Dr Irene Papanicolas COW.3.04

This course will be led by Dr. Michael Holland, Medical Director and Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust.

This course is available on the Executive MSc in Health Economics, Policy and Management. This course is not available as an outside option.

An introduction and overview of quality improvement methodology as used in healthcare settings internationally. The course will cover the following areas:

1) History of quality management: The course will start with an overview of key theories in quality management such as those described Taylor, Shewhart, Deming and Juran. An overview of quality assurance systems used in healthcare, such as ISO 9000, Magnet, Baldridge award and their role in quality improvement. It will also include a discussion and overview of value-based healthcare.

2) A critical assessment of the mainstream schools of thought of quality as part of the production process - this will include a study of the relationship between supply chain procurement management and quality as well as the requirements for good production models and the critique of evidence-based decision-making in the clinical setting

3) Quantitative methods in quality management - This course will examine a number of tools for quality management purposes - both how to do them as well as how they fit into the various schools of thought on quality management. It will cover statistical process control which is a method of statistical analysis of time series data that is used in quality management. This method shows whether there is variability in processes and gives the user an ability to both measure improvements and declines in performance of both processes and outcomes and to understand whether processes are performing within acceptable limits. An overview of the quality improvement methodology known as Design of Experiments will also be given. The role of case mix adjustment in quality assessment will also be discussed.

4) Process Mapping - Understanding the value and power of mapping processes both at a systems level and at the individual process level. They will also be given an example of a process map from a healthcare environment to work on optimising.

5) Theories of capacity and flow management and examples of this in both in-patient and outpatient settings will be discussed. This will also include how DRG/HRG payment has a role within organisations of capacity management.

6) A critical overview of Lean, Six Sigma and Model for Improvement. While these models can be useful in healthcare management, these are not deep philosophies of organisation and many of the things which make healthcare unique (e.g. asymmetry of information, difficulty of measuring quality, patient behaviour and societal preferences for fairness) are sometimes not accounted for in these models.

5 lectures (5 x 2 hours) and 5 workshops (5 x 2 hours). The 5 workshops will focus on analysing case studies with of view of giving students a practical understanding of approaches to quality management in healthcare settings.

A case study will be provided for the students to analyse and write an essay answering questions relating to it. Feedback will be provided on this essay by the seminar leader.

Donabedian, A. (1966). "Evaluating the quality of medical care." The Millbank Memorial Fund Quarterly 44(3): 166-203.

Hackman, J. Richard, and Ruth Wageman (1995), "Total Quality Management: Empirical, Conceptual, and Practical Issues," Administrative Science Quarterly 40 (2): 309-342.

Garvin, David A. "Competing on the Eight Dimensions of Quality." Harvard Business Review 65, no. 6 (November-December 1987).

Going Lean in Health Care. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2005.

Langley, Moen, Nolan et al., 2009, The Improvement Guide, 2nd Edition (Wiley)

Morton, A. and J. Cornwell (2009). "What's the difference between a hospital and a bottling factory?" British Medical Journal 339: 428-430

Crossing the Quality Chasm - Institute of Medicine, 2001

S Spear and H Kent Bowen; Harvard Business Review, Sept- Oct 1999; 97-106; Decoding the DNA of the Toyota Production system

To Err is Human - Institute of Medicine, 2000

Understanding variation - D Wheeler, 1993

The Machine that changed the world - Womack JP, Jones DT and Roos D, 2007

M.E. Porter and T. H. Lee; Harvard Business Review, Oct 2013; The Strategy That Will Fix Health Care

Essay (50%, 2500 words) and essay (50%, 2500 words).

Two 2,500 word case study essays (50% each)

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