Accountable Care Organization (ACO)
An organization of healthcare providers accountable for the quality, cost, and overall care of Medicare beneficiaries who are assigned and enrolled in the traditional fee-for-service program
Admission utilization review
A review of planned services (intensity of service) and/or a patient's condition (severity of illness) to determine whether care must be delivered in an acute care setting
Affinity grouping
A technique for organizing similar ideas together in natural groupings
Agency for Healthcare Research and Quality (AHRQ)
The branch of the United States Public Health Service that supports general health research and distributes research findings and treatment guidelines with the goal of improving the quality, appropriateness, and effectiveness of healthcare services
Bar graph
A graphic technique used to display frequency distributions of nominal or ordinal data that fall into categories
Benchmark
A standard of performance or best practice, for a particular process or outcome
Brainstorming
A group problem-solving technique that involves the spontaneous contribution of ideas from all members of the group
Case management
1. The ongoing, concurrent review performed by clinical professionals to ensure the necessity and effectiveness of the clinical services being provided to a patient
2. A process that integrates and coordinates patient care over time and across multiple si
Cause-and-effect diagram
An investigational technique that facilitates the identification of the various factors that contribute to a problem
Checksheet
A tool that permits the systematic recording of observations of a particular phenomenon so that trends or patterns can be identified
Claims management
A function related to risk management that enables an organization to track descriptive claims information (incidents, claimants, insurance, demands, dates, and so on), along with data on investigation, litigation, settlement, defendants, and subrogation
Clinical practice guidelines
A detailed, step-by-step guide used by healthcare practitioners to make knowledge-based decisions related to patient care and issued by an authoritative organization such as a medical society or government agency
Clinical protocols
Specific instructions for performing clinical procedures established by authoritative bodies, such as medical staff committees, and intended to be applied literally and universally
Common-cause variation
Variation that is inherent within the system
Continued-stay (or concurrent) utilization review
A periodic review conducted during a hospital stay to determine whether the patient continues to need acute care services
Continuous improvement
1. A management philosophy that emphasizes the importance of knowing and meeting customer expectations, reducing variation within processes, and relying on data to build knowledge for process improvement
2. A continuous cycle of planning, measuring, and m
Customer
An internal or external recipient of services, products, or information
Dashboards
Reports of process measures to help leaders know what is currently going on so that they can plan strategically where they want to go next; sometimes called
Data abstracts
A defined and standardized set of data points or elements common to a patient population that can be regularly identified in the health records of the population and coded for use and analysis in database management systems
Discharge abstract system
A data repository (usually electronic) used for collecting information on demographics, clinical conditions, and services in which data are condensed from hospital health records into coded data for the purpose of producing summary statistics about discha
Discharge planning
The process of coordinating the activities related to the release of a patient when inpatient hospital care is no longer needed
Discharge utilization review
A process for assessing a patient's readiness to leave the hospital
External customers
Individuals from outside the organization who receive products or services from within the organization
Financial indicators
A set of measures designed to routinely monitor the current financial status of a healthcare organization or of one of its constituent parts
Fishbone diagram
A performance improvement tool used to identify or classify the root causes of a problem or condition and to display the root causes graphically; also called cause-and-effect diagram
Flowcharts
A graphic tool that uses standard symbols to visually display detailed information, including time and distance, of the sequential flow of work of an individual or a product as it progresses through a process
Force-field analysis
A performance improvement tool used to identify specific drivers of, and barriers to, an organizational change so that positive factors can be reinforced and negative factors reduced
Ground rules
An agreement concerning attendance, time management, participation, communication, decision making, documentation, room arrangements and cleanup, and so forth, that has been developed by PI team members at the initiation of the team's work
Health Care Quality Improvement Program (HCQIP)
A quality initiative begun in 1992 by the Health Care Financing Administration and implemented by peer review organizations that uses patterns of care analysis and collaboration with practitioners, beneficiaries, providers, plans, and other purchasers of
Histogram
A graphic technique used to display the frequency distribution of continuous data (interval or ratio data) as either numbers or percentages in a series of bars
Incident/occurrence report
A quality/performance management tool used to collect data and information about potentially compensable events (events that may result in death or serious injury)
Inputs
Data entered into a hospital system (for example, the patient's knowledge of his or her condition, the admitting clerk's knowledge of the admission process, and the computer with its admitting template are all inputs for the hospital's admitting system)
Intensity-of-service screening criteria
Pre-established standards used to determine the most efficient healthcare setting in which to safely provide needed services
Internal customers
Individuals within the organization who receive products or services from an organizational unit or department
ISO 9000 certification
An internationally agreed-upon set of generic standards for quality management systems established by the International Standards Organization
The Joint Commission
A private, not-for-profit organization that evaluates and accredits hospitals and other healthcare organizations on the basis of predefined performance standards; formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Mission
The defined purpose for which a group of people or an organization joins forces to accomplish specific goals
Multivoting technique
A decision-making method for determining group consensus on the prioritization of issues or solutions
National patient safety goals (NPSGs)
Goals issued by the Joint Commission on Accreditation of Healthcare Organizations to improve patient safety in healthcare organizations nationwide
Nominal group technique
A group process technique that involves the steps of silent listing, recording each participant's list, discussing, and rank ordering the priority or importance of items
Opportunity for improvement
A healthcare structure, product, service, process, or outcome that does not meet its customers' expectations and, therefore, could be improved
Outcome indicators
Measure the actual results of care for patients and populations, including patient and family satisfaction
Outcome measures
Document the results of care for individual patients as well as for specific types of patients grouped by diagnostic category
Outputs
The outcomes of inputs into a system (for example, the output of the admitting process is the patient's admission to the hospital)
Pareto chart
A bar graph that includes bars arranged in order of descending size to show decisions on the prioritization of issues, problems, or solutions
Patient advocacy
The function performed by patient representatives (sometimes called ombudsmen) who respond personally to complaints from patients and/or their families
Performance improvement (PI)
The continuous study and adaptation of a healthcare organization's functions and processes to increase the likelihood of achieving desired outcomes
Performance indicators
Measures used by healthcare facilities to assess the quality, effectiveness, and efficiency of their services
Potentially compensable event
An event that may result in financial liability for a healthcare organization, for example, an injury, accident, or medical error
Preadmission utilization review
A type of review conducted before a patient's admission to an acute care facility to determine whether the planned service (intensity of service) or the patient's condition (severity of illness) warrants care in an inpatient setting
Process indicators
Specific measures that enable the assessment of the steps taken in rendering a service
Processes
The day-to-day tasks and methods utilized in a standardized procedure to accomplish the provision by an individual or organization of products and services to its customers
Productivity indicators
A set of measures designed to routinely monitor the output and quality of products and/or services provided by an individual, an organization or one of its constituent parts
Prospective utilization review
A review of a patient's health records before admission to determine the necessity of admission to an acute care facility and to determine or satisfy benefit coverage requirements
Quality indicators
A standard against which actual care may be measured to identify a level of performance for that standard
Retrospective utilization review
A review of records some time after the patient's discharge to determine any of several issues, including the quality or appropriateness of the care provided
Risk
1. The probability of incurring injury or loss
2. The probable amount of loss foreseen by an insurer in issuing a contract
3. A formal insurance term denoting liability to compensate individuals for injuries sustained in a healthcare facility
Risk management program
A comprehensive program of activities intended to minimize the potential for injuries to occur in a facility and to anticipate and respond to ensuing liabilities for those injuries that do occur
Root-cause analysis
A technique used in performance improvement initiatives to discover the underlying causes of a problem
Run chart
A type of graph that shows data points collected over time and identifies emerging trends or patterns
Scatter diagrams
A graph that visually displays the linear relationships among factors
Scorecards
Reports of outcomes measures to help leaders know what they have accomplished; sometimes called dashboards
Severity-of-illness screening criteria
Standards used to determine the most appropriate setting of care based on the level of clinical signs and symptoms that a patient shows upon presentation to a healthcare facility
Six Sigma
Disciplined and data-driven methodology for getting rid of defects in any process
Special-cause variation
An unusual source of variation that occurs outside a process but affects it
Standard
1. A scientifically based statement of expected behavior against which structures, processes, and outcomes can be measured
2. A model or example established by authority, custom, or general consent or a rule established by an authority as a measure of qua
Statistical process control chart
A type of run chart that includes both upper and lower control limits and indicates whether a process is stable or unstable
Structure indicators
Quality indicators that measure the attributes of an organizational setting, such as number and qualifications of staff, adequacy of equipment and facilities, and adequacy of organizational policies and procedures
Structured brainstorming
A group problem-solving technique wherein the team leader asks each participant to generate a list of ideas for the topic under discussion and then report them to the group in a nonjudgmental manner
Time ladders
Usually paper-based with the intervals of time necessary to address the problem under consideration listed down the right side of one, two, or three columns on a sheet of paper. Then, as observations are made, are recorded next to the time of occurrence.
Unstructured brainstorming method
A group problem-solving technique wherein the team leader solicits spontaneous ideas for the topic under discussion from members of the team in a free-flowing and nonjudgmental manner
Utilization review (UR)
The process of determining whether the medical care provided to a specific patient is necessary according to pre-established objective screening criteria at time frames specified in the organization's utilization management plan
Virtuoso teams
Group of experts brought together to address an issue or situation