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Tools of the Trade Continuous Quality Improvement

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Capability & Learning Consultant Area Quality Manager ... Standardised quality improvement methodology ... Alarm clock malfunction. Summary of Day One. Defined quality ... – PowerPoint PPT presentation

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Title: Tools of the Trade Continuous Quality Improvement


1
Tools of the Trade Continuous Quality Improvement
  • Anne Mason Tonia Easton
  • Capability Learning Consultant Area Quality
    Manager
  • Organisational Capability Learning Clinical
    Governance Unit
  • Day One
  • 2007

2
Program Goals
  1. Standardised quality improvement methodology
  2. Improved skills in applying quality improvement
    methodology
  3. De-mystify the process straight forward
    widely applicable.
  4. It applies to all staff. Not just the
    responsibility of Quality Managers.
  5. Method can assist in improving service delivery.

3
Learning Outcomes
  • To achieve these goals the program will
  • Use data to identify and prioritise
    opportunities for improvement and monitor
    outcomes
  • Develop an understanding of the tools of
    Continuous Quality Improvement and their
    appropriate application
  • Apply the tools of Continuous Quality Improvement
    to address a problem area (variation)
  • Develop teams to complete a quality project that
    meets the requirements for HNE Quality Awards
    submission
  • Develop presentation skills to sell outcomes of
    completed project

4
Program structure
  • Day1
  • Overview of quality
  • CQI methodology
  • Project Phase
  • Diagnostic Phase
  • Day 2
  • Intervention Phase
  • Impact Phase
  • Sustainability
  • Presentation Skills
  • Day 3
  • Project presentations CE, Director,etc

5
Day One Learning Objectives
  • Define quality in customer terms
  • Differentiate between CPI and Maggie methodology
    criteria
  • Establish a quality improvement project team
  • Develop a specific aim and mission statement for
    a CPI project
  • Select and apply appropriate tools for the
    collection of evidence
  • Organise and prioritise data to provide
    information

6
What do we mean by Quality?
  • When you go to your favourite restaurant or have
    your car serviced what features do those business
    offer that are quality to you?
  • Why do you go back?

7
What do we look for?
  • Consistency
  • Reliability
  • Dependability
  • In other words no variation in the service
    provided.
  • Quality is also about the control of variance.

8
Quality
  • Can be doing the right thing the first time, in
    the right way, and at the right time. (NSW
    health)
  • Quality can also be construed as the absence of
    error, harm or failure.
  • The control of variance

9
Continuous Quality Improvement
  • What is it?
  • Every system is perfectly designed to achieve
    exactly the results it gets..
  • ..if you dont like the results, change the
    system.
  • Professor Donald Berwick, CEO. Institute for
    Healthcare Improvement, Boston
  • it requires the understanding of variation, a
    focus on the customer, and the involvement of
    employees at all levels in an organisation in
    pursuit of improvement

10
Principles of Quality Improvement
  • The principles of quality improvement include
  • Health care delivery is a system that is made up
    of many individual processes
  • Health services quality issues and adverse events
    are usually system-related and process-related
  • Individuals who work in the system are highly
    motivated to do the best they can and have
    extensive knowledge of their area of expertise
  • Improving quality requires data-based decisions,
    teamwork, change management and creative thinking
    techniques

11
So what is all the fuss about?
  • Developing new strategies of innovative
    healthcare
  • Supporting continuous service review
  • Supporting the practice of safe and
    evidence-based healthcare.
  • Supporting the provision of a quality healthcare
    experience.
  • Listening to the voice of the customer
  • Aligning core processes to strategy

12
Different Methodologies
  • Within HNE Health you will hear of
  • Maggie Program
  • CPI projects
  • CSRP (NSW Health)
  • These are all QI methods or processes that are
    based on the same philosophy and objectives.
  • They all use a generic set of tools and
    techniques.

13
CSRP
  • Clinical Systems Redesign Process (NSW Health)
  • May be supported by a Maggie Process or
  • Six sigma methodology

14
6 sigma overview
  • Six Sigma is a measure of variability
  • Used to indicate how often we meet our customers
    requirements
  • The higher the sigma level the fewer the defects
  • A sigma process has on average 3.4 defects per
    million opportunities
  • 6 sigma I miss spelt word in all of the books
    in a small library or in time 6 seconds over 1
    century
  • Aircraft are designed to a 9 sigma level

15
  • 6 sigma is the bringing together of
  • Process improvement
  • Change management
  • Project management

16
Six Sigma Process Redesign
17
Maggie Project - Overview
18
Maggie Project Criteria
  • A number of patients/clients are dissatisfied or
    disadvantaged as evidenced by patient
    satisfaction surveys, complaints or incidents
  • There will be a positive organisational impact
    according to the following indicators
  • Staff satisfaction
  • Safety
  • Access
  • Efficiency (LOS)
  • Other organisational KPIs

19
Maggie Project Criteria cont
  • The proposed project is consistent with the
    Maggie Program Aims patient centred,safe,
    effective,accessible,efficient
  • There is a potential for return on investment
    significant benefits/improvements to the service.
  • Readiness/commitment/capacity within the service
    to participate

20
Clinical Practice Improvement
21
CPI Project Criteria
  • Proposed projects may address one of the
    following
  • A high priority outcome from an RCA
  • Management of clinical costs and high variation
  • Consumer or staff dissatisfaction around a
    certain area or process of care
  • Significant performance gap between current
    practice / performance and best practice / EBM

22
PI Project Criteria cont
  • Proposed project must address one of the
    following
  • A high priority area for the AHS as identified
    by
  • Clinical Excellence Commission initiatives
  • Professional Bodies ie. RACS, RACP etc
  • Managed Clinical Networks / Clinical Councils /
    Streams
  • Improvement of a specific process within a unit
    or across a department
  • ?Templates for submission of prospective
    projects!

23
CPI Project Criteria cont
  • Proposed project must satisfy the following
    requirements
  • Assist in achieving HNE Healths strategic
    priorities
  • Provide an opportunity to spread the lessons
    learnt / innovation from the project to other
    clinical areas within HNE
  • Demonstrate there is a readiness/ senior
    clinician commitment/ capacity within the service
    to conduct the project
  • Organisational sponsor

24
Unsuitable projects
  • Service development plans
  • Randomised control trials
  • Where there is no link to the provision of
    clinical service e.g. structural, interpersonal
    or professional competency

25
Workshop 1
  • In project groups
  • Review potential projects in terms of meeting CPI
    criteria

26
The Basic CPI Concept includes
  • Find a process to improve
  • Organise a team that knows the process
  • Clarify current knowledge of the process
  • Understand the causes of the variation
  • Select the area of the process for improvement
  • Plan the improvement, data collection and
    analysis
  • Study the results and lessons learned from the
    team effort
  • Act to hold the gain and continue to improve the
    process

27
The improvement process
28
Project Phase
29
Project Phase
30
Mission / Aim Statement
  • Specific setting boundaries
  • Measurable include a numerical goal
  • Appropriate - related to the project title
  • Result orientated focused on outcome
  • Time scheduled defining a time period

31
  • Example
  • To decrease the rate of infections in joint
    replacement surgery to less than 1 within 12
    months.

32
Workshop 2
  • In project groups
  • Develop aim / mission statements for projects

33
Team membership
  • Ideally 5 9 members
  • Members with fundamental knowledge
  • Different perspectives
  • Quality advisor on the team
  • Identified team leader

34
Team Rules
  • Safe (no personal attacks)
  • Inclusive (open to all potential contributors)
  • Open and consensus seeking (considers all ideas
    fairly)
  • Defined roles and responsibilities
  • Agreed interest in outcome
  • Team meetings have agreed ground rules

35
Team Roles
  • Senior Executive
  • Executive Sponsor
  • Team Leader
  • Team Member

36
Senior Executives Role
  • Provide leadership
  • Establish targets
  • Establish importance of improvement
  • Review results

37
Executive Sponsors Role
  • Select improvement project to align with
    organisations' objectives
  • Provide information on requirements
  • Monitor progress of project
  • Break down barriers
  • Engage stakeholders
  • Reward team success
  • Communication plan (The what and the how)

38
Team Leaders Role
  • Establish team
  • Engage stakeholders
  • Manage communications within the team and with
    sponsor
  • Champion the improvement project
  • Manage reporting
  • Celebrates team success

39
Team Members Role
  • prepare for team meetings
  • Arrive on time for meetings
  • Complete action items
  • Treat team members with courtesy
  • Actively participate in discussions
  • Keep the team informed of activities

40
Effective meetings
  • Agenda
  • Arrive on time
  • All contribute
  • All contributions valued
  • Records of meetings
  • Action plan
  • Only when needed
  • Release to attend

41
Stakeholders
  • Any individual or group who
  • Can influence the outcome or ultimate success
  • Will be affected by the changes / solutions
  • May be internal or external to the service

42
Keeping Records
  • Team leader manages team and performs
    administrative duties
  • Action minutes should be kept to record progress
    of project and individual responsibilities

43
The improvement process
44
Diagnostic Phase
45
Diagnostic Phase
46
Diagnosing the Problem
  • Involves collecting the evidence needed to
    diagnose the problem
  • Determining the causes
  • Prioritising the causes

47
Collecting Evidence
  • Range of tools available
  • Flow chart
  • Brainstorming
  • Multivoting
  • Customer Focus Groups
  • Tag alongs
  • Data sources available

48
Data sources
  • Utilisation / activity
  • Benchmarking
  • Performance indicators
  • Adverse events
  • Incident reports
  • Complaints
  • Staff surveys
  • Audits

49
Workshop 3
  • What data do you have already?
  • Do you require any further data?
  • Does it exist?
  • If not how will you access it?

50
Flow Chart
  • Usually the first task done by the team
  • Flow chart of the existing problem
  • After the aim or mission has been defined
  • Represents the sequence of steps or decision
    flows in a process

51
Flow chart
  • Flow charting facilitates
  • Understanding of the process as it currently
    exists
  • Open criticism of the process, comparison and
    identification of improvement points
  • Identifies the complexity of the process and its
    management
  • Identifies outcome and process steps
  • Establishes process measures
  • A better, less complex process

52
Flow chart
53
Workshop 4
  • Work in teams of 5-6
  • Use the flow chart conventions
  • Construct a flow chart of getting up in the
    morning
  • Not a detailed flow chart an overview

54
Brainstorming
  • Objective is to generate as many ideas as
    possible from the team
  • Useful tool when trying to identify causes of a
    particular problem or solutions to the causes
  • Process can quickly identify causes and solutions
    (right team with fundamental knowledge)
  • Two common methods
  • Structured contribute in turn until out of ideas
  • Unstructured anyone calls out an idea, no order
    until out of ideas

55
Brainstorming
  • Next step is to identify priority issues some
    form of voting
  • Issue is complex and large number of people
    involved, multivoting is the best option

56
Multivoting
  • Structured approach used by groups to select the
    most significant or top priority items on a list
  • Usually follows a brainstorming session that has
    generated many ideas
  • Objective is to identify a small number of items
    requiring or worthy of immediate action
  • Outcome from multivoting reflects popular opinion
    and should not be confused with data collection

57
Cause and effect diagram
  • Is sometimes called a fishbone diagram or an
    Ishekawa.
  • Organises and categorises ideas generated from
    brainstorming
  • Graphically displays an organised list of
  • Possible causes
  • Solutions
  • Factors
  • Can be used to support multivoting

58
Cause and Effect diagram
59
Workshop 5
  • Construct a cause and effect diagram to identify
    the causes of not arriving to work on time.
  • Suggested categories are
  • Environment
  • People
  • Equipment
  • Procedures

60
Prioritising Information
  • Affinity Diagram
  • Pareto Chart
  • Graphs e.g. Run chart, Statistical Process
    Control chart

61
Pareto Charts
  • A graphical display of the relative frequencies
    of different choices or options (expressed as )
  • Drawn as a bar chart
  • Options or choices are ranked in order from
    greatest to least.
  • Often includes a cumulative total line above the
    bars

62
Pareto chart
63
Workshop 6
  • Working in groups
  • Construct a Pareto Chart of the following options
  • Causes of not arriving at work on time

Alarm clock malfunction 23
Slow in morning 15
Child care problems 45
Roster change not communicated 5
Mechanical problems with car 12
64
Summary of Day One
  • Defined quality
  • Discussed the various improvement methodologies
  • Identify problems that require a CPI project
  • Establish a quality improvement project team
  • Develop a specific aim and mission statement for
    a CPI project
  • Select and apply appropriate tools for the
    collection and prioritisation of evidence

65
Homework
  • Aim / mission statement
  • Team (Action minutes of meetings)
  • Determine team leader
  • Identify project sponsor
  • Identify relevant data
  • Flowchart
  • Cause and effect diagram

66
  • Next learning session
  • Establishment of 2nd weekly teleconferences with
    team leader
  • Enrolment Statement of attendance
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