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Show Table 2 Quality Thinking Compared With Traditional Management Oualitv thinking Traditional thinking 1. Definition of quality Healthcare quality is intangible 2. Customer orientation Department orientation 3. Supplier partnerships We-they relationships 4. Work process focus End product focus 5. Preventive systems Reactive systems 6. Error-free goals Numerical quotas 7, Employee involvement Employee control 8. Management by fact Management by intuition 9. Total organization Quality assurance department 10. Continuous improvement Acceptable quality levels 6. Collect and organize data. 7. Initiate evaluation. 8. Take actions to improve care and service. 9. Assess the effectiveness of actions and maintain the gain. 10. Communicate results to relevant individuals and groups (Joint Commission on the Accreditation of Healthcare Organizations [JCAHO], 1991). In the 1992 Accreditation Manual for Hospitals, the JCAHO began an incremental revision of its standards on quality assessment and improvement. The emphasis upon Continuous Quality Improvement is intended to overcome certain weaknesses associated with QA activities. According to the 1992 Accreditation Manual for Hospitals, these weaknesses include: • a frequent focus on only the clinical aspects of care (for example what the doctor and nurse do with the patient), rather than on the full series of interrelated governance, managerial support, and clinical processes that affect patient outcomes; • a frequent compartmentalization of QA activities in accordance with hospital structure (for example, by department, by discipline) rather than organizing quality improvement activities around the flow of patient care, in which the interrelated processes are often cross-disciplinary and cross-departmental; • a frequent focus on only the performance of individuals, especially on problem performance, rather than on how well the processes in which they participate are performed, how well the processes are coordinated and integrated [...], and how the processes can be improved; • frequently initiating action only when a problem is identified, rather than also trying to find better ways of carrying out processes; and • separating the appropriateness ("Was the right thing done?") and effectiveness ("Was it done right?") of care from the efficiency of care, rather than integrating the efforts to improve patient outcomes with those to improve efficiency (that is, improving value) (JCAHO, 1992). While QA is more reactive, addressing and monitoring problems once they have occurred, CQI is more proactive, focusing instead upon preventive measures. CQI emphasizes processes rather than persons, coordination rather than division. In order to maintain JCAHO accreditation, as well as meet various state and federal regulations, hospitals must adapt to the changing quality environment. The 1992 and 1993 Accreditation Manuals rely upon 82 WHAT ABOUT THE PATIENT? |