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Quality Improvement Tools and Techniques: 2007 An MPRO Self-Instructional Module

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Quality Improvement Tools and Techniques: 2007 An MPRO Self-Instructional Module Patricia L. Baker, RN, MS * Another decision-making tool is multi-voting. – PowerPoint PPT presentation

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Title: Quality Improvement Tools and Techniques: 2007 An MPRO Self-Instructional Module


1
Quality Improvement Tools and Techniques
2007An MPRO Self-Instructional Module
  • Patricia L. Baker, RN, MS

2
Tools for the Continuous Quality Improvement
Journey
3
Objectives
  • Identify common quality improvement (QI) tools
    used to focus on important problems
  • List tools for identifying problem causes
  • Recognize tools for defining solutions
  • Review tools used to develop QI plans
  • Plan to display QI data

4
MODEL for IMPROVEMENT
Reference Langley, G.J. Nolan, K.M. Nolan,
T.W. Norman, C.L. and Provost, L.P. (1996). The
Improvement Guide, San Francisco, CA Jossey-Bass
Publishers
5
Continuous Quality Improvement
P
A
D
S
6
Tools to Identify the QI Focus
  • Define the problem areas
  • Compare the current state with the desired state
  • Check alignment with organizational mission and
    goals

7
Tools to Identify Focus
  • Brainstorming
  • Idea writing
  • Impact analysis
  • Pareto Diagram
  • Problem statement
  • Selection grid

8
Brainstorming
  • A focused creativity technique designed to
    collect multiple ideas about an issue
  • Benefits
  • Encourages creative thinking
  • Generates a large number of ideas
  • Gets all team members involved
  • Eliminates fear of criticism
  • Increases the number of options

9
Brainstorming Rules
  • No criticisms or compliments
  • No discussion
  • No questions
  • Speed is important
  • Think broadly
  • Develop wild, outrageous ideas
  • Build on ideas of others
  • Listen
  • Do not interrupt
  • Quantity is important

10
Brainstorming Steps
  • 1. Clarify the brainstorming objective
  • 2. Write the objective at the top of the flip
    chart
  • 3. Review brainstorming rules
  • 4. Determine process free flow or take turns
  • 5. Record each idea on the flip chart
  • 6. Continue until all ideas are exhausted
  • 7. Clarify each idea after all ideas are listed
  • 8. Group like ideas together

11
Idea Writing
  • Individual brainstorming on paper
  • Benefits
  • Idea notes may be written before the team meeting
  • Protects anonymity
  • Idea notes shared at the meeting
  • Includes those who cannot attend

12
Impact Analysis
  • Survey technique to discover the impact or effect
    of a situation or problem
  • Benefits
  • Confirms the problem or project is worthwhile
  • Indicates the severity of the problem
  • Often uncovers new information
  • Allows for sharing of thoughts, opinions, and
    ideas

13
Pareto Diagram
  • Bar chart that demonstrates the distribution of
    issues that cause most of the problems
  • Benefits
  • Applies the 80/20 rule
  • Focuses on the 20 of the work that cause 80 of
    the problems
  • Gives the biggest return for your efforts
  • Helps explain problem to others

14
Pareto Diagram
15
Problem Statement
  • Defines and summarizes the issue or problem
  • Benefits
  • Spells out the impact of the current state
  • Defines the opportunities of the desired state
  • Explains the expected impact of correcting the
    situation
  • Delivers a consistent message

16
Define Goals
  • What are we trying to accomplish?
  • SMART Goals
  • Specific
  • Measurable
  • Attainable
  • Realistic
  • Timely

17
Tools to Understand the Cause
  • Clarify the process
  • Flow chart the process
  • Determine cause
  • Fishbone or Cause and Effect Diagram
  • Impact analysis
  • Data
  • Pareto Diagram

18
Flowchart the Process
  • A diagram of the sequence of steps in a work
    effort
  • Benefits
  • Clarifies current knowledge of process
  • Demonstrates the work flow
  • Examines parts of a process and their
    relationship to each other
  • Identifies the sources of variation for each step
    from start to finish
  • Points out unnecessary complexity, inefficiency,
    and redundancy
  • Develops a common understanding

19
Flowchart Steps
  • Involve those most knowledgeable about the
    process
  • Define the boundaries (beginning and end)
  • List the work activities, decisions, and
    documents
  • Place the activities, decisions, and documents in
    the order that they occur
  • Connect the activities with arrows

20
Diabetic Patient Registers
Nurse/MA reviews the diabetic flowsheet
NO
A1C due?
YES
Nurse/MA obtains blood sample and documents
results
Patient escorted to exam room
21
Diabetic Foot Exam Needed
NO
YES
Nurse/MA conducts foot exam and documents on foot
exam form
Physician/PA/NP enters exam room
Physician/PA/NP reviews documentation
Physician/PA/NP examines patient and completes
documentation
Patient checks out at receptionist
Patient Leaves Office
22
Fishbone or Cause Effect Diagram
  • Explores and displays the identified causes and
    relationships leading to a specific outcome
  • Benefits
  • Involves multiple team members
  • Allows grouping of information
  • Displays related causes
  • Gives ideas for goals
  • Points out data needs
  • Provides ideas for solutions
  • Presents big picture of the problem
  • Easy to understand

23
Fishbone or Cause Effect Steps
  • Agree on the problem statement or outcome
  • Identify major cause categories
  • Brainstorm reasons for each of the major causes
  • Clarify the diagram
  • Post for others to review

24
Fishbone or Cause Effect Diagram
  • Employees Materials Equipment


Outcome
Methods
Environment
25
Examine Solutions
  • Tools to generate solutions
  • Brainstorming
  • Impact analysis
  • Pareto Diagram
  • Flowchart
  • Fishbone
  • Collaboration with others
  • Literature

26
Select a Change Option
  • What change can we make that will result in
    improvement?
  • Tools
  • Decision matrix
  • Selection grid
  • Multi-voting
  • Cost-benefit analysis
  • Force Field Analysis

27
Decision Matrix
Easy to Do
Hard to Do
High Pay Off
A.
B.
Low Pay Off
C.
D.
28
Selection Grid
29
Multi-voting
  • A group decision-making technique designed to
    reduce a large list of ideas to a manageable
    number.
  • Benefits
  • Eliminates peer pressure
  • Equal participation
  • Allows for consensus
  • Gains buy-in among the team

30
Multi-voting Steps
  • List ideas or options on flip chart or chalk
    board
  • Each team member votes for their top three
    choices
  • Clarify among the team and eliminate choices with
    one or zero votes
  • Each team member selects top two choices from the
    remaining list
  • Repeat the process until the top one or two ideas
    have been selected

31
Cost-benefit Analysis
  • Determine the financial impact by comparing the
    costs and benefits
  • Benefits
  • Evaluates the cost of a change
  • Supports decision-making
  • Provides supporting documentation for QI teams
    recommendation

32
Force Field Analysis
  • Identify and discuss forces that support or
    interfere with a change
  • Benefits
  • Identifies obstacles
  • Lists supporting elements
  • Suggests action steps

33
Force Field Analysis
Desired State
Current State
Driving Forces
Restraining Forces
34
Determine Measures
  • How will we know that a change is an improvement?
  • What are the data needs?
  • Consider
  • Data collection methods
  • Data analysis plan
  • Accountable persons

35
Check List
  • A method to systematically record data from
    observations or historical sources
  • Benefits
  • Easy-to-use form
  • Minimal data collector training
  • Efficient and fast data collection
  • Detects patterns and trends

36
Check List
  • Steps
  • Decide on data to collect
  • Clarify definitions
  • Decide on time period for collection
  • Select sample size
  • Decide who will collect data
  • Design and test the check list
  • Distribute form and collect the data
  • Tally and evaluate

37
Develop Action Plan
  • Brainstorm
  • Force Field Analysis
  • Political action plan
  • Presentation

38
Action Plan
39
Political Action Plan
  • A communication strategy designed to inform and
    gain support
  • Benefits
  • Share information
  • Build support
  • Receive feedback
  • Build consensus
  • Eliminate surprises

40
Presentation
  • A communication technique to share information
    and obtain feedback
  • Benefits
  • Deliver a consistent message
  • Gain understanding
  • Elicit support
  • Teach and share
  • Receive ideas

41
Presentation Strategies
  • Be prepared
  • The three tells
  • Use visual aids
  • Storyboard
  • Slides
  • Diagrams, charts, and graphs
  • Practice

42
Continuous Quality Improvement
P
D
A
S
43
Continuous Quality Improvement
P
A
D
S
44
Pie Chart
  • A picture depicting parts of the whole
  • Benefits
  • Easily understood
  • Draws interest
  • Good visual

45
Bar Chart Aspirin at Arrival for AMI Patients
46
Run Chart
New flow sheet
47
Continuous Quality Improvement
P
A
D
S
48
May your QI journey be fun, interesting, and
successful!
49
QI References
  • Brassard M, Ritter D. The Memory Jogger II.
    GOAL/QPC, Methuen, MA, 1994.
  • Brassard M, Joiner BL. The Team Memory Jogger.
    GOAL/QPC and Joiner Associates Inc, Methuen, MA,
    1995.
  • Langley GJ, Nolan KM, Nolan TW, Norman CL, and
    Provost LP. The Improvement Guide. Jossey-Bass
    Publishers, San Francisco, 1996.
  • Scholtes PR. The Team Handbook. Joiner
    Associates, Inc. Madison, WI. 1988.

50
Creativity References
  • DeBono E. Serious Creativity. New York Harper
    Collins, 1993.
  • Higgens JM, 101 Creative Problem Solving
    Techniques, Winter Park, FL New Management
    Publishing Company, 1994.
  • Plsek PE, Creativity, Innovation, and Quality.
    Milwaukee, WI ASQC Quality Press, 1997.
  • Van Oech R, A Whack on the Side of the Head. New
    York Warner Books, 1983.

51
Continuing Education (CE) Contact Hours
  • Answer the post test questions
  • Minimum passing score 76
  • Minimum correct answers 19/25
  • Complete the evaluation
  • Print your certificate
  • Thank You for Reading This SIM

52
Additional Information
  • Patricia L. Baker RN, MS
  • Director, Staff Development
  • 248-465-7324
  • pbaker_at_mpro.org
  • Carol J. Grubba, RN, MSN, BC
  • Project Manager, Continuing Education
  • 248-465-7337
  • cgrubba_at_mpro.org

53
  • 7SOW-MI-CE-05-05
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