Read the summary and the most important questions on Quality and Safety

• 1 Week 1

• 1.1 Lecture 1.1 - Introducing Quality & Safety

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• How can we define quality in healthcare according to the IoM?

  Institute of medicine: 
  
  6 dimensions 
  

  • effectiveness
  • efficiency 
  • equity 
  • patient centeredness 
  • Safety 
  • Timelessness 

  
  
  The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge 

• 1.2 Lecture 1.2 - The Organizing for Quality framework

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• What are the six challenges for Q&S  according to the book organizing for quality

  1. Structual
  2. Educational
  3. cultural
  4. Political
  5. Technological & Physical
  6. Emotional
     

  
  
  -> basis of conceptual framework that we use in this course each week, as a new way of looking at Q&S

• 1.3 Lecture 1.3 - The Structural Challenge

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• What is the downside of focussing too much on structure?

  Bureaucratisering = Probleem: er zijn heel veel termen waarmee het teveel aan regels en administratie wordt aangeduid. En dat maakt het lastig om te meten of er daadwerkelijk iets is verbeterd op dat vlak, constateert een bureau in opdracht van het ministerie van VWS
  

• What are the two forms of decoupling? No explanation

  Policy-practice decoupling 
  
  
  
  
  means-ends decoupling 

• Example of policy-practice decoupling = use of workarounds. What is this?

  Defined in different ways 
  
  workarounds are things we do all the times in our lives -> ignore rules/steps etc. 
  
  workarounds are inherent to organizing, national part and necessary to get the job done -> workarounds could be positive thing 
  
  drift = policy practice gap gets more and more -> good and bad things can happen 

• What is the second form of policy-practice decoupling?

  Means end decoupling 
  
  when rules and policies are implemented but the daily practice are disconnected from intended outcomes 
  
  more and more prevalent in current organizations 

• Policy practice decoupling VS Means end decoupling

  Policy practice decoupling happens when there is little or no relation between formal policies and daily practice 
  
  
  means end decoupling there is little or no relation between daily practices and intended outcomes of daily policies 

• 1.5 Lecture 1.5 - Leading patient safety improvements in practice pt1

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• Why is patient safety so hard to improve? (4 challenges)

  1. Visibility
  2. Ambiguity
  3. Complexity
  4. Autonomy

• What is Visibility of unsafety?

  Dit beeld is raar -> niet veilig, maar je weet niet hoe/wat
  
  Healthcare: je kan vaak niet zien -> dialyse omdat hij verkeerde medicatie heeft gekregen of dat hij een nierziekte heeft, je ziet het niet

• What is Complexity of unsafety?

  Alles in het grote complex van erasmus MC kan effect hebben op patient safety -> medicatie, bed waar je uit kan vallen, vloer wat glad zou kunnen zijn
  
  Ofwel: alles heeft te maken met safety -> difficult to make a decision on what to improve