Post on 04-Jun-2018
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KeyPerformance
Indicators
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Objectives
Improve the understanding of KPIs and whatthey indicate.
Identify the Key Performance Indicators at
SKMC
PDCA, RCA
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Quality measurement reflectsthe compassion,
safety and effectiveness ofnursing care.
It is both a challenge and an
opportunity.
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It begins with the
Mission
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"If you can't measure it you can't manage it
MISSIONTo provide compassionate, patient centeredcare of the highest qualityin a setting ofeducation and research
VISIONSheikh Khalifa Medical City will be recognizedas a preeminent medical center that strivesto provide an outstanding patient experience,superior clinical outcomes and improved qualityof life for the people it serves.
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VALUES
Collaboration
Compassion
Integrity
Patient Safety and Quality
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In 1859, Florence Nightingale created the
worlds first performance tables of
hospitals. Florence Nightingale was the
architect of the modern British (arguablyEuropean) hospitaland, most importantly,
the means of measuring its performance.
It may seem a strange principle to
enunciate as the very first requirement in ahospital that it should do the sick no harm,
An Early Challenge
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History of Evaluating Nursing Care
Quality
Pat ient ou tcom es versus
environmental cond i t ions.
Night ingale also
demonstrated that high
death rates, wh ich were
invariable then in largehosp itals, were
preventable.
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Definitions of Quality(as it Relates to Health Care)
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Definition of Quality
in the 1990s:Meeting customers expectations
Doing the right thing and doing it well
(JCAHO, 1994)
Clinically effective, efficient, and affordable
health services that are delivered
satisfactorily.
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What is an Indicator?
Valid and reliable quantitativeprocess or outcome measure relatedto one or more dimensions of
performance, such aseffectiveness or appropriateness
(The Joint Commission)
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Measures? Metrics?KPI?
Indicators?Performance?
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Performance Management
Management = getting work donethrough others
Managers performance is only asgood as his/her employees
performance
Managersjob = performancemanagement of others
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Performance Improvement
Two Special Objectives in view with regards to disease,namely,
To do good or to do no harm.
VALUE = Qualityof Care+ OutcomeCost
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Measures Focus on:
Consistent indicators across theorganization
Comparison of indicators over time inthe organization
Comparisons with pre-determinedstandard (internal)
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Performance measures are focused on process andoutcomes
Reflect actual practice/ performance
Leaders determine the focus
Set priorities/ goals Collection of data
How to use the data
Detail & frequency of data collection
When do you have enough data to proceed to nextprocess
Analysis ( to compare data)
Act on it!
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Quality Improvement Process
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K
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Key These are the impo rtant th ings
that the team does to support the
patient /focus on m iss ion (di rect ly o r
indirect ly)
Performance High , average, low
what do we want as the standard for
ou r pat ients?
Indicators What can we focus on
regu lar ly th at tells us we are (o r are
no t) ach ieving those key goals?
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"If you can't measure it you can't manage it
Specific:Directly supports understanding how the company is performing
relative to one or more of its goals.
Measurable: Is it getting better or worse.
Achievable: Within the reach of the organization.
Relevant:
Can determine the health of the organization by focusing on a few
key indicators.
Time-Based: Performance over time.
Key performance indicators share five
important SMART " characteristics.
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Key (Critical) Success Factors
KPIs measure the health of the
organization
BUT about.
CRITICAL SUCCESS FACTORS?
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Examples of Key (Critical)
Success Factors in Health Care
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Leadership
Resources
Relationships
Patient and Family Engagement Competent Management and Finances
Improvement Technique
Expert and Facilitated Assistance Health IT.
Capacity to Deliver Coordination Professional and Staff Roles and Training
(TEAMWORK)
KPI t k f i t
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KPIs are directly linked to the overall
goals of the organization.
Business Objectives are defined atcorporate level.
These goals determine critical
activities (Key Success Factors) thatmust be done well for a particular
operation to succeed.
.
KPIs track performance against
established key success factors
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Key Success Factors (KSFs) only
change if there is a fundamental shift
in business objectives.
Key Performance Indicators (KPIs)
change as objectives are met, or
management focus shifts.
.
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How do I interpret a KPI?
Excellence
KPIs do NOT give answers,
rather they raise questionsand direct attention.
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How do I interpret a KPI?
If Our KPI for Infections is this indicates that the business objective,
is NOTbeing fulfilled. This should direct attention to the key success factor.
Problems / Issues should be identified and resolved with a view to
decreasing safety KPIs and therefore achieving the business
objective.
If Our KPI for Infections is this indicates that the business objective,
isbeing fulfilled. This indicates safety practices / education are proving successful.
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OK
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OK
Now What?
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measurement without change is waste, whilechange without measurement is foolhardy.
AVOIDmeasurement for measurements sake
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THE PDCA IMPROVEMENT
PROCESS
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Model for continuous improvement.New improvement project.Developing a new or improved design of a
process, product or service.Defining a repetitive work process.Planning data collection and analysis inorder to verify and prioritize problems or root
causes.Iplementing any change.
When to UsePlan-Do-Check-Act
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PLAN
Most time consuming part of PDCA!
1. Develop aim statementWhat are we going to do?
How will we measure it?Why?
2. Identify your stakeholders
- ICD, Physicians, Nurses, QD
3. Take into account timelines, resources, and process
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Aim Statement
1. What are we trying to accomplish?To decrease the number of CLABSI by 50% in 90days
2. How will we know that a change is animprovement?There is an increase in the quality and safety of
the patients and LOS
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3. What changes can we make that will result in animprovement?
(Use data to decide on interventionTechnique used in Emergency dept identified most problematicIdentify causes of not-metCause-and-Effect (Fishbone) diagram todetermine root cause of why ED have
problems meeting standards of CL insertiontechniques )
3. What changes can we make that will result in animprovement?1. Time out check list2. Education/ awareness
PLAN, cont
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Select the project
Understand and clarifythe process
Data
Flowcharting
Brainstorming
Fishbone Diagram
Develop a Plan ofAction
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Effect(Y)
Management Man Method
Measurement Machine Material
Cause
Cause
Cause
Cause
Cause
Cause
Cause
Cause CauseCause
Cause
Ishikawa Fishbone Diagram; Continuous
Process Improvement; Cause and Effect
http://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsxhttp://localhost/var/www/apps/conversion/tmp/scratch_8/FOCUS_PDCA_PI.xlsx8/13/2019 KPI Presentation 2012 . Pptx
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Provide training, education to physicians
who need to improve
Pilot use of time out check list
Implement in next cycle
Do
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1. Bar chart to compare before and after
2. Was there an improvement? ( Measure it- KPI)
CHECK
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replicating
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1. Institutionalize the change (replicating success)2. Continue to monitor
3. If there was no change, do more data
analysis to determine why
4. Root cause
5. The 5 whys
6. CELEBRATE,
REWARD & RECOGNITION!
ACT
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Its not always
easy BUT YOU CAN!
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Where to find the KPIs in SKMC?
Excellence
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What is Benchmarking?
. (There is no single benchmarking process that has beenuniversally adopted)
Measures an organization's internal processes
Helps you understand where you are in relation to aparticular standard
Who performs well and has process practices that areadaptable to your own unit or/and organization
Best Practices Benchmarking is the processof seeking out and studying the best internal
practices that produce superior performance.53
What are
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When an object is divided into a number of equal parts then each part is called a fraction.
We have a box of gingerbread men. There are 5 men in the box.
Each man is of the box contents.
The whole box has 5 fifth parts.
We write it: 1 =
Two gingerbread men are pink.Two pink men are of the box contents.
What are
Numerators and Denominators
2 numerator says how many parts in the fraction
= "divide by"
5 denominator says how many equal parts in the whole
object
Always remember: denominatorcan NEVERbe 0.
Why? Because you cannot divide by 0.
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EXAMPLE:
EXAMPLE:
Numerator =
Total number of ? Not meeting the goal/ benchmark/
standards
Denominator =
Total number of files/patients audited/ checked/ monitored=
sample
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Dashboards
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http://ishare/QMD/Folder/SKMC%20KPIs%20Dashboard/SKMC%20KPIs_JCI%20Red%20Light%20Green%20Light%20Da
shboard.xls
http://ishare/QMD/default.aspx
http://ishare/QMD/Folder/SKMC%20KPIs%20Dashboard/SKMC%20KPIs_JCI%20Red%20Light%20Green%20Light%20Dashboard.xlshttp://ishare/QMD/Folder/SKMC%20KPIs%20Dashboard/SKMC%20KPIs_JCI%20Red%20Light%20Green%20Light%20Dashboard.xlshttp://ishare/Pages/category.aspxhttp://ishare/Pages/category.aspxhttp://ishare/QMD/Folder/SKMC%20KPIs%20Dashboard/SKMC%20KPIs_JCI%20Red%20Light%20Green%20Light%20Dashboard.xlshttp://ishare/QMD/Folder/SKMC%20KPIs%20Dashboard/SKMC%20KPIs_JCI%20Red%20Light%20Green%20Light%20Dashboard.xls8/13/2019 KPI Presentation 2012 . Pptx
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replicating
Quality indicator dashboards fororganizations are valuablebenchmarking tools, but theinteresting data analysis happens
when you drill down to the unitlevel. You might discover that oneunit has had fewer catheter-
associated urinary tract infectionsthan another unit with a similarpatient population. Then it becomesa question of replicating success
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Dashboards
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Dashboards
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http://ishare/QMD/Folder/SKMC%20KPIs%20Dashboard/SKMC%20KPIs_JCI%20Red%20Light%20Green%20Light%20Da
shboard.xls
http://ishare/QMD/default.aspx
Linking Strategy to Metrics
Help you visualize and track trends on every
level of your business and to align activities withkey goals.
REMEMBER!
http://ishare/QMD/Folder/SKMC%20KPIs%20Dashboard/SKMC%20KPIs_JCI%20Red%20Light%20Green%20Light%20Dashboard.xlshttp://ishare/QMD/Folder/SKMC%20KPIs%20Dashboard/SKMC%20KPIs_JCI%20Red%20Light%20Green%20Light%20Dashboard.xlshttp://ishare/Pages/category.aspxhttp://ishare/Pages/category.aspxhttp://ishare/QMD/Folder/SKMC%20KPIs%20Dashboard/SKMC%20KPIs_JCI%20Red%20Light%20Green%20Light%20Dashboard.xlshttp://ishare/QMD/Folder/SKMC%20KPIs%20Dashboard/SKMC%20KPIs_JCI%20Red%20Light%20Green%20Light%20Dashboard.xls8/13/2019 KPI Presentation 2012 . Pptx
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3 types of measuresStructure:Physical equipment and facilities
Process:How Healthcare is providedHow the system worksOutcome:Health statusDoes it make a difference?
Measurement: Process and Outcome
Indicators -How do Customers look at Quality?
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As a Patient, suppose you wanted to measure
the quality of care for a knee replacement;
consider what you could measure for each.
Structure:Are there OR
facilitiesavailable?
Process:How consistently does
the OR Process followthe policy?
Outcome:What is the
success rate?
You could consider:
A li ti f PI d l
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Application of a PI model
Structure Process Outcome
Have wereduced thelikelihood of
harm?
Are we doingwhat we aresupposed to
do?
How do weHarm?What isHarm?
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HMMMI wonder what we
measure at SKMC?
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International Patient
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International Patient
Safety Goals
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Unit Specific KPIs
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HA AD Patient Safety Goals
http://ishare/Nursing/Nursing%20Monthly%20Reports/Forms/current.aspx?RootFolder=/Nursing/Nursing%20Monthly%20Reports/2011%20Monthly%20Report/Critical%20Care%20_%20Heart%20and%20Vascular%20Surgery%20Institute/C4%20Cardiac%20and%20Transplant%20IC8/13/2019 KPI Presentation 2012 . Pptx
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HA-AD Patient Safety Goals
1. Improve the accuracy of patient identification2. Improve the effectiveness of communication among care
givers and care recipients3. Improve the safety of using medications and medical devices4. Reducing the risk of healthcare associated infections5. Ensuring correct site, correct procedure, correct patient for
all procedures6. Accurately and completely reconcile medications across the
continuum of care7. Encourage patients active involvement in their own care as a
patient safety strategy8. Improve recognition and response to changes in a patients condition9. Reducing risk of patient harm resulting from falls
10. Reduce the risk of hospital fires
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it 65
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Core Measure Sets
(Clinical Starter Sets)
Wh t i ?
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What is a core measure?
They are standardized evidence
basedperformance measures
They are PROCESS measures (howrecommended care is provided)
The core measure results are reported toSEHA
Results can be tied to$$$$$$ REIMBURSEMENT $$$$$$
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Clinical Starter Sets(Core Measure Sets)
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Clinical Starter sets are here to stay.
Quality Measures enables us to not only pinpoint and address
quality-of-care issues, but also spot and correct data-collection
problems.
Core Measures are like practice standards that guide us to give
the best possible care.
These standards challenge us to re-evaluate the way we
coordinate and deliver care. For example, improved teamwork
and communication can lead to 100% of STEMI patients
receiving PCI within 90 minutes of arrival at the hospital.
Clinical Starter Sets
Goals of NDNQI
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Goals of NDNQI
Providecomparativeinformation tohospitals for use
in qualityimprovementactivities
Develop national
data on therelationshipbetween nurse
staffing andpatient outcomes
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Data Model
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Data Model Adapted Donabedians conceptual framework
Structure Measures of quantity and quality of nursing staff
Hospital characteristics like Magnet recognition,teaching status, bed size, etc.
Process Measure aspects of nursing care
(assessment/intervention)
Outcome Patient outcomesrelated to quantity or quality of
nursing careA. Donabedian, The Quality of Care, JAMA1988:260 (12):1743-1748
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NDNQI Data Collection
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Patient falls -As it occursPatient falls with injury-As above
Pressure ulcers:- Snapshot, all pts on the unit at the
time once per month
Community acquired
Hospital acquired
Unit acquiredStaff mix - Monthly
Nursing hours per patient dayMonthly
Patient Days- Monthly
RN Surveys: - Annually
Job satisfaction- AnnuallyPractice environment scale
NDNQI Data Collection
Methodology
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Pediatric pain assessment cycle -Snapshot, all pts on the
unit at the time once per month
Pediatric IV infiltration rate-Snapshot, all pts on the unit atthe time once per month
Restraints prevalence-Snapshot, all pts on the unit at the
time once per month
Nurse turnover- Monthly
RN Education & Certification - Quarterly
Nosocomial infections:-
-Ventilator-assisted pneumonia VAP)
-Central line associated blood
stream infection (CLABSI)
-Catheter associated urinary
tract infections (CAUTI)
Monthly
Final word on PI
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Final word on PI
Every person in the organization has an
influence on certain KPIs and PI
KPIs do NOT give answers, rather they raise
questions and direct attention.
Structure, Process and Outcomes ( think like
the customer)
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QUALITY IS EVERYBODYs
BUISNESS
4 key traits for
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1. Nurses must be actively involved..
2. Quality outcomes should be visible.
3. Support
4. Promote autonomy and accountability.
4 key traits for
outstanding nursing quality
Strong leadersh ip, Teamwork , Comm itment
to ongoing imp rovement in pat ient care
Qual i ty, Con t inuous s taff educat ion , and
Efficient use of resources.
BUILDING A HOUSE OF QUALITY
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BUILDING A HOUSE OF QUALITY
CONTINUOUSIMPROVEMENT
Thevo
iceo
fthe
Pa
tien
t
HIGHEXPEC
TATIONS
INVOLVE
MENT
ASSESSM
ENT&
FEEDBAC
K
SHARED VALUES AND GOALS/ OBJECTIVES
TRUST
MANAGEMENT BUY-IN
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