Medical quality management system based on full process, full data, and all-user concept

1 Full process content design based on total quality management

By drawing on comprehensive quality management theory, process management theory, quality evaluation and quality continuous improvement theory, we design a scientific and reasonable quality assessment and quality monitoring system to evaluate the whole process of medical treatment; through special quality improvement and specialist quality improvement work, respectively Improve medical core processes and supporting processes.

1.1 Full process quality evaluation

As the basic work of medical quality improvement, based on the Donabedian structure, process and results three-dimensional evaluation model, combined with hospital information level and quality management needs, design quality assessment and monitoring system, evaluate the whole process of medical treatment.

Focus on the process and key indicators to carry out medical quality assessment. The design of the assessment content is based on the construction of the medical quality control organization system and the construction of the medical quality control system. The implementation of the medical core system is the process assessment content, and some key indicators in the final result are used as the result assessment content. In the design of specific indicators, based on the SMART principle, the balanced scorecard method, and the 360-degree evaluation idea, a three-level indicator system for medical quality assessment was established, involving more than 100 evaluation factors, to achieve accurate and refined medical quality assessment.

Focus on the final results to carry out medical quality monitoring. The design of the monitoring system is guided by the advanced experience in the industry, based on the requirements of the health administrative department, considering the development goals and needs of the hospital's quality management, and combining the differences in the disease types and surgical structures of various hospital departments, and ultimately forming medical efficacy. 11 first-level indicators and more than 100 secondary indicators including medical safety, technical difficulty, surgical management, pharmacy management, and consultation management. The quality monitoring index system provides basic data support for the quality assessment system, which is a useful supplement to the quality assessment index system, and also lays a foundation for hospitals to participate in regional medical quality evaluation.

1.2 Process quality improvement

Quality evaluation is the basic work of quality management, and continuous improvement of quality is the ultimate goal of quality management. Through quality evaluation, attention to short-term quality, and improvement of weak links are the focus of overall process control.

Carry out key special quality improvement and improve the core medical process. Based on the theory of process management and project management, special teams are set up to focus on key issues and key links of hospitals, and special work is carried out to improve and rebuild core business processes. Including closed-loop medical records as the core of medical record quality control, venous thromboembolism prevention, clinical pathway management, key disease management.

Give full play to the initiative of the specialist in quality management activities, carry out quality control within the department and quality management across departments, and promote the improvement of medical procedures within the department and hospital. First, in combination with the development of the specialties and management needs, take the initiative to carry out quality management activities within the department; second, to participate in the quality management of the whole hospital to achieve academic exchanges and share management experience across departments; third, to achieve clinical and medical skills through the contact system of medical technology departments. Departmental communication and interaction.

2 Information analysis processing based on full data integration

2.1 Overall situation

On the basis of the whole process design of the medical quality system, the hospital officially developed the medical quality management system. The preliminary research included visiting relevant management departments and some clinical medical technology departments to collect user content requirements; researching hospital information system management departments and application manufacturers to understand technical needs. The survey found that the demand is divided into common demand and characteristic demand. The common problem is solved first in the initial stage of construction, and then the characteristic demand is gradually improved by establishing a special quality control module. In addition, the investigation of hospital information system construction found that the hospital has multiple heterogeneous system platforms and non-standard information formats, which seriously hindered information exchange.

2.2 Specific aspects

It is necessary to standardize the data structure before data collection and utilization. In addition, diversified data collection methods include automatic extraction of system interface, batch import of Excel and manual entry to meet the quality control methods of automatic calculation and manual verification of objective indicators currently used. The data application is intelligent. The first is the intelligent analysis of data. It is reflected in the background calculation of the assessment results, report indicators, statistical charts and multi-level and multi-angle data tracing. Second, the data display is intelligent, and the permissions can be set according to different needs of users. Display, and flexible configuration to achieve user personalized needs, using query analysis, online analytical processing (OLAP), data mining and other tools to achieve user-defined reports and graphical display.

With the deep application and promotion of the system, the data risk problem is increasingly prominent, and the data standardization management can fully satisfy the needs of users at all levels, and ensure the user behavior is controllable and the data is safe and reliable. First, full-motion monitoring, using data collection logs and system operation logs to record the main operations; second, single sign-on and dual network card, dual-channel, unified single sign-on through the hospital office platform (OA), the system also uses dual network cards, Dual access, as long as the IP address is in the hospital range, both internal and external networks can be used flexibly; the third is double-layer access control, the first layer through the hospital OA single sign-on for access control, non-hospital employees will not be able to log in because of the unassigned login account; The second layer assigns different menu permissions, data permissions, and operation permissions to different user roles through system internal user management and role permission settings.

3 Full user coverage based on quality management organizational structure

According to the hierarchical management theory proposed by Professor Fu Guohua of Hainan University, the system user structure is analyzed, and the medical quality management system hierarchy is scientifically divided. According to the needs of different levels of management functions of the body, using role management method, the system gives the user different roles for different functions, in order to meet medical quality management process all the daily management of the whole user-related needs.

3.1 User Full Coverage User full coverage is the basis for implementing full user services.

Through the application of hierarchical management theory, the system will set all the organizations, departments and personnel involved in the medical quality management activities as users. According to their status and functions of medical quality management activities, medical quality management system from top to bottom is divided into five-layer structure: decision-making, coordination, management, executives, self-control layer. The decision-making layer corresponds to the Medical Quality and Safety Management Committee; the coordination level corresponds to the professional committee, including the hospitality committee, the medical record quality management committee, etc.; the management includes the medical department, the nursing department and other functional departments; the executive level corresponds to the department quality control team, including all Clinical medical technology department; self-control layer refers to specific medical personnel, such as medical care.

3.2 Full coverage of functions Full coverage is the core of full user services.

In order to meet the needs of daily medical quality management activities, the system assigns all users to different roles according to the level, and uses the role management method to organically combine users and permissions to achieve different medical quality management functions of different users. Through function construction: (1) Decision-level users realize quality management decision support, timely and systematic understanding of various medical quality indicators of hospitals, and provide basis for decision-making; (2) Management departments can use the system for daily medical quality supervision Activity and medical quality assessment management, through the system for medical quality supervision or work, effectively store the inspection results directly in the server, especially for data indicators, but also through the system for automatic processing, display, greatly optimize the workflow, Reduce the workload and improve work efficiency; (3) Through the establishment of a specialist quality control platform, the executive level can timely understand the quality status of the department, review the completion of the quality indicators of the specialist medical care, and provide the basis for the improvement of the quality management work of the department; (4) Using the PDCA cycle concept and method, the system built the functions of medical quality rectification feedback, department solicitation opinions, and mutual evaluation of consultations, so that system users at different levels can communicate with each other and realize the function of full user interaction.

4 Discussion and recommendations

4.1 The construction of medical quality management system needs to be continuously improved

The first phase of the medical quality and safety management system has basically achieved the full process, full data, and full user function realization. There are still areas for improvement in the construction of multiple courtyards, data analysis and processing, and maintenance of quality control organization. In addition, in order to achieve the goal of continuous improvement of medical quality, it is necessary to continuously improve the construction of hospital medical quality management system, and promote scientific and rational by introducing disease risk adjustment tools such as DRGs, medical risk prevention tools such as HFMEA, and root cause analysis tools for medical systems such as RCA. medical quality Assessment and medical procedures continue to improve in order to establish long-term mechanism of medical quality management.

4.2 Hospital information construction needs to be strengthened

Throughout the development process of China's medical information, financial charges from the beginning, and then to build the whole hospital HIS, PACS, LIS, EMRS and a series of clinical information systems, OA, HRP, president of decisions and a series of management information systems, focusing now Data integration and exchange platform construction. But overall, the development of China in terms of medical quality management information system still lags behind. At present, there is no mature related software in China, so the hospital chooses to jointly develop with the software company. In order to maximize the software system to help the hospital's medical quality and safety management, the hospital hardware network foundation, information system status and data quality overall progress and improvement, and further strengthen the hospital-related information construction.

4.3 Limitations of the system and prospects for the second phase

At present, the hospital's medical quality management system has taken shape. The system development cycle is expected to be 3 months, but the actual cost is about 1 year. From the demand research to the technical realization, it takes a long process. The lack of technologically advanced quality management information systems and data unification and proofreading problems in China is a difficult problem for system development. The system mainly collects inpatient data and needs to be strengthened in the quality management of outpatient and medical technology departments. As the user demand expands toward the detailed evaluation unit, and the opening of the hospital branch area and the overall information system planning adjustment, the hospital has begun construction of the second phase of the system.

(Source: excerpt from "China Digital Medicine" 2017, No. 5, Author: Gang Xia Haipeng Xie Zaiqiu other units: Tongji Medical College, Tongji Hospital)