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