promoting quality for better health services qi presentation: skills and examples dr david gozzard...

Promoting quality for better health services

QI Presentation: Skills and Examples

Dr David Gozzard

Senior Fellow, Institute for Healthcare Improvement, Boston US

Objectives of the Session

• Understanding of relationship between structure and process

• Introduction to process mapping

• Driver diagram development

• PDSA worked examples

System Design

Every system is perfectly designed to achieve exactly

the results it gets

The Healthcare System

The Patient133 People to take careof the patient

STRUCTURE+

PROCESS=

OUTCOME

DGCL

PROCESS MAPPING

Why Map Processes?

A Simple Flowchart

Dealing with a non-functioning lamp

Waking up in the morning

Another Simple Flowchart

Process Maps

A New Tool – Driver Diagrams

12

A tool to help us understand the messiness of life!

What changes can we make?

• Primary Drivers– System components which will contribute to

moving the primary outcome

• Secondary Drivers– Elements of the associated Primary Driver. They

can be used to create projects or a change package that will affect the Primary Driver.

Stroke Driver Diagram

Driver Diagram Exercise

• Establish stakeholder group• Objectives• Discussion regarding concerns (group)• Flipchart exercise (smaller groups)• Sticky notes exercise (individual)• Coffee!!

– Whilst this is taking place the notes are “themed”• Stakeholders view themes (primary drivers)• Group exercise to format driver diagram

Anaemia ManagementDriver Diagram

PrimaryDriversOutcome

SecondaryDrivers

Ideas for ProcessChanges

AIM:A New

ME!

Calories In

Limit dailyintake

TrackCalories

CaloriesOut

Substitutelow calorie

foods

Avoidalcohol

Work out 5days

Bike towork

PlanMeals

Drink H2ONot Soda

drives

drives

drives

drives

drives

drives

drives

drives

• Weight• BMI• Body Fat• Waist size

• Daily caloriecount

• Exercisecalorie count

• Days betweenworkouts

• Avg drinks/week

• Runningcalorie total

• % ofopportunitiesused

• Sodas/week

• Meals off-plan/week

• Avg cal/day

Exercise

Fidgiting

HackySack inoffice

Percent of dayson bike

Etc...

How Will We Know We Are Improving?How Will We Know We Are Improving?Understanding the System for Weight Loss with MeasuresUnderstanding the System for Weight Loss with Measures

Measures let us• Monitor progress in

improving the system• Identify effective changes

Group Work

• Working in pairs, for an improvement aim arising from a national audit define the following:

• Primary drivers• Secondary drivers• Possible projects

• Allow 10 minutes for this exercise

21

Guidance for testing a change concept

A test of change should answer a specific question!

A test of change requires a theory and a prediction!

Test on a small scale and collect data over time.

Build knowledge sequentially with multiple PDSA cycles for each change idea.

Include a wide range of conditions in the test sequence.

Don’t confuse a task with a test!

22

The Model for Improvement

Define the question Gather information and resources (observe) Form hypothesis

Perform experiment and collect data

Analyze and interpret data

Generate new hypothesis and

retest

Why Test?

Why not just implement then spread?• Increase degree of belief• Document expectations • Build a common understanding • Evaluate costs and side-effects• Explore theories and predictions• Test ideas under different conditions• Learn and adapt

24

Repeated Use of the PDSA Cycle

Hunches Theories

Ideas

Changes That Result in

Improvement

A P

S D

APS

D

A P

S D

D SP A

DATA

Very Small Scale Test

Follow-up Tests

Wide-Scale Tests of Change

Implementation of Change

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

The Sequence for Improvement

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Spreading a change to other locations

Developing a change

Implementing a change

Testing a change

Act Plan

Study DoTheory and Prediction

Test under a variety of conditions

Make part of routine

operations

Group Work

• Working in pairs, devise a PDSA cycle to test an idea based upon a problem arising from a national audit.

• Note – your driver diagram exercise will have developed some ideas for testing!

• Allow 10 minutes for the exercise

Promoting quality for better health services

Thank You

Any Questions?