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PERFORMANCE IMPROVEMENT What is it and how is it done? What is it and how is it done? 2002 Presented by: John F. Neale, DDS, MPH CAPT, USPHS (ret.) Slide 2 Course Outline b Introduction b NNMC PI program b Process/Outcomes b Dimensions/Functions b Identifying projects/indicators for your department b Tools Slide 3 Learning Objectives b At the completion of this session, participants should be able to do the following: Define & discuss the the varying definitions of qualityDefine & discuss the the varying definitions of quality Define FOCUS-PDCA & apply to daily tasks & departmental PI activitiesDefine FOCUS-PDCA & apply to daily tasks & departmental PI activities Define process/outcome & how you apply to your PIDefine process/outcome & how you apply to your PI Define the Dimensions of Performance & apply to PIDefine the Dimensions of Performance & apply to PI Describe various PI tools and how they are usedDescribe various PI tools and how they are used Slide 4 What is QUALITY? b Meeting or exceeding the customers expectations the first time and every time b In Healthcare: The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Slide 5 What is QUALITY? b How do you define quality? b How do you think your departments customers define quality? Slide 6 Customers b Who are your departments customers? ExternalInternal Slide 7 What is Performance Improvement? b JCAHO defines PI as: The continuous study and adaptation of a healthcare organizations functions and processes to increase the probability of achieving desired outcomes and to better meet the needs of individuals and other users of services. Slide 8 What Performance Improvement is NOT b Peer Review b Customer Satisfaction Surveys b Quality Control Activities b Routine Monitoring and Evaluation b All of the above activities are ways to gather data to identify where performance can be improved Slide 9 What is a Process? b A goal directed, interrelated series of actions, events, mechanisms, or steps. An interrelated series of events, activities, actions, mechanisms, or steps that transform inputs into outputs. Slide 10 What is an OUTCOME? b The result of the performance (or non- performance) of a function(s) or process(es). Slide 11 Functions Slide 12 Dimensions of Performance Slide 13 Performance Improvement tools b Flow chart b Cause & effect or fishbone diagram b Pareto chart b Control charts b Histograms b Scatter diagram b Run chart Slide 14 Flow Chart Slide 15 Cause and Effect Diagram Slide 16 Pareto Chart Slide 17 Control Chart Slide 18 Histogram Slide 19 Scatter Diagram Slide 20 Run Chart Slide 21 The PI Mindset Doing whatever it takes to ensure the best service the best outcome customer satisfaction employee satisfaction financial success Slide 22 The PI Mindset Continuously examining processes and seeking opportunities for improvement that will: benefit customers improve our results make us more efficient maximize the quality of everything we do b It is no longer if it aint broke, dont fix it, it is now even if it aint broke, improve it. Slide 23 If 99.9% were good enough Every year there would be: 20,000 prescription errors made 15,000 newborn babies dropped during delivery 32,000 missed heartbeats per person. Every month there would be: 1 hour of unsafe drinking water Every week there would be: 500 incorrect surgical procedures performed Every day there would be: 2 unsafe landing at OHare airport Every hour there would be: 22,000 checks deducted from the wrong bank accounts. 16,000 pieces of mail lost by the US Postal Service Slide 24 Hospital Corporation of America Performance Improvement Methodology b F ind an opportunity for improvement b O rganize a team b C larify the process b U nderstand variations b S elect the improvement b P lan b D o b C heck b A ct Slide 25 Find an opportunity to improve How or where do we find opportunities for improvement? Ongoing monitoring activities such as: Safety/RM/IC/PIOngoing monitoring activities such as: Safety/RM/IC/PI Customer feedback (patient or staff satisfaction surveys)Customer feedback (patient or staff satisfaction surveys) OutcomesOutcomes Strategic PlanningStrategic Planning New servicesNew services Slide 26 Organize a team b Size large enough to include all disciplines or departments involved, but small enough to be workable. b Membership include all knowledge/skills/departments needed to address the process in question b Resources money, time, materials, training, etc. b roles/responsibilities see team guidelines in the Service Unit PI plan Slide 27 Clarify current knowledge of the process Break the process down into its component parts or steps in order to better understand how it works and to find areas where the process varies from its purpose. Flow chartFlow chart Cause & effect or fishbone diagramCause & effect or fishbone diagram ResearchResearch LiteratureLiterature Past experiencePast experience Slide 28 Potential Sources of Variation - Why things dont turn out as planned o oPeople*Not trained or oriented to a procedure *Forget to perform a step in a complex process o oMachinery*Machine malfunctions *Different machines used o oMaterials*People use different procedures o oMethods*Missing steps or unpredictable sequence or tasks o oConditions *Different environments such as changes in weather, shift work Slide 29 Understand causes of process variation Collect and analyze data on the various steps in the process identified in the previous step to see where problems or inefficiencies occur Pareto diagrams the 80/20 rulePareto diagrams the 80/20 rule Run chartsRun charts Control chartsControl charts HistogramsHistograms Slide 30 Select the step(s) in the process that will be improved b Use the results your C and U activities to identify the step or steps in the process that contribute the majority of the process variation. Slide 31 Plan b How will the improvement be done? b Who will do it? b What is the Timeline for implementation? b What Outcomes are desired? b How much will it Cost b What Training or Education is needed? b Is a Trial Period or Pilot Program indicated? b What data will need to be collected to monitor the changes? Slide 32 Do b Implement the Plan b Schedule needed training b Collect the needed data b Pilot Test the plan if appropriate Slide 33 Check Collect and Analyze data to determine the following: Did the action work?Did the action work? Did you achieve the desired outcomes?Did you achieve the desired outcomes? Is the process working as predicted, or is further refinement needed?Is the process working as predicted, or is further refinement needed? Slide 34 Act b Change processes or further tweak the Plan if needed to achieve desired outcomes b Repeat the PDCA cycle as needed to maximize improvement b Finalize and implement full scale b Develop New flow chart and/or New P/P for the redesigned process b Educate/orient patients and staff b Story board & report to communicate results to staff and customers Slide 35 Identifying opportunities for improvement in your department b Outcomes b Process b Strategic Planning b Prioritizing b Staff/Customer feedback