o Simulation Modeling Techniques
o Difference between Discrete-event simulation and Monte Carlo simulation
Discrete Event Simulation:
o Understand elements of Discrete-event simulation (for example, entities, events, variables, replications…..)
o Be prepared to read and interpret the output from a discrete event simulation model
1. Clinicians: cure rates, mortality, morbidity
2. Patients: patient satisfaction surveys
3. Health facility managers: cure rates, mortality, morbidity, intermediate process measures (patient falls, infection rates, medication errors, appropriate staffing
4. Community: area service distribution, insurance coverage, incidence and prevalence rates
Quality Gaps: Another way to look at the maintenance of quality is how mistakes are to be avoided – design mistake-proof processes across the whole spectrum of the care, to reduce undesired outcomes.
Variance in diagnostic and therapeutic interventions and the associated errors hamper the delivery of safe, effective patient care and add to poor outcomes.
To minimize the variation and the errors – sometimes euphemistically called “quality gaps” – and work toward completely eliminating them are major goals for healthcare systems.
Chassin (1998) classifies the underlying causes of “quality gaps” into three categories:
1) Over-utilization. When the potential benefit of a therapy is less than its risk, overuse of health services affects the quality of care. Pressures for overuse of services may come from either providers or patients.
2) Under-utilization. A patient’s lack of insurance or insurance that has high co-payments and deductibles can cause under-utilization of necessary health care.
3) Miss-utilization. Avoidable complications, negligent care, mistakes, and mishaps create miss- utilization of services. Healthcare providers who generate such conditions harm the quality of patient care and produce poor outcomes; they also waste the organization’s resources and increase lengths of stay.
Healthcare providers do have an arsenal of methods to deal effectively with the problems affecting quality of care.
They include the programs called quality control (QC), total quality management (TQM), continuous quality improvement (CQI), reengineering, and Six-Sigma.
All these programs include data gathering, analysis and statistical monitoring to identify the problem and its cause.
Nevertheless, the crux of the solution to quality problems lies in changing human behavior, changing minds to perform care in new ways.
o Statistical process control tools
Cause and Effect Diagram
Defect Concentration Diagram
o Process vs outcome measure
Process: MAJORITY OF HEALTH CARE QUALITY MEASURES. Indicate what a provider does to maintain or improve health, either for healthy people or for those diagnosed with a health care condition. Can inform consumers about medical care they may expect to receive...