Implementing QI ProjectsImplementing QI Projects

Title I HIV Quality Management ProgramTitle I HIV Quality Management ProgramCase Management Providers MeetingCase Management Providers Meeting

May 26, 2005May 26, 2005

Presented by Lynda A. O’Hanlon Presented by Lynda A. O’Hanlon Title I HIV QI ConsultantTitle I HIV QI Consultant

What is “Quality Improvement”?What is “Quality Improvement”?

Patients and our customers are the Patients and our customers are the firstfirst priority priority Emphasis on systems of care, instead of individual Emphasis on systems of care, instead of individual

providersproviders Routine and periodic measurement of performanceRoutine and periodic measurement of performance QI goals are based upon performance dataQI goals are based upon performance data Improvements are made by implementing specific Improvements are made by implementing specific

quality projectsquality projects Improvement projects include participation by those Improvement projects include participation by those

persons involved in the delivery of servicepersons involved in the delivery of service

QUALITY IMPROVEMENT QUALITY IMPROVEMENT Model: Project LevelModel: Project Level

Step 1: Collect and Analyze Baseline DataStep 1: Collect and Analyze Baseline Data Step 2: QI Team SelectionStep 2: QI Team Selection Step 3: Develop a Project Team Work PlanStep 3: Develop a Project Team Work Plan Step 4 Project Team Investigates the Process Step 4 Project Team Investigates the Process Step 5. Project Team Plans and Tests Change(s)Step 5. Project Team Plans and Tests Change(s) Step 6: Project Team Evaluates Result(s) with Key Step 6: Project Team Evaluates Result(s) with Key

StakeholdersStakeholders Step 7: Systematize ChangeStep 7: Systematize Change

Step 1: Collect and Analyze Baseline Step 1: Collect and Analyze Baseline DataData

Review existing performance measurement dataReview existing performance measurement data Identify specific indicators to be measuredIdentify specific indicators to be measured Establish methodology, define population sample and design Establish methodology, define population sample and design

data collection tooldata collection tool Share results with quality committeeShare results with quality committee

Case Management ProgramCase Management Program Data collected by NYCHRO based on established indicatorsData collected by NYCHRO based on established indicators Results shared with case management providersResults shared with case management providers Areas for improvement identifiedAreas for improvement identified

2004 – Coordination of Services2004 – Coordination of Services 2005 – Quality Improvement Collaboratives 2005 – Quality Improvement Collaboratives

Step 2: QI Team SelectionStep 2: QI Team Selection

Multi-disciplinary and intra-departmental. Multi-disciplinary and intra-departmental. Persons affected by process change should be team Persons affected by process change should be team

membersmembers Provide on-going assistance and supportProvide on-going assistance and support Ask them to work on complex meaningful problems, Ask them to work on complex meaningful problems,

e.g., Coordination of caree.g., Coordination of care Ongoing projects should be shared with all staff Ongoing projects should be shared with all staff

during the process.during the process. Involve customers/clients when possibleInvolve customers/clients when possible

Step 3: Develop a Project Team Step 3: Develop a Project Team Work PlanWork Plan

Identify team membersIdentify team members Establish team roles and “Rules of the Road”Establish team roles and “Rules of the Road” Develop project team work plan with Develop project team work plan with

assignments and expected dates of task assignments and expected dates of task completion – “completion – “QI Project Plan” toolQI Project Plan” tool

Complete improvement project memoComplete improvement project memo Clearly state the team’s goal, distribute to team Clearly state the team’s goal, distribute to team

members and to the QI Committeemembers and to the QI Committee

Step 4: Project Team Investigates Step 4: Project Team Investigates the Processthe Process

Review data and reassess project goalsReview data and reassess project goals Investigate the process being reviewedInvestigate the process being reviewed Chart the process flow within teamChart the process flow within team Identify and prioritize root causesIdentify and prioritize root causes

Step 5: Project Team Plans and Tests Step 5: Project Team Plans and Tests Change(s)Change(s)

Select solutions for pilot testingSelect solutions for pilot testing Plan and implement pilot testsPlan and implement pilot tests Measure and assess impact of pilot testsMeasure and assess impact of pilot tests Implement further pilot tests if indicatedImplement further pilot tests if indicated

Plan/Do/ Study/ Act !Plan/Do/ Study/ Act !

Plan a changePlan a change Try it on a small scaleTry it on a small scale Observe the resultsObserve the results Refine the change as necessary Refine the change as necessary

Example for PDSA CycleExample for PDSA Cycle

Use of flowsheet

will improve care to known

standards

Improved Decision Support

A PS D

APS

D

A PS D

D SP A

DATAD SP A

Cycle 1A: Develop tracking tool to communicate with medical providers

Cycle 1B: Test with eight clients and two medical providers

Cycle 1C: Refine the tool based on feedback

Cycle 1D: Test revised tool withadditional clients and providers

Cycle 1E: Implement and monitor the standards

Step 6: Project Team Evaluates Step 6: Project Team Evaluates Result(s) with Key StakeholdersResult(s) with Key Stakeholders

Review and document pilot test resultsReview and document pilot test results Present pilot results to key stakeholders and Present pilot results to key stakeholders and

“Decision Makers”“Decision Makers” Gather feedback and generate buy-inGather feedback and generate buy-in

Evaluate pilot results and revise plan as Evaluate pilot results and revise plan as indicatedindicated

Step 7: Systematize ChangeStep 7: Systematize Change

Integrate improvements into daily workIntegrate improvements into daily work Policy & procedure revisions, staff training, ongoing Policy & procedure revisions, staff training, ongoing

communication, etc.communication, etc. Re-collect data to assess improvementRe-collect data to assess improvement Assess effectiveness against original project work Assess effectiveness against original project work

planplan Benchmark against other programsBenchmark against other programs Spread improvements into wider system, if indicatedSpread improvements into wider system, if indicated Celebrate Success!! Spread the word !! Communicate Celebrate Success!! Spread the word !! Communicate

results to customers.results to customers.

Critical Ingredients for SuccessCritical Ingredients for Success

LeadershipLeadership Establish organizational commitmentEstablish organizational commitment Support staff and activitiesSupport staff and activities Set priorities and goalsSet priorities and goals

Resource CommitmentResource Commitment Create infrastructureCreate infrastructure Provide staff development and trainingProvide staff development and training

Improvement is about LearningImprovement is about Learning Use quantitative informationUse quantitative information Learn from experienced sites and programsLearn from experienced sites and programs Share findings with staffShare findings with staff

Assistance from Title I HIV Quality Assistance from Title I HIV Quality Management Program Management Program

Individualized On-site Consultation Quality Learning Network Workshops

and Presentations Capacity-building for Quality

Improvement Peer Learning Opportunities