THE CONCEPT OF T.Q.M. IN HEALTHCARE

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------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/master06.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" THE CONCEPT OF T.Q.M. IN HEALTHCARE

THE CONCEPT OF T.Q.M. IN = HEALTHCARE

Dr. A. Ziko <= /span>

MRCP, FRCPCH, C.P.H.Q.= (Certified Professional in Healthcare <= i>Quality)

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“Quality”

<= span style=3D'font-size:129%'>lHaving high degree= of excellence

<= span style=3D'font-size:129%'>lDoing right things= right first time

<= span style=3D'font-size:129%'>lIs cost - reductio= n, not a cost

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Concepts

lWHAT IS QUALITY?

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lFreedo= m from deficiency

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lProduct feature

------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/slide0004.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" THE CONCEPT OF T.Q.M. IN HEALTHCARE

TQM as a management philosophy

Aims to:

Customer service

Productivity

Profits

Market share

Cost

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T.Q.M.

l It is a broad management philosophy, espousing quality and leadership = commitment, which provides the energy and the rationale for implementation of the process of continuous quality improve= ment within the organization wide quality strategy.

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Aspects of Quality

1.Mea= surable

2.App= reciative

3.Per= ceptive

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Dimensions of Quality

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lApprop= riateness

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lCompet= ency

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lEffect= iveness

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lEffici= ency

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lTimeli= ness

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lPreven= tion and early detection

l Availability

l Continuity =

l Efficacy

l Safety

l Respect and care

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Key Concepts of TQM

lTop management leadership = ;

lCreating corporate framework = for quality

lTransformation of corporate c= ulture

lCustomer focus

lProcess-focus =

lCollaborative approach to process improvement!

lEmployee education & training

lLearning by practice & teaching

lBenchmarking

lQuality measurement & sta= tistics

lRecognition & reward&= #13;

lManagement integration

l

l

l

------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/slide0009.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" THE CONCEPT OF T.Q.M. IN HEALTHCARE

TQM believes in the values of:

<= span style=3D'font-size:71%'>1.Customers:

<= span style=3D'font-size:71%'>-Needs

<= span style=3D'font-size:71%'>-Expectations

<= span style=3D'font-size:71%'>-Opinions

<= span style=3D'font-size:71%'>2.Staff:

<= span style=3D'font-size:71%'>-Willingness & desire

<= span style=3D'font-size:71%'>-Abilities & desire

<= span style=3D'font-size:71%'>-Opinions

<= span style=3D'font-size:71%'>-Access to Top Management

<= span style=3D'font-size:71%'>-Involvement in:

<= span style=3D'font-size:80%'>1.DECISION MAKING

<= span style=3D'font-size:80%'>2.PROBLEM SOLVING

<= span style=3D'font-size:80%'>3.GOAL SETTING

<= span style=3D'font-size:80%'>4.PLANNING

<= span style=3D'font-size:71%;visibility:hidden'>1.

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<= span style=3D'font-size:71%'>3.Management:

<= span style=3D'font-size:71%'>-Commitment & Visibility

<= span style=3D'font-size:71%'>-Active Leadership

<= span style=3D'font-size:71%'>-Participation

<= span style=3D'font-size:71%'>-Empowerment of Employee

<= span style=3D'font-size:71%'>-Accountability

<= span style=3D'font-size:71%'>4.Teamwork:

<= span style=3D'font-size:71%'>-Unity

<= span style=3D'font-size:71%'>-Ownership

<= span style=3D'font-size:71%'>-More & better ideas

<= span style=3D'font-size:71%'>-Openness

<= span style=3D'font-size:71%'>-Encouragement

<= span style=3D'font-size:71%'>-Mutual respect

<= span style=3D'font-size:71%'>-Incentive & reward

------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/slide0011.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" THE CONCEPT OF T.Q.M. IN HEALTHCARE

Basic Elements of A Proc= ess

lSupplier         Processors        = ;      Customers

l Inputs       Seq= uence of steps         Output

l

lSystem, Function, Process & Step

lSystem

lFunction        = ;            &n= bsp;          Function

l

lProcess     Process        = ;     Process    P= rocess

l

lStep       Ste= p        = ;            Step        Step

l

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Module of Donabedian

l

lCAUSAL RELATIONSHIP =

l

lStructure = ; Process = ; Outcome

l Effective = ; Efficient = ; Good

------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/slide0012_image012.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMgAVAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAQAv ABIAgQAAAAAzZjPMzAECAwJThI+pu8EPIwtO2puCqLhHvXEIRZbmiaagsCkrC8fyTNesCLz2ztPU oesJhZXg8GhzGJFMGaUJnf2W0SGHWuWJVNzuKfbziEcw3FisCZ/X6jU7UgAAOw== ------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/slide0012_image013.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhPgAUAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAQA7 ABIAgQAAAAAzZjPMzAECAwJZhI+pyxwNo5wnPIpzDMLqDwKc0F2LhabqyrbuSJZnTNf2jee5Wen+ D7R5esGiETeEHZdLFPPZVEKnyIeUipUZrtnnsPIKi8PCkBmi/J7XiJGaDRe943AepAAAOw== ------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/slide0013.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" THE CONCEPT OF T.Q.M. IN HEALTHCARE

Change in Emphasis

l In part focus on

-Wh= at of care i.e. patient care GIVEN.

-Wh= o of care i.e. patient care GIVER.

-

- Concentrate on improving system & process, = = most of the time:-

-The <= i>how of care = ; patient care PROCESS

-The <= i>result of care = ; patient care OUTCOME

------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/slide0013_image014.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhQgA2AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAQBA ADIAgQAAAAAzZjPMzAECAwLIhI+py20BnZy0giBEsLxPnEXeSIKZRqaceYoKBMfyTNd2fOboq/f+ DwwKXQ+h8Yj8bQ6spPPpEzWhVOpmWs0mIdru9uoNB5cXsTlHxJ6zZObtDY9jiap6Ytq265no/H5v 4vcHqCE4qEd3qLjI2Oj4CBkpOUlZaXn5l4j5sbNZAWLoyRMSKlqEtiKnCtdTerdm5XoKCyWrRmvk eos7FLrLO8TwC6zUMEysU3qMXCixTCx7sTpdE2W60KR5zRK9GXjtgKEN/tB9UAAAOw== ------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/slide0014.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" THE CONCEPT OF T.Q.M. IN HEALTHCARE

Structure

The arrangement of parts of care system or elements that facilitate care

e.g.

Resources

Equipment

Number of staff

Qualification of staff

Work space

------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/slide0015.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" THE CONCEPT OF T.Q.M. IN HEALTHCARE

Process

Refer to the procedures, methods, means or sequence of steps for providing or delivering care, producing outcomes. =

- Clinical process =

- Care delivery process=

------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/slide0016.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" THE CONCEPT OF T.Q.M. IN HEALTHCARE

Outcome

l Refers to the results of care, adverse or beneficial e.g.

CLINICAL

<= span style=3D'font-size:86%'>-Short term

<= span style=3D'font-size:86%'>-Complication

<= span style=3D'font-size:86%'>FUNCTIONAL

<= span style=3D'font-size:86%'>-Long term health status

<= span style=3D'font-size:86%'>-Activities of daily living

<= span style=3D'font-size:86%'>PERCEIVED

<= span style=3D'font-size:86%'>Patient / family satisfaction

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Quality Management Trilo= gy

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lContro= l / measurement

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lImprov= ement

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lPlanni= ng

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Continuous Quality Improvement Process

lDO

PLAN = ; &n= bsp; = ; &n= bsp; STUDY

lACT

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Decision Making: Traditional Model
(Data Deficient)<= /span>

Intuition

Opinion

Logic = ; &n= bsp; = ; Recommendations/

Rationalization = ; &n= bsp; Action

Rumor

Hearsay

= lNO DEFINED PROCESS

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Decision Making: Q.M. Model
(Data-based)

Q. Planning = ; Q. Improvement = ; Q. Control

lDecision Decision

Interpretation/ = ; &n= bsp; = ; &n= bsp; Proposal/

Understanding = ; &n= bsp; = ; &n= bsp; Hypothesis

Statistical

Analysis = ; &n= bsp; = ; &n= bsp; Collection

Knowledge

Data

Information

Design

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General Management Functi= ons

Management is the sum of these activities to improve human and mate= rial resources toward achievement of stated goals.

lPLANNING

lORGANIZING & STAFFING

lDIRECTING

lCOORDINATING

lIMPROVING

------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/slide0022.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" THE CONCEPT OF T.Q.M. IN HEALTHCARE

Core Quality Improvement Standards

<= span style=3D'visibility:hidden'>l

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lQuality leadership

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lData collection for quality monitoring

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lAnalys= is of monitoring data

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lQuality improvement

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Do We Need These?

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lMedical record

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lInform= ation system

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lProtoc= ol & clinical guidelines

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lTeachi= ng session

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lApprai= sal system

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lReview= / audit of mortality & morbidity

<= span class=3DBB style=3D'position:absolute;left:-4.77%;top:.3em'>lQuality department

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ladel@ziko.info

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IN HEALTHCARE

مفهو&#= 1605; إدارة الجود= 577; الشاملة فى الخدمات الص= 581;ية

lد. عادل زيكو <= /div>

lزم= 610;ل الكلية الملكية البريطانية = ;

lرئ= 610;س قسم الأطفال= 3;

lمس= 578;شفى مصر للطيران

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ال= حالة

   مرزوق ع.ع عمره 3 سنوات يسكن قرية / عزبة الخصوص. أمه ست بيت و أبوه موظف فى وزارة ال= 588;ئون بالقاهرة. <= /span>

   له ثلاث شقيقات: خضرة 15 سنة, سعاد 10 سنوات، و سيدة 5 سنوات.

   أحضرته أمه للعيادة الخارجية بسبب حدوث حرارة و مغص و قئ لمدة ثلاث أيام، لم يست&#= 1580;ب للعلاج.&#= 13;

ال= عيادة الخارجية:

   مزدح= ;مة و لم تتمكن أم خضرة من الكشف إلا بعد مزاحمة أمام الطبيب لمدة ساعة، و قد سألها و وضع السم= ;اعة على بطن مرزوق فى مدة 5 دقائق فقط حتى يتسنى له الكشف على 50 حالة وحده. بالفحص تبين أن الحرارة 40درجة م و سرعة القلب 150/دقيقة و لا يوجد طفح جلد، و الولد بحالة جيدة = برغم الحرارة العالية. <= /div>
الي= 608;م الأول:

   الطبيب طال= 576; أذن قبول الحالة بقسم الأطفال الداخلى للأطفال مع أمه <= /b>

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•طالب التحاليل:

•صورة دم كاملة

•أيونات بالدم

•تحليل بول

•أشعة على القلب و الصدر

•العلا= 80;:

•محاليل بالوريد
•جارامايس= ين (وريد)

•حقنة أسبيجيك (وريد)

•اليوم الثانى:

•مرور النائب:
• ا= لحرارة أفضل 5, 38درجة = 605; و توقف القئ

• ا= لأشعة فقط هى التى ظهرت و كانت طبيعية

• ل= م يتم سحب بقية عينات الدم إلا اليوم <= /span>

• ا= لعلاج السابق كما هو مع بدء الأكل <= /span>

•تحليل براز و مزرعة&#= 13;

•وظائف كل = 9; و كبد

•أمبيسلين (وريد)

•باراسيتا= ;مول (لبوس)

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•اليوم الثالث:

•م&= #1585;ور الإستشارى:

• م= رزوق عاود القئ بصورة أشد و الحرارة 39 درجة م، ظهور طفح جلدى بسيط على البطن. لم يظهر سوى = صورة دم كاملة: =

•هيموجلوب= ين =3D 10 جرام

•عدد كرات الدم الحمرا= 569; =3D 4 مليون

•عدد الكرات البيضاء =3D 000= , 15

•صفائح دموية =3D 000 450

•تم تغيير العلاج:

<= span style=3D'mso-special-format:bullet;position:absolute;right:-4.43%'>•= وقف الامبيسلين = 608; الجارامايس= 10;ن

<= span style=3D'mso-special-format:bullet;position:absolute;right:-4.43%'>•= فورت= م الوريد

<= span style=3D'mso-special-format:bullet;position:absolute;right:-4.43%'>•= متاب= عة التحاليل

•فى آخر اليوم ظهرت نتيجة تحليل البول خلايا صديدية أكثر من 100

•اليوم الرابع:

•م&= #1585;ور النائب:
• مرزوق تحسن القئ عنده و كذلك الحرارة 5= , 38درجة = 605;

• اختفى الطفح الجلد= 609; و حالته العمومية أفضل=

•وقف الاسبيجيك

•عودة المحاليل

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•تحاليل:

•= ع= ;مل مزرعة للبول= 3;

•= م= ;زرعة الدم أطهرت حساسية Staph Au= rtaus

•= و حساسية Fortran Ciprofloxacin

•= و= ;ظائف الكبد و الكلى طبيعية

•= م= ;زرعة البراز لم تظهر بعد

•العلاج<= /b>:
•= ورق الكلافوران = 608; ابدأ فورتم

•= طالب فحص قاع العين

•= متابعة درج= 577; الوعى و انعكاسات الحرفة كل 6 ساعات

•= محاولة الاتصال بالاستشارى لطالب زرع نخاع شوكى

•اليوم الخامس:

•مرور الاستشارى: <= /b>

R= 26;مرزوق يبدو أفضل من حرارة 5, 38 درجة م و يلعب بالقسم و توقف القئ و اختفى الطفح الجلدى.

•العلاج: = ;

•= شراب سوتريم

•= فوار مظهر للبول

•

= 226;

•

•

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•معامل:

• ترتيب أشعة تليفزيونية على البطن <= /span>

•اليوم السادس:

•مرور النائب:
• مرزو = 2; يبدو أفضل كثيرا و ذو شهية أفضل للأكل و اللعب، لم يتمكن النائ= 576; من ترتي= ب الأشعة التليفزيون= 10;ة اليوم

•اليوم السابع:
• خرج الطفل و أمه بعد عمل الأشعة التليفزيون= 10;ة و ظهور مزرعة البول و حساسية إلى سوتر= يم مع موعد للمتابعة من العيادة بعد أسبوع.

•ملخص الحالة:

1.بقاء مرزوق و أمه 7 أيام بالمستشفى

2.المض= ادات الحيوية :   أمبيسلين – جارامايسين = 211; كلافوران – فورتم – سوتريم

3.خافض الحرارة : باراسيتامو= 04; - اسبيحيك =

•

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•4. = 5;حاليل وريدية

•لمدة 4 أيام

•

5.&#= 1578;حاليل:

–صورة دم و مزرعة 2/7

–وظائ&= #1601; كبد و كلى 2/7

–تحلي&= #1604; براز و مزرعة 1/7

–تحلي&= #1604; بول و مزرعة 4/7 =

–أشعة على القلب و الصدر 1/7

–أشعة تليفزيونية على البطن 7/7

–

6.&#= 1605;رور الإستشارى مرتان 3/7 ، 5/7 =

7.

= 7.حجز أم خضرة مع مرزوق 7/7 أربك البيت حتى أن خضرة طالبة الإعدادية مكثت بالبيت 3 أيام لترعى أختها الصغرى.

– <= /span>

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"document.body.start()", sld.filters.revealtrans.duration * = 1000 ); else document.body.start(); } } function MakeSldVis()=20 { var fTrans=3Dg_showAnimation && SldHasTrans() if( fTrans )=09 { if( g_bgSound ) { idx=3Dg_bgSound.indexOf(","); pptSound.src=3Dg_bgSound.substr( 0, idx ); pptSound.loop=3D -(parseInt(g_bgSound.substr(idx+1))); } SlideObj.filters.revealtrans.Apply()=09 } SlideObj.style.visibility=3D"visible" if( fTrans ) SlideObj.filters.revealtrans.Play() } function MakeNotesVis()=20 { if( !IsNts() ) return false=20 SlideObj.style.display=3D"none" nObj =3D document.all.item("NotesObj") parent.SetHasNts(0) if( nObj ) {=20 nObj.style.display=3D"" parent.SetHasNts(1) } return 1 } function ChkAutoAdv() { if(SldHasTrans()) SlideObj.onfilterchange=3DAutoAdv else AutoAdv() } function AutoAdv() { if(!IsWin("PPTSld") || !gUseSldTimings )return var sld=3DGetCurSld() if( (sld.mAdvDelay>0) && !parent.IsFramesMode() ) setTimeout("parent.GoToNextSld()",sld.mAdvDelay) } function GetObj(id) { if(g_supportsPPTHTML) return document.all(id); else return document.getElementById(id); } function SldHasTrans() { return SlideObj.style.filter !=3D ""; } function GetSldId()=20 { var regExp =3D /file:\/\/\//i var pos =3D location.href.search(regExp) if (MHTMLPrefix !=3D "" && pos !=3D -1) sId =3D location.href.substring(pos) else { sId =3D RemoveFilePrefixFromHref(location.href); var regExp =3D /\// var fixedHref =3D sId var pos =3D -1 =09 pos =3D fixedHref.search(regExp) while (pos !=3D -1) { fixedHref =3D fixedHref.replace(regExp, "\\") pos =3D fixedHref.search(regExp) } =09 if (g_fBaseHyperlink =3D=3D true) sId =3D "file:///" + fixedHref; else sId =3D fixedHref.substring(fixedHref.lastIndexOf('\\') + 1) } =09 return sId } function HideMenu() { if( frames["PPTSld"] && PPTSld.document.all.item("ctx= tmenu") && PPTSld.ctxtmenu.style.display!=3D"none" ) { PPTSld.ctxtmenu.styl= e.display=3D'none'; return true } return false } function IsWin( name ) { return window.name =3D=3D name } function IsNts() { return IsWin("PPTNts") } function IsSldOrNts() { return( IsWin("PPTSld")||IsWin("PPTNts") ) } function SupportsPPTAnimation() { return( navigator.platform =3D=3D "Win32"= && navigator.appVersion.indexOf("Windows")>0 ) } function SupportsPPTHTML() { var appVer=3Dnavigator.appVersion, msie=3DappVer.indexOf("MSIE "), ver=3D0 if( msie >=3D 0 ) ver=3DparseFloat( appVer.substring( msie+5, appVer.indexOf(";",msie) ) ) else ver=3DparseInt(appVer) return( ver >=3D 4 && msie >=3D 0 ) } function _RSW() { if( !g_supportsPPTHTML || IsNts() || ( !g_scaleInFrame && (!IsWin("PPTSld") || !parent.IsFullScrMode()) ) ) return var padding=3D0; if( IsWin("PPTSld") && parent.IsFramesMode() ) padding=3D6 cltWidth=3Ddocument.body.clientWidth-padding cltHeight=3Ddocument.body.clientHeight-padding factor=3D(1.0*cltWidth)/g_origW if( cltHeight < g_origH*factor ) factor=3D(1.0*cltHeight)/g_origH newSize =3D g_origSz * factor if( newSize < 1 ) newSize=3D1 s=3DSlideObj.style s.fontSize=3DnewSize+"px" s.posWidth=3Dg_origW*factor s.posHeight=3Dg_origH*factor s.posLeft=3D(cltWidth-s.posWidth+padding)/2 s.posTop=3D(cltHeight-s.posHeight+padding)/2 if( g_scaleHyperlinks ) ScaleHyperlinks( factor ) } function _InitAnimations() { animRuntimeInstalled =3D ''+document.body.localTime !=3D 'undefined'; isFullScreen =3D (window.name =3D=3D "PPTSld") && !parent.IsFramesMode(); g_animUseRuntime =3D g_showAnimation && animRuntimeInstalled && !(isFullSc= reen && parent.IsSldVisited()); if( g_animUseRuntime ) { collSeq =3D document.all.tags("seq"); if( collSeq !=3D null ) { for(ii=3D0;ii numSlds ) gSldJumpIdx =3D numSlds; if ( gSldJumpIdx >=3D 0 ) { if ( gSldJumpIdx =3D=3D 0 ) gSldJumpIdx =3D 1; var jumpTo =3D parseInt(gSldJumpIdx); gSldJump =3D 0; gSldJumpIdx =3D ""; win.GoToSld( parent.GetSldList().mList[jumpTo-1].mSldHref ) } } } function _KDH() { if( event.keyCode =3D=3D 8 ) { event.returnValue =3D 0; parent.GoToPrevSld(); } }function DocumentOnClick() { if( IsNts() || parent.HideMenu() ) return; if( ( g_allowAdvOnClick && (window.name=3D=3D"PPTSld") && !parent.IsFrames= Mode() ) || (event && event.keyCode=3D=3D32) ) { =09 if( g_animUseRuntime && g_animMainSequence && g_animMainSequence.cangonex= t ) return; parent.GoToNextSld(); } } var g_supportsPPTHTML =3D SupportsPPTHTML(), g_scaleInFrame =3D 1, gId=3D""= , g_bgSound=3D"", g_scaleHyperlinks =3D false, g_allowAdvOnClick =3D 1, g_showInBrowser = =3D 0, gLoopCont =3D 0, gUseSldTimings =3D 1; var g_showAnimation =3D g_supportsPPTHTML && SupportsPPTAnimation() && ( (w= indow.name=3D=3D"PPTSld" && !parent.IsFramesMode()) || g_showInBrowser );va= r g_animManager =3D null; var g_animUseRuntime =3D false; var g_animItemsToHide, g_animInteractiveItems, g_animSlideTime; var g_animMainSequence =3D null; var ENDSHOW_MESG=3D"End of slide show, click to exit.", SCREEN_MODE=3D"Fram= es", gIsEndShow=3D0, NUM_VIS_SLDS=3D31, SCRIPT_HREF=3D"script.js", FULLSCR_= HREF=3D"fullscreen.htm"; var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO= tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true window.gPPTHTML=3DSupportsPPTHTML() var g_fBaseHyperlink =3D false; var gMainDoc=3Dnew Array(new hrefList("slide0001.htm",1,-1,1),new hrefList(= "slide0002.htm",1,-1,1),new hrefList("slide0003.htm",1,-1,1),new hrefList("= slide0004.htm",1,-1,1),new hrefList("slide0005.htm",1,-1,1),new hrefList("s= lide0006.htm",1,-1,1),new hrefList("slide0007.htm",1,-1,1),new hrefList("sl= ide0008.htm",1,-1,1),new hrefList("slide0009.htm",1,-1,1),new hrefList("sli= de0010.htm",1,-1,1),new hrefList("slide0011.htm",1,-1,1),new hrefList("slid= e0012.htm",1,-1,1),new hrefList("slide0013.htm",1,-1,1),new hrefList("slide= 0014.htm",1,-1,1),new hrefList("slide0015.htm",1,-1,1),new hrefList("slide0= 016.htm",1,-1,1),new hrefList("slide0017.htm",1,-1,1),new hrefList("slide00= 18.htm",1,-1,1),new hrefList("slide0019.htm",1,-1,1),new hrefList("slide002= 0.htm",1,-1,1),new hrefList("slide0021.htm",1,-1,1),new hrefList("slide0022= .htm",1,-1,1),new hrefList("slide0023.htm",1,-1,1),new hrefList("slide0029.= htm",1,-1,1),new hrefList("slide0030.htm",1,-1,1),new hrefList("slide0024.h= tm",1,-1,1),new hrefList("slide0025.htm",1,-1,1),new hrefList("slide0026.ht= m",1,-1,1),new hrefList("slide0031.htm",1,-1,1),new hrefList("slide0027.htm= ",1,-1,1),new hrefList("slide0028.htm",1,-1,1)); /********************************************* Frameset functions These functions control slide navigation and state of the frameset. **********************************************/ function RemoveFilePrefixFromHref(href) { var regExp =3D /^file:\/\/\//i; return href.replace(regExp, "") } function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) {=09 var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix =3D CalculateMHTMLPrefix();=20 function CalculateMHTMLPrefix() { if ( document.location.protocol =3D=3D 'mhtml:') {=20 href=3Dnew String(document.location.href)=20 Start=3Dhref.indexOf('!')+1=20 End=3Dhref.lastIndexOf('/')+1=20 if (End < Start)=20 return href.substring(0, Start)=20 else=20 return href.substring(0, End)=20 } return ''; } function GetTags(base,tag) { if(g_supportsPPTHTML) return base.all.tags(tag); else return base.getElementsByTagName(tag); } function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP= refix+GetHrefObj( gCurSld ).mNtsHref ) } function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() } function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() } function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() } function SetHasNts( fVal ) { if( gHasNts !=3D fVal ) { gHasNts=3DfVal UpdNavPane() } } function ToggleOtlText() { gOtlTxtExp=3D!gOtlTxtExp UpdOtlPane() } function ClearMedia() { // Clear any sounds playing before launching another browser window. Other= wise, // in fullscreen mode, you'll continue to hear the sound in the frames mod= e. if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() {=20 if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if (MHTMLPrefix !=3D "") href =3D RemoveFilePrefixFromHref(href) if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { =20 obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else =20 return gCurSld } function GetNumSlds() { =20 if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; =09 if (MHTMLPrefix !=3D "") PPTSld.location.replace(MHTMLPrefix+RemoveFilePrefixFromHref(obj.mSldHref= )) else PPTSld.location.replace(obj.mSldHref) =09 if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 if (MHTMLPrefix !=3D "") PPTSld.location.replace(MHTMLPrefix+RemoveFilePrefixFromHref(href)) else PPTSld.location.replace(href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; =09 var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('

' + ENDSHOW_MESG + '
') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); /********************************************* Navigation button implementation There are 2 types of buttons: ImgBtn, TxtBtn implemented as function objects. They share a similiar interface so the event handlers can call SetActive, for example, on a button=20 object without needing to know exactly=20 what type of button it is. **********************************************/ //---------------------------------- function ImgBtn( oId,bId,w,action ) //---------------------------------- { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0=20 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { =20 obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0=20 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } =20 } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } //----------------------------------------- function TxtBtn( oId,oeId,action,chkState ) //----------------------------------------- { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { =20 this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) {=20 if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } =20 } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1=20 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() {=20 b =3D gBtnArr[this.mBorderId]=20 if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() {=20 b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState /********************************************* Context menu implementation _CM() is the function that's hooked up to the oncontextmenu event. Once we're asked to show the menu, we first build it by creating DIVs on-the-fly. Then we position it=20 within the screen area so it doesn't get clipped. 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charset="us-ascii" THE CONCEPT OF T.Q.M. IN HEALTHCARE ------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"

No= tes

Slide Show

Outline

1

THE CONCEPT OF T= .Q.M. IN HEALTHCARE

Dr. A. Ziko

MRCP, FRCPCH, C.P.H.Q. (Certified Professional in Healthcare Quality= )

2

“Quality&#= 8221;

Having high degree of excellence

Doing right things right first time

Is cost - reduction, not a cost

3

Concepts

WHAT IS QUALITY?

Freedom from deficiency

Product feature

4

TQM as a managem= ent philosophy

Aims to:

   Customer servic= e

   Productivity
   Profits

   Market share
   Cost

5

T.Q.M.

It is a broad management philosophy, espousing quality and leaders= hip commitment, which provides the energy and the rationale for implementation of the process of continuous quality improvement with= in the organization wide quality strategy.

6

Aspects of Quali= ty

Measurable

Appreciative

Perceptive

7

Dimensions of Qu= ality

Appropriateness

Competency

Effectiveness

Efficiency

Timeliness

Prevention and early detection

8

Key Concepts of = TQM

Top management leadership

Creating corporate framework for quality

Transformation of corporate culture

Customer focus

Process-focus

Collaborative approach to process improvement!

Employee education & training

Learning by practice & teaching

Benchmarking

Quality measurement & statistics

Recognition & reward

Management integration

9

TQM believes in = the values of:

Customers:

Needs

Expectations

Opinions

Staff:

Willingness & desire

Abilities & desire

Opinions

Access to Top Management

Involvement in:

DECISION MAKING

PROBLEM SOLVING

GOAL SETTING

PLANNING

10

"Managemen= t"

Management:

Commitment & Visibility

Active Leadership

Participation

Empowerment of Employee

Accountability

Teamwork:

Unity

Ownership

More & better ideas

Openness

Encouragement

Mutual respect

Incentive & reward

11

Basic Elements = of A Process

Supplier       = ; Processors       = ;       Customers

Inputs       Sequence of steps       = ; Output

System, Function, Process & Step

System

Function       = ;            &n= bsp;           Function

Process     Process       = ;      Process    Process

Step     &= nbsp; Step       = ;             Step        Step

12

Module of Donab= edian

CAUSAL RELATIONSHIP

Structure       = ;      Process       = ;        Outcome

Effective       = ;      Efficient       = ;           Good

13

Change in Empha= sis

In part focus on

What of care i.e. patient care GIVEN.

Who of care i.e. patient care GIVER.

Concentrate on improving system & process, most of the time:-<= /li>
The how of care       = ;       patient care PROCESS

The result of care       = ;     patient care OUTCOME

14

Structure

The arrangement of parts of care system or elements that facilitate care

e.g.

Resources

Equipment

Number of staff

Qualification of staff

Work space

15

Process

Refer to the procedures, methods, means or sequence of steps for providing or delivering care, producing outcomes.

- Clinical process

- Care delivery process

16

Outcome

Refers to the results of care, adverse or beneficial e.g.

CLINICAL

Short term

Complication

FUNCTIONAL

Long term health status

Activities of daily living

PERCEIVED

Patient / family satisfaction

17

Quality Managem= ent Trilogy

Control / measurement

Improvement

Planning

18

Continuous Qual= ity Improvement Process

DO

    PLAN       = ;            &n= bsp;            = ;            &n= bsp;    STUDY

ACT

19

Decision Making: Traditional Model
(Data Deficient)

Intuition

Opinion

Logic       = ;            &n= bsp;            = ;       Recommendations/

Rationalization       = ;            &n= bsp;         Action

Rumor

Hearsay

NO DEFINED PROCESS

20

Decision Making= : Q.M. Model
(Data-based)

Q. Planning       = ;    Q. Improvement       = ;        Q. Control

Decision       Decision

Interpretation/       = ;            &n= bsp;            = ;            &n= bsp;      Proposal/

Understanding       = ;            &n= bsp;            = ;            &n= bsp;     Hypothesis

   Statistical

Analysis       = ;            &n= bsp;            = ;            &n= bsp;           Collection

21

General Managem= ent Functions

Management is the sum of these activities to improve human and material resources toward achievement of stated goals.

PLANNING

ORGANIZING & STAFFING

DIRECTING

COORDINATING

IMPROVING

22

Core Quality Improvement Standards

Quality leadership

Data collection for quality monitoring

Analysis of monitoring data

Quality improvement

23

Do We Need Thes= e?

Medical record

Information system

Protocol & clinical guidelines

Teaching session

Appraisal system

Review / audit of mortality & morbidity

Quality department

24

"adel@ziko= .info"

adel@ziko.info

25

مف&= #1607;وم إدارة الجودة الشاملة فى الخدمات الص&#= 1581;ية

د. عادل زيكو

زميل الكلية الملكية البريطاني= 7;

رئيس قسم الأطفال

مستشفى مصر للطيرا= 06;

26

27

"ط&#= 1575;لب التحاليل"=

طالب التحاليل:

صورة دم كاملة

أيونات بالدم

تحليل بو&#= 1604;

أشعة على القلب و الصدر

العلاج:
محاليل بالوريد

جاراماي= 587;ين (وريد)

حقنة أسبيجيك (وريد)

اليوم الثانى:

مرور النائب:

الحرارة أفضل 5, 38درجة م و توقف القئ

الأشعة فقط هى التى ظهرت و كانت طبيعية

لم يتم سحب بقية عينات الدم إلا اليوم

العلاج السابق كما هو مع بدء الأكل

28

"ا&#= 1604;يوم الثالث"

اليوم الثالث:

مرور الإستشارى:

مرزوق عاود القئ بصورة أشد و الحرارة 39 درجة م، ظهو= 585; طفح جلدى بسيط على البطن. لم يظهر سوى صو= 585;ة دم كاملة:

هيموجلو= 576;ين =3D 10 جرام

عدد كرات الدم الحمراء =3D 4 مليون

عدد الكرات البيضاء =3D 000, 15

صفائح دموية =3D 000, = 450

تم تغيير العلاج:

وقف الامبيسلي = 6; و الجارامايž= 7;ين

فورتم الوريد

متابعة التحاليل

فى آخر اليوم ظهرت نتيجة تحلي= 04; البول خلاي= 75; صديدية أكث= 85; من 100

اليوم الرابع:

مرور النائب:

مرزوق تحسن القئ عنده و كذلك الحرارة 5,= 38درجة م

اختفى الطفح الجلدى و حالته العمومية أفضل

29

"ت&#= 1581;اليل"

تحاليل:

عمل مزرعة للبول

مزرعة الدم أطهرت حساسية Staph A= urtaus

و حساسية= Fortran Ciprofloxacin

وظائف الكبد و الكلى طبيعية

مزرعة البراز لم تظهر بعد

العلاج:

ورق الكلافورا= 606; و ابدأ فورتم

طالب فحص قاع العين
متابعة درجة الوعى و انعكاسات الحرفة كل 6 ساعات

محاولة الاتصال بالاستشار= 609; لطالب زرع نخاع شوكى

اليوم الخامس:

مرور الاستشارى:

مرزوق يبدو أفضل من حرارة= 5,<= span dir=3Drtl> 38 درجة م و يلعب بالقسم و توقف القئ و اختفى الطف&#= 1581; الجلدى.

العلاج:

شراب سوتريم

فوار مظهر للبول

30

"م&#= 1593;امل"

معامل:

ترتيب أشعة تليفزيوني= 7; على البطن

اليوم السادس:

مرور النائب:

مرزوق يبدو أفضل كثيرا و ذو شهية أفضل للأكل و اللعب، لم يتمكن النائب من ترتيب الأشعة الت= 04;يفزيونية اليوم

اليوم السابع:

خرج الطفل و أمه بعد عمل الأشعة التليفزيو = 6;ية و ظهور مزرع= 577; البول= و حساسية إلى سوتريم مع موعد للمتابعة م= 06; العيادة بع= 83; أسبوع.

ملخص الحالة:

بقاء مرزوق و أمه 7 أيام بالمستشفى

المضادا= 578; الحيوية :   أمبيسلين R= 11; جارامايسي = 6; – كلافوران = 211; فورتم – سوتريم

خافض الحرارة : باراسيتام = 8;ل - اسبيحيك

31

"4"

4. محاليل وريدية

لمدة 4 أيام

تحاليل:

صورة دم و مزرعة 2/7

وظائف كب&= #1583; و كلى 2/7

تحليل براز و مزرعة 1/7

تحليل بو&= #1604; و مزرعة 4/7

أشعة على القلب و الصدر 1/7

أشعة تليفزيوني= 77; على البطن 7/7

مرور الإستشارى مرتان 3/7 ، 5/7

حجز أم خضرة مع مرزوق 7/7 أربك البيت حتى أ= 606; خضرة طالبة الإعدادية مكثت بالبي= 78; 3 أيام لترعى أختها الصغرى.

<= /a>= = = = =
------=_NextPart_01C60753.DC67FBC0 Content-Location: file:///C:/EC2C4CD2/2_files/filelist.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C60753.DC67FBC0--

1	THE CONCEPT OF T= .Q.M. IN HEALTHCARE Dr. A. Ziko MRCP, FRCPCH, C.P.H.Q. (Certified Professional in Healthcare Quality= )
2	“Quality&#= 8221; Having high degree of excellence Doing right things right first time Is cost - reduction, not a cost
3	Concepts WHAT IS QUALITY? Freedom from deficiency Product feature
4	TQM as a managem= ent philosophy Aims to: Customer servic= e Productivity Profits Market share Cost
5	T.Q.M. It is a broad management philosophy, espousing quality and leaders= hip commitment, which provides the energy and the rationale for implementation of the process of continuous quality improvement with= in the organization wide quality strategy.
6	Aspects of Quali= ty Measurable Appreciative Perceptive
7	Dimensions of Qu= ality Appropriateness Competency Effectiveness Efficiency Timeliness Prevention and early detection
8	Key Concepts of = TQM Top management leadership Creating corporate framework for quality Transformation of corporate culture Customer focus Process-focus Collaborative approach to process improvement! Employee education & training Learning by practice & teaching Benchmarking Quality measurement & statistics Recognition & reward Management integration
9	TQM believes in = the values of: Customers: Needs Expectations Opinions Staff: Willingness & desire Abilities & desire Opinions Access to Top Management Involvement in: DECISION MAKING PROBLEM SOLVING GOAL SETTING PLANNING
10	"Managemen= t" Management: Commitment & Visibility Active Leadership Participation Empowerment of Employee Accountability Teamwork: Unity Ownership More & better ideas Openness Encouragement Mutual respect Incentive & reward
11	Basic Elements = of A Process Supplier = ; Processors = ; Customers Inputs Sequence of steps = ; Output System, Function, Process & Step System Function = ; &n= bsp; Function Process Process = ; Process Process Step &= nbsp; Step = ; Step Step
12	Module of Donab= edian CAUSAL RELATIONSHIP Structure = ; Process = ; Outcome Effective = ; Efficient = ; Good
13	Change in Empha= sis In part focus on What of care i.e. patient care GIVEN. Who of care i.e. patient care GIVER. Concentrate on improving system & process, most of the time:-<= /li> The how of care = ; patient care PROCESS The result of care = ; patient care OUTCOME
14	Structure The arrangement of parts of care system or elements that facilitate care e.g. Resources Equipment Number of staff Qualification of staff Work space
15	Process Refer to the procedures, methods, means or sequence of steps for providing or delivering care, producing outcomes. - Clinical process - Care delivery process
16	Outcome Refers to the results of care, adverse or beneficial e.g. CLINICAL Short term Complication FUNCTIONAL Long term health status Activities of daily living PERCEIVED Patient / family satisfaction
17	Quality Managem= ent Trilogy Control / measurement Improvement Planning
18	Continuous Qual= ity Improvement Process DO PLAN = ; &n= bsp; = ; &n= bsp; STUDY ACT
19	Decision Making: Traditional Model (Data Deficient) Intuition Opinion Logic = ; &n= bsp; = ; Recommendations/ Rationalization = ; &n= bsp; Action Rumor Hearsay NO DEFINED PROCESS
20	Decision Making= : Q.M. Model (Data-based) Q. Planning = ; Q. Improvement = ; Q. Control Decision Decision Interpretation/ = ; &n= bsp; = ; &n= bsp; Proposal/ Understanding = ; &n= bsp; = ; &n= bsp; Hypothesis Statistical Analysis = ; &n= bsp; = ; &n= bsp; Collection
21	General Managem= ent Functions Management is the sum of these activities to improve human and material resources toward achievement of stated goals. PLANNING ORGANIZING & STAFFING DIRECTING COORDINATING IMPROVING
22	Core Quality Improvement Standards Quality leadership Data collection for quality monitoring Analysis of monitoring data Quality improvement
23	Do We Need Thes= e? Medical record Information system Protocol & clinical guidelines Teaching session Appraisal system Review / audit of mortality & morbidity Quality department
24	"adel@ziko= .info" adel@ziko.info
25	مف&= #1607;وم إدارة الجودة الشاملة فى الخدمات الص&#= 1581;ية د. عادل زيكو زميل الكلية الملكية البريطاني= 7; رئيس قسم الأطفال مستشفى مصر للطيرا= 06;
26
27	"ط&#= 1575;لب التحاليل"= طالب التحاليل: صورة دم كاملة أيونات بالدم تحليل بو&#= 1604; أشعة على القلب و الصدر العلاج: محاليل بالوريد جاراماي= 587;ين (وريد) حقنة أسبيجيك (وريد) اليوم الثانى: مرور النائب: الحرارة أفضل 5, 38درجة م و توقف القئ الأشعة فقط هى التى ظهرت و كانت طبيعية لم يتم سحب بقية عينات الدم إلا اليوم العلاج السابق كما هو مع بدء الأكل
28	"ا&#= 1604;يوم الثالث" اليوم الثالث: مرور الإستشارى: مرزوق عاود القئ بصورة أشد و الحرارة 39 درجة م، ظهو= 585; طفح جلدى بسيط على البطن. لم يظهر سوى صو= 585;ة دم كاملة: هيموجلو= 576;ين =3D 10 جرام عدد كرات الدم الحمراء =3D 4 مليون عدد الكرات البيضاء =3D 000, 15 صفائح دموية =3D 000, = 450 تم تغيير العلاج: وقف الامبيسلي = 6; و الجارامايž= 7;ين فورتم الوريد متابعة التحاليل فى آخر اليوم ظهرت نتيجة تحلي= 04; البول خلاي= 75; صديدية أكث= 85; من 100 اليوم الرابع: مرور النائب: مرزوق تحسن القئ عنده و كذلك الحرارة 5,= 38درجة م اختفى الطفح الجلدى و حالته العمومية أفضل
29	"ت&#= 1581;اليل" تحاليل: عمل مزرعة للبول مزرعة الدم أطهرت حساسية Staph A= urtaus و حساسية= Fortran Ciprofloxacin وظائف الكبد و الكلى طبيعية مزرعة البراز لم تظهر بعد العلاج: ورق الكلافورا= 606; و ابدأ فورتم طالب فحص قاع العين متابعة درجة الوعى و انعكاسات الحرفة كل 6 ساعات محاولة الاتصال بالاستشار= 609; لطالب زرع نخاع شوكى اليوم الخامس: مرور الاستشارى: مرزوق يبدو أفضل من حرارة= 5,<= span dir=3Drtl> 38 درجة م و يلعب بالقسم و توقف القئ و اختفى الطف&#= 1581; الجلدى. العلاج: شراب سوتريم فوار مظهر للبول
30	"م&#= 1593;امل" معامل: ترتيب أشعة تليفزيوني= 7; على البطن اليوم السادس: مرور النائب: مرزوق يبدو أفضل كثيرا و ذو شهية أفضل للأكل و اللعب، لم يتمكن النائب من ترتيب الأشعة الت= 04;يفزيونية اليوم اليوم السابع: خرج الطفل و أمه بعد عمل الأشعة التليفزيو = 6;ية و ظهور مزرع= 577; البول= و حساسية إلى سوتريم مع موعد للمتابعة م= 06; العيادة بع= 83; أسبوع. ملخص الحالة: بقاء مرزوق و أمه 7 أيام بالمستشفى المضادا= 578; الحيوية : أمبيسلين R= 11; جارامايسي = 6; – كلافوران = 211; فورتم – سوتريم خافض الحرارة : باراسيتام = 8;ل - اسبيحيك
31	"4" 4. محاليل وريدية لمدة 4 أيام تحاليل: صورة دم و مزرعة 2/7 وظائف كب&= #1583; و كلى 2/7 تحليل براز و مزرعة 1/7 تحليل بو&= #1604; و مزرعة 4/7 أشعة على القلب و الصدر 1/7 أشعة تليفزيوني= 77; على البطن 7/7 مرور الإستشارى مرتان 3/7 ، 5/7 حجز أم خضرة مع مرزوق 7/7 أربك البيت حتى أ= 606; خضرة طالبة الإعدادية مكثت بالبي= 78; 3 أيام لترعى أختها الصغرى.