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Foundation Quality Improvement Training
Session Aims
By the end of this session you will:
• Be aware of the Six Dimensions of Quality Healthcare
• Understand the Model for Improvement
• Be able to write a SMART aim
• Understand a Driver Diagram
• Understand the importance of PDSA cycles and tests of change
Quality Improvement is about making the
Six Dimensions of Quality Healthcare
better for receipts of care.
What is Quality Improvement in the context of healthcare ?
Six Dimensions of Quality Healthcare
QI – The science
• Has its origins in US and Japanese manufacturing in the 1950s.
• Focused on the methods, theories and approaches that facilitate or
hinder efforts to improve quality.
• W Edwards Deming created his System of Profound Knowledge
• Be a “Systems’ Thinker”:
• Understand how the system is performing and you can change it
• We work in human systems so…improvement is prediction
Model for Improvement….
Asks three Questions.
What are we trying to accomplish? A good aim will help you to achieve you goal and should be
SMART.
Stre-e-e-e-e-e-e-e-e-e-etch
Specific
Measurable
Achievable
Relevant
Time limited
Aim Statements
We aim to reduce harm and improve patient safety for all our internal and external customers.
To reduce all Hospital acquired Pressure Ulcers including DTI’s by 50% across Innovation wards by January 2021.
Consider the above aims, are they SMART?
See next slide for comments
Aim Statements We aim to reduce harm and improve patient safety for all our internal and external customers.
• Not specific – What does “reduce harm and improve patient safety” mean? • No measure – How will you know what has been achieved? • Not time limited – When does the objective need to be reached by?
To reduce all Hospital acquired Pressure Ulcers including DTI’s by 50% across Innovation wards by January 2021.
• Specific – Reduce all Hospital acquired Pressure Ulcers including DTI’s • Measurable – By 50% • Achievable - Ambitious but not unrealistic • Relevant – Linked to the goals of the organisation i.e.: Reducing harm, mortality, or safely reducing costs • Time Limited – Clear deadline (avoiding statement like within 6 months, etc.)
X
The acid test
What Do We Know About Successful Teams?
If a team is truly engaged five team members can articulate the aim when asked without prompting or variation.
How do we know that a change is an improvement?
“When you can measure what you are speaking about and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind.”
Lord Kelvin, May 3, 1883
Why we measure… Research… Where the aim is often new healthcare knowledge i.e. Is a new treatment effective in combatting a particular disease? Researchers often have fixed hypotheses that they try to either prove or disprove by collecting lots of data.
Accountability… Otherwise known as data for comparison, looking at 2 data points and asking are we better than this point last year? We are judged by the government and regulatory bodies with this type of measurement.
Improvement… With measurement for quality improvement, we are focusing on learning from the variation in our data, and collecting just enough data to know if our changes have improved our processes.
Why is measurement important in Quality Improvement ?
• Gives credibility to your position
• Proves ideas work
• Shows an understanding of the process
• Increase the appetite for improvement
“Don’t just tell me it is better, show me.”
Types of measures
Outcome Measures Tell you whether you will achieve the overall aim Process Measures Tell you whether you are implementing actions that are expected to improve the outcome measure Balancing Measures Monitor whether changes to improve one part of the system aren’t causing new problems in other parts of the system
Session Aims To reduce the number of
category 2 pressure ulcers by 50% by January 2020
Outcome measures the number of category 2 pressure ulcers per year
Process measures compliance with enhanced care documentation
Balancing measures An increase in catheter related Urinary Tract Infections due to an increase in the use of catheters due to fear of skin damage in incontinent patients
Data analysis
What questions do we want to answer with our data in improvement?
1) Has there been change over time?
2) Can we understand the variation in this process?
What changes can we make?
A driver diagram
• A helpful improvement tool when developing change ideas
• It helps to reinforces the aim statement as the goal
• It clarifies the big picture
• Aids in development of measurement
Most importantly: Helps teams to articulate their contribution to
the overall aim and avoid missing important system components.
What are the component parts?
Aim or goal of the improvement effort
Primary drivers - system components that contribute directly to the chosen aim or goal. Processes, rules of conduct, structure
Secondary drivers - elements of the primary drivers and which can be used to create change projects. Components and activities
Relationship arrows - show the connection between the primary and secondary drivers. A single secondary driver may impact upon a number of primary drivers
100% of patients on A7 receive their lunch of choice
everyday by 12.30, by 30th June
2021
Know what patient want/need for lunch
Lunch & equipment arrives on time
Ward staff are available to give out
lunch
Patients are available to receive lunch
Aim/Outcome Primary drivers Secondary drivers
Menu cards distributed
Choices recorded & communicated
Dietary requirements understood
Numbers established & communicated
Time for delivery agreed
Access to ward available
Allocate lunch duty
Complete other tasks prior to lunch
Staff are appropriately trained
Schedule inpatient appts appropriately
Appropriately positioned
Maintained at appropriate temperature
PDSA Cycles
A fact….
All improvement will require change,
but not all change will result in improvement!
Therefore, we need to “test” change.
The PDSA Cycle
Plan
Do Study
Act
Act Adapt?
Adopt? Abandon?
Study Analyse data
Study the results Compare results
& predictions
Plan Develop the test (Who? What?
When? Where? Data?) Predict what will happen.
Do Try out the test on a small
scale Observe & document results
Why test change before implementing it?
• It involves less time, money and risk
• The process is a powerful tool for learning; from both ideas that
work and those that don’t
• It is safer and less disruptive for patients and staff
• Because people have been involved in testing and developing
ideas, there is often less resistance
PDSA - Conclusion • Small scale • Hunches • Don’t always need to ask permission • Collect and use data! • Document success, and failures, it’s all learning! • Repeat and test again…
Develop Test Implement Spread
Repeated PDSA cycles
Repeated PDSA cycles
• Repeated use of the PDSA cycle will lead to changes that will result in an improvement, but it may take many cycles.
• Start off with a hunch or a theory and test it. • Learn from the outcomes of that test. • Make multiple small scale tests, each time adapting based on what you
learned from the previous test. • When achieving 95% compliance in the small scale setting , test it over a
broader area, perhaps over the whole ward rather than one bay if that is successful you may choose to scale up to the whole ward and change the time you are testing for example over the weekend, or away from 9 – 5.
• Eventually you will have tested multiple cycles, over different time periods across different settings, and you feel that it is robust enough to be offered as a change that other areas can adopt to improve their areas.
Reflection - What did you learn?
Thank you
