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Introduction to Quality Improvement

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Introduction to Quality Improvement Maria Isabel Diaz, MD Pediatric Ambulatory Care St. Barnabas Hospital 08-04-10 Overview Definitions. Aims for improvement in ... – PowerPoint PPT presentation

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Title: Introduction to Quality Improvement


1
Introduction to Quality Improvement
  • Maria Isabel Diaz, MD
  • Pediatric Ambulatory Care
  • St. Barnabas Hospital
  • 08-04-10

2
Overview
  • Definitions.
  • Aims for improvement in health care.
  • Why is QI important for residents ?
  • Benefits of QI projects.
  • How to start a QI project.
  • Model for Improvement.
  • PDSA cycle.
  • Examples of success using QI.
  • References.

3
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4
Definitions
  • Healthcare Quality Improvement is the body of
    knowledge, attitudes, and skills necessary to
    efficiently influence and continuously improve
    the multiple elements of care delivery within a
    medical practice.

5
Definitions
  • Quality Meeting the needs and exceeding the
    expectations of those we serve. Delivery all and
    only the care that the patient and family needs.

6
Definitions
  • Improvement It is not,
  • Yelling at people to work harder, faster, or
    safer.
  • Creating order sets or protocols and then failing
    to monitor their use or effect.
  • Traditional QA.
  • Research (but they can co-exist nicely)

7
  • v Doing the right thing
  • (evidence based)
  • For every patient (equal care)
  • Every time
  • (consistent care)

8
Why Quality Improvement?
  1. RIGHT THING TO DO
  2. PRACTICE PRIVILEDGES
  3. REPORT CARD
  4. INCOME

9
Six specific aims for improvement. Health care
should be
  • Safe Avoid injuries to patients from the care
    that is intended to help them.
  • Effective Avoid overuse of ineffective care and
    underuse of effective care.
  • Patient-Centered Providing respectful,
    responsive, individualized care.

10
Six specific aims for improvement. Health care
should be
  • Timely Reducing waits and harmful delays in
    care.
  • Efficient Avoiding waste of equipment, supplies,
    ideas and energy.
  • Equitable Providing equal care regardless of
    personal characteristics, gender, ethnicity,
    geographic location, and socio-economic status.

11
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12
  • The Goal for Quality improvement in health care
    is TO PROVIDE THE RIGHT CARE FOR EVERY PATIENT,
    EVERY TIME!!

13
Why is Quality Improvement important for YOU???
  • Why should you care? Why WE care?

14
Benefits of resident involvement in Quality
Improvement.
  • Patient care outcomes
  • Resident learning and professional development
  • Resident engagement and satisfaction
  • Faculty and other team member engagement and
    satisfaction.

15
One of the Competencies Practice Based Learning
and Improvement
  • Residents must be able to investigate and
    evaluate their patient care practices, appraise
    and assimilate scientific evidence, and improve
    their patient care practices.

16
How do you start a QI project?
17
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18
Model for Improvement
  • The model has two parts
  • Three fundamental questions, which can be
    addressed in any order.
  • The Plan-Do-Study-Act (PDSA) cycle to test and
    implement changes in real work settings.

19
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20
What are you trying to accomplish?
  • Setting Aims
  • The aim should be time-specific and measurable
    it should also define the specific population of
    patients that will be affected.

21
How will you know that a change is an improvement?
  • Establishing Measures Use quantitative measures
    to determine if a specific change actually leads
    to an improvement

22
What changes can you make that will result in
improvement?
  • Selecting Changes All improvement requires making
    changes, but not all changes result in
    improvement. Therefore we must identify the
    changes that are most likely to result in
    improvement.

23
The Model for Improvement
  • Setting Aims Improvement requires setting
    aims. The aim should be time-specific and
    measurable it should also define the specific
    population of patients that will be affected.
  • Establishing Measures Teams use quantitative
    measures to determine if a specific change
    actually leads to an improvement.
  • Selecting Changes All improvement requires making
    changes, but not all changes result in
    improvement. Organizations therefore must
    identify the changes that are most likely to
    result in improvement.
  • Testing Changes The Plan-Do-Study-Act (PDSA)
    cycle is shorthand for testing a change in the
    real work setting by planning it, trying it,
    observing the results, and acting on what is
    learned. This is the scientific method used for
    action-oriented learning.  

24
Testing changes
  • The Plan-Do-Study-Act (PDSA) cycle is shorthand
    for testing a change in the real work setting
    by planning it, trying it, observing the results,
    and acting on what is learned. This is the
    scientific method used for action-oriented
    learning.

25
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26
Wheels in Motion Continuous Quality improvement
27
  • Implementing Changes After testing a change on a
    small scale, learning from each test, and
    refining the change through several PDSA cycles,
    the team can implement the change on a broader
    scale for example, for an entire pilot
    population or on an entire unit.

28
  • Spreading Changes After successful implementation
    of a change or package of changes for a pilot
    population or an entire unit, the team can spread
    the changes to other parts of the organization or
    in other organizations.

29
How hospitals and clinics have shown success
using QI.
  • Mortality has declined.
  • Rates of adverse events have decreased.
  • The cost of care in ICU has seen a gradual
    decline.
  • Critically ill patients have been recognized
    early by medical response teams.

30
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31
References
  • Road Map for Quality Improvement. Manoj Jain, MD
    MPH.
  • Institute for Healthcare Improvement.
    www.ihi.org
  • American Medical Association. www.ama-assn.org.

32
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33
Be Happy!!
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