Andrea McCormick RN, MN

SickKids, Toronto

Key terms and Definitions

Regulations

Three fundamental questions, which can be addressed in any order.

The Plan-Do-Study-Act (PDSA) cycle to test changes in real work settings. The PDSA cycle guides the test of a change to determine if the change is an improvement.

“Lean is popular for its methodical approach to streamlining both manufacturing and service processes by eliminating waste while continuing to deliver value to customers.”

“Six Sigma is simply a method of efficiently solving a problem. Using Six Sigma reduces the amount of defective products manufactured or services provided, resulting in increased revenue and greater customer satisfaction.”

https://goleansixsigma.com/what-is-lean-six-sigma/

Easy to jump to conclusions

Many will describe the problem as the intervention◦ Example- Our supply chain in ICU needs a total redesign so staff

can find what they need◦ Digging deeper might indicate that the problem is not quite as

described above

Ask yourself WHY five times to understand the core of your problem◦ Example #1- staff cannot find what they need in our current

supply chain◦ Example #2- we have a problem with high usage items in the

supply chain related to inaccurate par levels◦ Example #3- we have a problem with inaccurate par levels in the

supply chain of high usage items in the critical care unit because of outdated data in the stores dept.

Must have front line representation or equivalent

Must continually refer back to your core stakeholders to check your assumptions and planned interventions

Organizing stakeholders using a stakeholder analysis tool

Utilize SMART Goals:◦ Specific, Measurable, Achievable, Relevant and

Timely

Understand the hierarchy of interventions before designing your strategy

Process measures: the steps or parts of the system that contribute to the outcome measure either indirectly or directly ◦ Example: % of compliant audits of practice for CLABSI*

Outcome measures: the end impact on patients, staff, system etc. that can be objectively measured◦ Example: CLABSI infections per 1000 line days

Balancing measures: will changes in this new project/program have upstream or downstream effects on the system and stakeholders?◦ Example: introduction of a new practice for CLABSI that

increases time burden on front line staff

Metrics should be selected to have the following characteristics:

Driver and Watcher on unit or quality scorecards◦ As few as possible to provide meaningful

information

◦ Measured as a rate whenever possible

◦ Measure over time

◦ Clear targets based on rational data

Past performance, benchmarks, past rate of improvement, theoretical best

Understand your project’s SCOPE:◦ Unit based

◦ Hospital based

◦ Multi centre and collaboratives- data sharing agreements in place?

Submission for Approvals◦ REB

◦ Quality and Safety Office

Privacy, Personal Health Information, Consent

Measurement for ResearchMeasurement for Learning and Process Improvement

Purpose To discover new knowledge To bring new knowledge into daily practice

Tests One large "blind" test Many sequential, observable tests

Biases Control for as many biases as possible

Stabilize the biases from test to test

Data Gather as much data as possible, "just in case"

Gather "just enough" data to learn and complete another cycle

Duration Can take long periods of time to obtain results

"Small tests of significant changes" accelerates the rate of improvement

Bryson, J. (1995) Strategic Planning for Public and NonprofitOrganizations (rev. edn), San Francisco, CA: Jossey- Bass. Latest edition Strategic Planning for Public and NonprofitOrganizations: A Guide to Strengthening and Sustaining Organizational Achievement (Bryson on Strategic Planning).

Source: Stakeholder Analysis | BEST way to analyse Stakeholders https://www.stakeholdermap.com/stakeholder-analysis.html#bryson

Cefazzo, J & St. Cyr, O. (2012). From Discovery to Design: The Evolution of Human Factors in Healthcare. HealthCare Quarterly April:24-29 doi.

Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.

Martin LA, Nelson EC, Lloyd RC, Nolan TW. Whole System Measures. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2007. (Available on www.IHI.org)

Scoville R, Little K. Comparing Lean and Quality Improvement. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2014. (Available at ihi.org)