SUMMARY STATEMENT:

V. MYTHS, TRAPS AND TRICKS ON THE WAY TO V. MYTHS, TRAPS AND TRICKS ON THE WAY TO QUALITY MANAGEMENTQUALITY MANAGEMENT



“ “ Theory without practice is Theory without practice is

armless. Practice without armless. Practice without

theory is blind” theory is blind”

Leonardo da VinciLeonardo da Vinci

“ “ Theory without practice is Theory without practice is

armless. Practice without armless. Practice without

theory is blind” theory is blind”

Leonardo da VinciLeonardo da Vinci



* The myth of global quality, the trap of listings.* The myth of global quality, the trap of listings.

* The myth of evaluating results, the trap of * The myth of evaluating results, the trap of apparent validity.apparent validity.

* The myth of the brilliant method, the trap of the * The myth of the brilliant method, the trap of the lack of feasibility. lack of feasibility.

* The myth of global quality, the trap of listings.* The myth of global quality, the trap of listings.

* The myth of evaluating results, the trap of * The myth of evaluating results, the trap of apparent validity.apparent validity.

* The myth of the brilliant method, the trap of the * The myth of the brilliant method, the trap of the lack of feasibility. lack of feasibility.

METHODS FOR QUALITY OF CARE METHODS FOR QUALITY OF CARE EVALUATION.: Myths, traps and EVALUATION.: Myths, traps and

tricks (1991)tricks (1991)



1. The myth of the “models”1. The myth of the “models” (EFQM, JCAHO, ISO…)(EFQM, JCAHO, ISO…)

2. The myth of control: monitoring without appropriate 2. The myth of control: monitoring without appropriate

methologogy.methologogy.

3. The (in practice) myth of total quality management.3. The (in practice) myth of total quality management.

4. Management by processes: the new vision.4. Management by processes: the new vision.

5. The never-ending terminology traps.5. The never-ending terminology traps.

6. The myth of leadership6. The myth of leadership

1. The myth of the “models”1. The myth of the “models” (EFQM, JCAHO, ISO…)(EFQM, JCAHO, ISO…)

2. The myth of control: monitoring without appropriate 2. The myth of control: monitoring without appropriate

methologogy.methologogy.

3. The (in practice) myth of total quality management.3. The (in practice) myth of total quality management.

4. Management by processes: the new vision.4. Management by processes: the new vision.

5. The never-ending terminology traps.5. The never-ending terminology traps.

6. The myth of leadership6. The myth of leadership

Myths, traps, and tricks (2002)Myths, traps, and tricks (2002)



CHARACTERISTICS AND RESPONSABILITIESCHARACTERISTICS AND RESPONSABILITIESCHARACTERISTICS AND RESPONSABILITIESCHARACTERISTICS AND RESPONSABILITIESSYSTEM LEVELS FOR SYSTEM LEVELS FOR QUALITYQUALITY

SYSTEM LEVELS FOR SYSTEM LEVELS FOR QUALITYQUALITY

Quality management through the health care systemQuality management through the health care system

Population-based indicators, including all dimensions of quality Population-based indicators, including all dimensions of quality and all institutions.and all institutions.

Focus on overall system strategies.Focus on overall system strategies.

Responsibility of high level managers and political authorities.Responsibility of high level managers and political authorities.

Indicators on the quality of the specific services for the specific Indicators on the quality of the specific services for the specific population served by the institution. population served by the institution.

Focus on optimizing resources and regulating processes Focus on optimizing resources and regulating processes Indicators on the quality of the organization.Indicators on the quality of the organization.

Responsibilty of the managers of the institution Responsibilty of the managers of the institution

Indicators on satisfaction, technical quality and effectiveness for Indicators on satisfaction, technical quality and effectiveness for specific conditions and type of patients.specific conditions and type of patients.

Focus on clinical quality on a broad sense.Focus on clinical quality on a broad sense.

Responsibility mostly of clinical personnel.Responsibility mostly of clinical personnel.

HEALTH SYSTEM HEALTH SYSTEM QUALITYQUALITY

QUALITY OFQUALITY OF INDIVIDUALINDIVIDUAL

HEALTH CAREHEALTH CARE

INFORMATION

INFORMATION



QUALITY OF AQUALITY OF A HEALTH CAREHEALTH CARE

INSTITUTION/CENTREINSTITUTION/CENTRE



A NEW VISION FOR HEALTH CARE ORGANIZATIONS.A NEW VISION FOR HEALTH CARE ORGANIZATIONS.

““EMPOWERMENT”.EMPOWERMENT”.

A DIFFERENT CONCEPT OF PROCESS.A DIFFERENT CONCEPT OF PROCESS.

A NEW VISION FOR HEALTH CARE ORGANIZATIONS.A NEW VISION FOR HEALTH CARE ORGANIZATIONS.

““EMPOWERMENT”.EMPOWERMENT”.

A DIFFERENT CONCEPT OF PROCESS.A DIFFERENT CONCEPT OF PROCESS.

4. MANAGING BY PROCESSES:4. MANAGING BY PROCESSES:4. MANAGING BY PROCESSES:4. MANAGING BY PROCESSES:



Before focusing on processesBefore focusing on processes After focusing on processes After focusing on processes

DepartamentsDepartaments DepartamentsDepartaments

Processes Processes

Processes Processes

A FIGURE SHOWING THE CHANGE TO A FOCUS ON PROCESSESA FIGURE SHOWING THE CHANGE TO A FOCUS ON PROCESSES

MANAGING BY PROCESSES: MANAGING BY PROCESSES:

AN ORGANIZATIONAL VISIONAN ORGANIZATIONAL VISION

MANAGING BY PROCESSES: MANAGING BY PROCESSES:

AN ORGANIZATIONAL VISIONAN ORGANIZATIONAL VISION



5. THE NEVER-ENDING TERMINOLOGY TRAPS.

CLINICAL PROTOCOLS CLINICAL PROTOCOLS

CLINICAL PRACTICE CLINICAL PRACTICE GUIDELINESGUIDELINES

PRACTICE STANDARDSPRACTICE STANDARDS

PRACTICE PARAMETERSPRACTICE PARAMETERS

..

. .

CLINICAL PROTOCOLS CLINICAL PROTOCOLS

CLINICAL PRACTICE CLINICAL PRACTICE GUIDELINESGUIDELINES

PRACTICE STANDARDSPRACTICE STANDARDS

PRACTICE PARAMETERSPRACTICE PARAMETERS

..

. .

CLINICAL PATHWAYSCLINICAL PATHWAYS

CRITICAL PATHWAYSCRITICAL PATHWAYS

CARE MAPSCARE MAPS

COLLABORATIVE CARECOLLABORATIVE CARE

..

. .

..

..

CLINICAL PATHWAYSCLINICAL PATHWAYS

CRITICAL PATHWAYSCRITICAL PATHWAYS

CARE MAPSCARE MAPS

COLLABORATIVE CARECOLLABORATIVE CARE

..

. .

..

..

PROCESSES PROCESSES TYPOLOGIES TYPOLOGIES

PROCESSES PROCESSES TYPOLOGIES TYPOLOGIES



6. THE MYTH OF LEADERSHIP6. THE MYTH OF LEADERSHIP6. THE MYTH OF LEADERSHIP6. THE MYTH OF LEADERSHIP

“It is not enough to know what

things should be done. One has to

know also how to do them right”

“It is not enough to know what

things should be done. One has to

know also how to do them right”



AGAINST MYTHS AND TRAPS:AGAINST MYTHS AND TRAPS:

The trick of greater The trick of greater scientific rigourscientific rigour and and

empirical validationempirical validation of theories, of theories,

methods and models.methods and models.

AGAINST MYTHS AND TRAPS:AGAINST MYTHS AND TRAPS:

The trick of greater The trick of greater scientific rigourscientific rigour and and

empirical validationempirical validation of theories, of theories,

methods and models.methods and models.



DEAR AUDIENCE,DEAR AUDIENCE,

IF YOU OR ANYONEIF YOU OR ANYONE

YOU LOVE UNDERSTANDS YOU LOVE UNDERSTANDS

THE PRECEDINGTHE PRECEDING

CONVERSATION CONVERSATION

YOU HAVE MYYOU HAVE MY

DEEPEST SYMPATHYDEEPEST SYMPATHY

[email protected]@um.es

http://www.calidadsalud.comhttp://www.calidadsalud.com

Pedro J. SaturnoPedro J. SaturnoUniversidad de Universidad de Murcia,Murcia,EspañaEspaña

elements for quality management implementation in primary health care pedro j. saturno profesor de...

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