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Performance Improvement Team Handbook

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We use the PDCA model for PI teams and we are introducing the Rapid Performance Improvement (RPI) Methodology. Teams make improvements related to the six aims: ... – PowerPoint PPT presentation

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Title: Performance Improvement Team Handbook


1
Performance Improvement Team Handbook
  • Developed by Southeast Georgia Health System
  • Quality Management Department

2
Introduction
  • Congratulations! You all have been selected as
    members in a new PI team. The most critical task
    for any new team is to establish its purpose,
    process and measures of team progress. Once
    these are established, they should be posted at
    each team meeting for reference.
  • Many teams enjoy terrific starts and then soon
    fizzle. The real challenge is to keep a team
    focused on its purpose.
  • We use the PDCA model for PI teams and we are
    introducing the Rapid Performance Improvement
    (RPI) Methodology.
  • Teams make improvements related to the six aims
    safe, effective, patient centered, timely,
    efficient and equitable. As a result clinicians
    experience greater satisfaction at being able to
    better do their jobs and bring improved health to
    those who receive their care.

3
Teams Utilize the PDCA Methodology
  • P Plan the improvement
  • D Do the data collection needed, implement the
    modified or new process
  • C Check the data for improvement
  • A Act to sustain the improvement

4
The PDCA cycle for learning and improvement
Act
Plan
Objective Questions and predictions (why) Plan
to carry out the cycle (who, what, where, when)
What changes are to be made? Next cycle?
Check
Do
Complete the analysis of the data Compare
data to predictions Summarize what was learned
Carry out the plan Document problems and
unexpected observations Begin analysis of the
data
5
Principles of PDCA Cycles
  • Use shorter cycles of changes to accelerate rate
    of improvement
  • small scale tests (What can you test by next
    Tuesday)
  • just collect enough information
  • Create flow of ideas, then emphasize
    implementation
  • increase the frequency of tests
  • increase the belief that the change will result
    in improvement and minimize resistance upon
    implementation
  • Adoption of existing knowledge (not more
    research but more application of existing
    knowledge)
  • Steal shamelessly, Share senselessly
  • Promote peer learning

6
Tips for PDCA Cycles
  • - formulate question and predict results
  • - test first in safe zones (with team members,
    volunteers)
  • - Just-do-it mentality
  • collect useful just enough data, not perfect data
  • think a couple of cycles ahead
  • scale down size of test ( of patients, clinics)
  • be innovative to make test feasible

7
Smaller Scale Tests Scale Down Timeframe
  • Years
  • Quarters
  • Months
  • Weeks
  • Days
  • Hours
  • Minutes

Reduce your timeframe to plan Test Cycle!
8
New Teams may utilize the Rapid Performance
Improvement (RPI) Methodology
  • Rapid Performance Improvement (RPI) Methodology,
    a practical performance-based process
    improvement approach. The sequence of steps
    involved is
  • Document the goals and problems to be addressed
  • Current performance is documented
  • Practices are compared to best practice and
    gaps are identified
  • Gaps are prioritized and a revised process is
    developed to achieve these objectives
  • The revised processes are deployed to the target
    groups and results are monitored
  • Performance and process adherence are assessed to
    determine the level of success. The resulting new
    practices become the target groups current
    performance and the cycle is repeated.

9
Rapid Performance Improvement (RPI) Methodology
Tools
Gap Analysis
Current Performance Best Practice Gaps Identified



Gap Prioritization
Gap Identified Description Severity Rating Probability Rating Detectability Rating Hazard Score priority number




Severity 1 No Harm 2 Temporary Harm 3 Permanent Harm 4 Death/major loss of function Severity 1 No Harm 2 Temporary Harm 3 Permanent Harm 4 Death/major loss of function Severity 1 No Harm 2 Temporary Harm 3 Permanent Harm 4 Death/major loss of function Severity 1 No Harm 2 Temporary Harm 3 Permanent Harm 4 Death/major loss of function Severity 1 No Harm 2 Temporary Harm 3 Permanent Harm 4 Death/major loss of function Severity 1 No Harm 2 Temporary Harm 3 Permanent Harm 4 Death/major loss of function
Probability 1 Remote 2 Uncommon 3 Occasional 4 Frequent Probability 1 Remote 2 Uncommon 3 Occasional 4 Frequent Probability 1 Remote 2 Uncommon 3 Occasional 4 Frequent Probability 1 Remote 2 Uncommon 3 Occasional 4 Frequent Probability 1 Remote 2 Uncommon 3 Occasional 4 Frequent Probability 1 Remote 2 Uncommon 3 Occasional 4 Frequent
Detectability 1 Very Likely 2 Likely 3 Unlikely 4 Very Unlikely Detectability 1 Very Likely 2 Likely 3 Unlikely 4 Very Unlikely Detectability 1 Very Likely 2 Likely 3 Unlikely 4 Very Unlikely Detectability 1 Very Likely 2 Likely 3 Unlikely 4 Very Unlikely Detectability 1 Very Likely 2 Likely 3 Unlikely 4 Very Unlikely Detectability 1 Very Likely 2 Likely 3 Unlikely 4 Very Unlikely
Hazard Score Risk Priority Number (RPN Severity x Probability x Detectability) Hazard Score Risk Priority Number (RPN Severity x Probability x Detectability) Hazard Score Risk Priority Number (RPN Severity x Probability x Detectability) Hazard Score Risk Priority Number (RPN Severity x Probability x Detectability) Hazard Score Risk Priority Number (RPN Severity x Probability x Detectability) Hazard Score Risk Priority Number (RPN Severity x Probability x Detectability)
10
Team Roles
All members except the facilitator are active
team members even though they may have additional
roles.
11
Team Roles
  • Team Member
  • Members are chosen because they work in, have
    knowledge of that is the focus of the team. or
    receive benefit of the process that is the focus
    of the team. They share responsibility for the
    effectiveness of the team.
  • Contribute ideas
  • Make decisions
  • Plan future work
  • Support collaboration
  • Collect and analyze data
  • Team Leader
  • The leader is generally the person who is
    recognized as the owner of the process that is
    the focus of the team.
  • Works with the facilitator to develop a plan for
    the team
  • Coordinates and directs the work of the team
  • Manages the meeting process
  • Recorder
  • Recorder can be assigned or rotated to help the
    team maintain a record of its work.
  • Records on flipchart when needed
  • Takes minutes
  • Timekeeper
  • Timekeeper can be assigned or rotated to help the
    team manage time.
  • Helps the team determine how it wants to be
    informed about the time

12
Team Rules
  • Keep an open mind
  • Listen and understand what is said
  • Avoid side conversations
  • Respect others opinions
  • Avoid personal agendas
  • Come prepared to do whats good for the health
    system
  • Complete assignments
  • Follow up on action items
  • No idea is a bad idea
  • Be creative
  • Take risks
  • No criticism allowed
  • Start on time
  • End on time
  • Participate!
  • Have fun!

13
Brainstorming Activity
  • Generate ideas
  • Use games and exercises to warm up your
    creative thinking
  • When ideas slow down, try another exercise to
    generate fresh ideas
  • Breaking into smaller groups may be helpful
  • Use a computer or flip chart to capture every
    comment/idea

14
Set SMART Goals
  • Goals are
  • Specific
  • Measurable
  • Achievable
  • Realistic
  • Time-phased
  • Set goals realistic, reasonable, challenging,
    attainable goals
  • Long-term
  • Intermediate-term
  • Short-term

15
Using Data
  • Identify why we are collecting the data
  • JCAHO PI.1.1, DHR, CMS
  • What are we going to do with it?
  • Always define data
  • Ask yourself if the data is complete or do we
    need additional information
  • When using data, define targets and benchmarks.
    Identify those benchmarks on the graphic
    displays.
  • Remember Data is not information until it has
    been interpreted!

16
Statistical Terms
  • Mean-sum of quantities/number of quantities (the
    average)
  • Median-middle value when all data points are
    arranged numerically used a lot of times as the
    middle line in run charts because it requires no
    calculation
  • Mode-the most frequently occurring value
  • Standard deviation-measure of the spread of a
    distribution
  • Control limit-an expected limit of common-cause
    variation referred to as either an upper or lower
    limit. Limits are calculated from process data
  • Variation-the inevitable difference among
    individual outputs of a process. The sources of
    variation can be grouped into two major classes
    Common Causes and Special Causes.

17
Performance Improvement Tools
  • Flowcharts are available in Powerpoint and QI
    Macros in Excel.
  • Oval represents the beginning or ending of a
    process
  • Rectangle represents an action step in the
    process.
  • Diamond represents a decision step.
  • Arrows represent the direction of the process
    flow.

18
Performance Improvement Tools
  • Tree Diagram
  • Run Chart
  • Histogram
  • Pareto Chart

Tools are available in QI Macros in Excel
19
Performance Improvement Tools
  • Failure Modes and Effects Analysis
  • Scatter Diagram and Probability Plot
  • Comparison Matrix
  • Relationship Diagram

Tools are available in QI Macros in Excel
20
Plans of Action
  • Develop programs/methods/plans of action
  • The requirements for achieving set goals.
  • Who will do which part.
  • How the different parts tie together.
  • Determine the phases of the action plan
  • Identify a representative that will be
    responsible for each phase.
  • Determine the beginning, middle, and end of each
    phase.
  • Determine benchmarks to measure strengths and
    areas of improvement

21
Good Luck and Have Fun!!!
22
References
  • Moen, Ronald, Thomas Nolan Process Improvement
    Quality Progress, 1987, p62
  • Langley, Gerald, Kevin Nolan and Thomas Nolan
    The Foundation of Improvement, Quality
    Progress, June 1994, p. 81
  • Langley, Gerald, Kevin Nolan, Thomas Nolan, Cliff
    Norman, and Lloyd Provost The Improvement
    Guide San Francisco, CA Jossey-Bass, 1996
  • Nolan, Kevin ASQs Accelerating Change
    Collaborative Series A Challenge for Industry,
    Quality Progress, Jan 1999, p55
  • 2006 Hospital Accreditation Standards. Joint
    Comission on Accreditation of Healthcare
    Organizations. 2006.
  • QI Macros Training Manual. Lifestar. 2005.
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