A successful case of hospital quality improvement planning
A hospital management consultant agency was invited to a downtown hospital for the overall planning of the hospital quality management model, the purpose of which is to improve its management system, improve the quality of service, and enhance business performance.
The two sides signed a one-year contract, from April 8, 2007 to April 8, 2008 to the end of 2008, the hospital performance from the end of 2006 less than 60 million yuan breakthrough of 90 million yuan, to achieve a 50% increase in performance; the hospital has formed a perfect operational management system; the number of medical disputes from 75 in 2006, down to 34 in 2008; all the staff of the hospital management consulting organization was invited to a downtown hospital quality management model overall planning. In 2008, the number of medical disputes dropped from 75 in 2006 to 34 in 2008; the concept of all the staff realized a fundamental change, and patient satisfaction reached more than 90%.
The planning was divided into two phases: the first three months was the program planning period, and the last nine months was the consultant period. After the plan was finalized, the hospital set up a team headed directly by President Jiang, Director Qin Bo of the hospital office (now Vice President), and Minister of Publicity Wang Gang (now Minister of Planning) to work with the consulting organization. The entire planning process is described below.
I, research stage
First of all, the hospital decision-making level and relevant management cadres were interviewed. Comprehensive understanding of the current situation of the hospital, quality management problems, etc., and at the same time tested the managers of the hospital quality management related theory mastery.
Secondly, a comprehensive research was conducted on the staff. A total of 800 questionnaires were distributed to all the employees of the hospital to learn from the employees about the current situation of the hospital, the assessment of the strengths and weaknesses, the satisfaction of the employees, the values of the employees, and the suggestions of the employees on the quality management of the hospital, and so on.
Thirdly, a comprehensive research was conducted on patients. The survey team specifically distributed 200 questionnaires to residents in the area covered by the hospital, 100 questionnaires to inpatients, and organized a patient forum. Comprehensive survey of patients and the public on the hospital's evaluation of various aspects of the overall satisfaction of patients and various sub-satisfaction, the local patients and the public's consumption of medical psychology, medical behavioral characteristics, the hospital's brand image visibility, reputation and a lot of first-hand data and information.
Fourth, the method of on-site observation is used to go deep into the hospital's various tasks to find out the problems and to assess some doctors and nurses.
Survey shows that from managers to employees, the quality management can not have a clear understanding of what is quality, quality of the classification and factors affecting the quality of the hospital quality, most people understand the characteristics of the hospital are very one-sided understanding of improving the quality of medical services is to improve the quality of attitude, care for patients and so on, which makes the work can not be comprehended and carried out in the work of ensuring the quality of the requirements of the service. The result is that patient satisfaction with the hospital is low, despite being one of the larger hospitals in the urban area where it is located, and nearby residents tend to go further afield for medical treatment.
1. Understanding of the concept and categorization of quality
2. Commonly used methods of quality evaluation
In terms of day-to-day management, the hospital was found to have the following problems:
1. Lack of clarity about the concept and content of early warning of medical risks, which was assumed to be an emergency response to a sudden public ****health emergency, resulting in the healthcare and nursing functions not collecting and timely analyzing abnormal medical information, did not seriously collect, timely analysis, timely reporting, timely processing, and no corresponding management system.
2. There is no hospital-wide (including medical, nursing, safety and security, logistics services, etc.) unified and coordinated medical safety management system and measures to prevent unintentional injuries.
3, large and medium-sized medical equipment file information is incomplete, lack of feasibility study report, and rational application of the situation analysis.
4, the clinical departments have no error and accident registry, no safety analysis of activity records.
5, emergency department rescue facilities are not perfect. Example: no artificial respirator and pacemaker, etc..
6, the hospital three doctors room system is not well implemented, the medical record does not reflect the details of the three-level room, only the second level of room. The record of the superior physician's room visit is too simple.
7, the medical record writing is not standardized, running medical records are arranged in a chaotic order, the first page of the medical record is difficult to find, or the first page is incomplete, (such as: drug allergy history, AIDS, syphilis, hepatitis B history, surgery, anesthesia, blood type, blood transfusion, etc.). The preoperative discussion could not clearly indicate the possible accidents and preventive measures during surgery.
8, postoperative antimicrobial use for too long, the existence of indiscriminate use of antimicrobials, such as: infected wounds, indiscriminate use of antimicrobials without doing the bacterial culture of infected wounds and determination of drug resistance, and even cause secondary infection.
The prescription and medical records have the problem of irrational use of medication, which is specifically manifested in the amount of medication is too large or too small, the method of medication is inappropriate, the course of treatment is too long, and too many medicines are sent out.
9, the hospital laboratory process and layout is unreasonable, clean area, semi-contaminated area, contaminated area is not clearly delineated, there is no obvious signs.
10, the clinical blood transfusion application form and blood transfusion treatment consent, not in accordance with the requirements of the Ministry of Health (Clinical Blood Transfusion Technical Specification) for the implementation of the pre-transfusion of blood and hepatitis B, hepatitis C, syphilis, HIV test, the content of the record is incomplete, fill out the non-standardized, and some did not do the test for infectious diseases.
11, the hospital outpatient clinic, ultrasound, electrocardiography, physical therapy, acupuncture and other departments did not provide patients with privacy protection shelter, radiology department did not provide patients with changing facilities.
12, the hospital doctor-patient communication system is not in place, no doctor-patient communication records in the medical record, asking patients about their treating doctors, nurses in charge of treatment and diagnosis of the situation, the answer is not clear.
13, the hospital pharmacy refrigerator in the food, emergency medicine car, wards, medicine storage, medicine library in the expiration date of the drug.
14, hospital nurses perform oxygen inhalation operations, only mastering the wall piping system oxygen delivery procedures, while ignoring the use of oxygen cylinder oxygen delivery method.
15, the operating room management is not standardized, there is no strict division of the three zones, changing clothes, changing shoes cross retrograde. Instrument cleaning is not in place, had found stains and blood on the sterilized instruments. Doctors aseptic technology operation is not standardized, before and after the change of drugs do not wash their hands, change drugs do not wear a mask.
3. Analyze and summarize the reasons for the occurrence of the above medical service quality problems? What are the possible effects?
Second, the program planning stage
According to the work plan agreed upon by the two sides, based on a comprehensive analysis of the actual situation of the research, the following planning plan:
(a) rationalize the quality management system, the introduction of the overall quality management model
In accordance with the characteristics and requirements of the overall quality management model, the quality of the management of the system from the point of view to consider the strategies and measures.
(2) Formulation of health service quality standards
Redefine the connotation of health service quality, formulate health service quality standards in a step-by-step manner, and clarify the job responsibility system of each clinical department and division.
(3) Conducting health service quality defect analysis,
Analyzing the causes of hospital service quality problems according to the health service quality defect analysis model.
(D) Conducting education on quality management for all staff and implementing total quality management
Improving diagnosis and treatment routines and work systems, conducting education on quality management for all staff, and adopting the method of the PDCA cycle in accordance with the characteristics and principles of total quality management, gradually correcting the quality problems of each medical process and realizing total quality management.
Questions raised:
4. Connotation of health service quality
5. Characteristics and requirements of the overall quality management model
6. Steps in the development of health service standards
7. Understanding of the health service quality defect analysis model
8. Concepts, principles, characteristics, and basic steps in the implementation of total quality management< /p>
9, trial PDCA cycle to solve a problem
In the program implementation consultant stage, hospital leaders showed a strong sense of change and great courage, the program has been directly supervised by the hospital leaders to promote, due to the advancement of the hospital's culture and training systems to promote, the new program is also strongly supported by the section chiefs and the front-line staff, and in the process of specific implementation, the hospital In the specific implementation process, the hospital leadership team and planning agencies and outside the planning program to make a lot of specific refinements and system adjustments to make the program more feasible, in just a few months to achieve better results.
1, patient satisfaction has been a real boost
Patient satisfaction is more than 90% every month, whether it is outpatient or inpatient, the number of visits rose significantly.
2, the initial formation of a new set of hospital quality management system.
Hospital quality management is becoming more standardized, all staff work in accordance with the new system of work systems and job responsibility system, there are rules to follow, there are laws to follow, health care, nursing, medical technology, infection and other management in order, effectively eliminating the occurrence of errors.
3, the staff service concept has been improved.
From the decision-making management to the staff, the concept of a great change, so that many reform and innovation initiatives to get the staff to understand, from passive coping with the initiative to change, the formation of new concepts to adapt to the needs of market competition.
4, a substantial reduction in medical disputes
After the operation of the new quality system, medical disputes have been substantially reduced, eliminating the occurrence of malignant accidents, the number of disputes decreased by 55%. Hospital brand image in the minds of patients, the public and peers greatly improved, forming a new brand image
5, hospital performance rose significantly
Since September 2006, the hospital performance began to rise significantly, under the premise of a significant increase in the number of visits, the hospital's business income per month increased by 15% -30%, the annual business income from 60 million yuan/year up to 90 million yuan / year or more, the overall operation on a new level, the hospital development of more energy.
6, the hospital cohesion enhanced
The new hospital management system from the spirit of cohesion of the staff **** knowledge, performance enhancement and from the material to improve the treatment of employees, staff cohesion increased significantly.