Utilization Management
What is the main purpose of utilization management?
Ensuring patients get the necessary health services at the lowest cost
Name two types of waste (or Muda) according to LEAN principles
Transportation, movement, over-processing, waiting or defect.
Name 2 types of either qualitative or quantitative performance improvement analytic tools.
Qualitative: affinity diagram, brainstorming, cause and effect (fishbone) diagram, survey, five whys, multivoting
Quantitative: bar graph, check sheet, control chart, histogram, line graph, scatter diagram, survey
The Board of Directors.
What is the name of the largest park in Ontario?
Algonquin Park
What are 3 different types of utilization reviews?
Three types of utilization reviews are prospective reviews, concurrent reviews and retrospective reviews.
If a service has too much variation, can it be reliable?
No - Too much variation in health care processes can lead to unreliable quality in health care.
The assessment phase.
What are the 6 dimensions in quality that impact client experience?
Safety
Effectiveness
Patient-centeredness
Timeliness
Efficiency
Equity
Who do children receive a response from if they send a letter to the North Pole using the postal code HOH OHO?
Santa Claus
What are some utilization management activities health care providers can do?
Utilization reviews to support good services at the lowest cost
Clinical paths to describe best practices for managing patients. These tools remind caregivers of interventions expected during an episode of care.
Standards of care are job aids that provide step-by-step instructions on how to perform tasks. For example: checklists, treatment protocols, and physician order sets.
These principles are part of what process improvement theory: Pull > Value stream > Perfection > Flow > Value
These are the 5 LEAN Principles of process improvement:
Pull - drive production with demand
Value Stream - ensure all activities are necessary and add value
Perfection - Prevent defects and rework
Flow - Strive for continued processing through the stream
Value - Identify what is important to the customer and focus on it.
What is one example of an error in health care caused by human factors?
Some examples:
Medication error (wrong medication or wrong dose)
Data error (wrong PHI or information breach)
Procedural error (wrong procedure provided or not provided)
The % of times patient visits where flu vaccine was given or how consistently therapists monitor and measure pain are examples of either process, structural, client feedback, or outcome measures?
These are process measures.
What is the tallest structure in Canada?
The CN Tower
What is the most visible aspect of utilization management?
Discharge planning - Inadequate discharge planning can adversely affect the quality and cost of patient care.
If a health care service only relies on people doing what they believe is the right thing in their health care delivery, what reliability level are they likely to reach?
Up to 80%!
80-90% reliaibility takes basic failure prevention such as order sheets, procedures and checklists
95% reliability takes sophisticated failure prevention and basic failure identification like decision aids and system generated reminders
99.5% reliability takes a redesign of the system to prevent failures with sophisticated failure prevenion, ID and mitigation strategies
>99.5% requires technology, advances system redesign and significant resource investment
What is a term that refers to catching mistakes before they happen?
Safeguards
Clear expectations, feedback on work, the physical environment, staff motivation and having the required skills and knowledge are all what types of factors?
These are performance factors.
The Blue Jays, Maple Leafs and the Raptors are sports teams for what city?
Toronto
What are 2 activities involved in discharge planning
1. Initial patient assessment (gather history, evaluation medical condition and treatment needs, assess support systems available)
2. Plan for continuing care - identify & prioritize short and long term needs, consider available resources (social, $), update plan according to condition at discharge
3. Implement Plan - arrange for services needed at discharge, provide post discharge treatment plan, services
4. Evaluation - follow up with patient, and address questions
If every gets a bag of m&ms candy, the different colours, misshapen candies, and strong/faded ink are examples of what?
Variation
What is the main reason that health care organizations fail at improving performance?
Human factors.
Health Quality Ontario is an organization that focuses on 3 quality activities. What is 1 activity?
Health Quality Ontario focuses on Quality Improvement Plans, wait times for surgery and patient safety indicators.
What famous male singer grew up in Stratford, Ontario? (just a 30min drive from Kitchener)
Justin Bieber