quality improvement: essential leadership improvement: essential leadership anne matlow, september...

The International Conference on Residency Education | La Conférence internationale sur la formation des résidents

Quality Improvement: Essential Leadership

Anne Matlow,

September 30, 2016


Je n’ai aucune affiliation (financière ou autre)

avec une entreprise pharmaceutique, un fabricant

d’appareils médicaux ou un cabinet de communication.

I do not have an affiliation (financial or otherwise)

with a pharmaceutical, medical device or

communications organization.

Anne Matlow,

September 30, 2016


INTRODUCTIONS


Learning objectives

• Discuss the importance of Quality improvement to everyday practice

• Identify an area needing process

improvement • Describe the 5 steps of developing a

quality improvement project • Apply 2 tools for process analysis • Understand the role of leadership in

effecting change


WHAT IS QUALITY?

BACKGROUND

5

Doing the right thing at the right time

in the right way for the right person.

The International Conference on Residency Education | La Conférence internationale sur la formation des résidents 6

Quality is personal….

ITEM SCORE

My desk is always clean.

I am caught up on my work.

I exercise daily.

I see my friends regularly.

I get enough exercise.

I am satisfied with my work-life

balance.

TOTAL


? QUALITY HEALTHCARE ?

WHAT IS QUALITY?

7



Safe, effective, efficient, equitable,

patient-centred, timely IOM 2001




Commonwealth Fund Study 2013

Quality of care: a global view


The Mission: Quality Health Care

9

F

FISHBONE (Cause and Effect) DIAGRAM

QHC


Leadership and QI

West M et al. Leadership in health care: a summary of the evidence base. Faculty of Medical Leadership and Management and King’s Fund. 2015.

10

“ There is clear evidence of the link

between leadership and a range of

important outcomes within health

services, including patient satisfaction,

patient mortality, organisational financial

performance, staff wellbeing,

engagement, turnover and absenteeism,

and overall quality of care.”


What are you going to do about it, Mr PM?


OK,I want to make things better.

13


Hall Barber. Academic Medicine October 2015

http://www.hqontario.ca/portals/0/documents/qi/qi-quality-improve-guide-2012-en.pdf


Personal Improvement Project

15

ITEM

My desk is never clean.

I gotta get

this under

control!

What would

being

‘in control’

look like?

OK: Get started. My

precise goal:

What? by how much?

Where?

By when?

Papers and

books, pens

and empty

coffee cups


TOOLS OF QI

16

5 why’s

Graph it out

Fishbone diagram

Walk it out

Process flow

map

Match solution

to problem,

small tests of

change Set SMART*

AIM

Measurement

• SMART aims: specific, measurable, achievable, realistic, time-based

• Eg: By Nov 30, 2016 all papers on my desk will be filed by the end of each day


5 why’s

Graph it out

Fishbone diagram

Walk it out

Process flow

map

Match solution

to problem,

small tests of

change

Assemble

team

Set SMART*

aims

Measurement

• SMART aims: specific, measurable, achievable, realistic, time-based

QI is a team sport


Outpatient Calls to a Tertiary Oncology Service

• The Quality Problem: Patients

experiencing a medical issue can wait long

periods of time for a callback from the on

call MD.

Slides courtesy of

Dr.Chris Willis, McMaster U


Who should be on the team?

• Provide input to the process

• Perform one or more of the process steps

• Receive output from the process

The Team

Chief Resident (Team Lead)

Program Director

Lead MD – Oncology

Hospital Paging

Answering Service

ER Resident

Outpatient RN



• Defining the problem



• Understanding the system


Process flow map


Patient

Provider

Answering

Service

Paging

Spaghetti diagram


PDSA

25

PDSA


IT’S YOUR TURN

Small group activity


The Change Opportunity

You are a PGY3 who has just completed a two month elective in

internal medicine at Elsewhere General Hospital. You were

impressed by the way the weekly Morbidity and Mortality

Rounds (MMRs) were conducted at Elsewhere General Hospital;

the philosophy behind MMRs there was one of continuous

learning and improvement, and not one of shame and blame.

Now back home after your elective, you are struck by how

much finger-pointing actually goes on during MMRs at your own

organization, and by the reluctance of trainees to speak up lest

they get blamed and/ or accused of making a stupid or

irrelevant comment. At the last evaluation, 50% of trainees

said they did not find MMRs useful. You would like to see the

approach to MMRs improved to more closely resemble those at

Elsewhere General Hospital, and are prepared to work with

others to improve the process using the Model for

Improvement Framework.


1. Complete the project charter for this project.

2. Present your SMART aim statement.

3. Using the “Model for Improvement” describe

how you will approach improving the MMRs

at your hospital.

• What will you try to achieve with your first two PDSA cycles?

4. Discuss with your group leadership strategies

that will help you to implement change ideas

for MMRs.

In your groups


• There are lots of opportunities to improve the delivery of health care (TIP: if you don’t know where to start, count something)

• There is a 5 step framework for doing QI

• Medical leadership is essential

Conclusions


BACK-UP SLIDES


LEADERSHIP

The main ingredient for successful QI


From January 2005 and

March 2009, 400-1,200

patients died as a result

of poor care.

Public inquiry:

- neglect

- pain relief late or not

at all.

- patients unwashed

- etc…… https://www.gov.uk/government/uploads/system/

uploads/attachment_data/file/226703/Berwick_Report.pdf

When things go wrong:

STAFFORD HOSPITAL

Exerpted from http://www.theguardian.com/society/2013/feb/06/mid-staffs-hospital-scandal-guide

https://www.gov.uk/government/uploads/system/

https://www.gov.uk/government/uploads/system/


When things go very well…..


Educational activities

1. formal curricula that teach concepts or

methods intended to facilitate trainees’

participation in QI activities;

2. educational activities that impart specific

related skills (i.e. disclosure of medical errors),

and,

3. QI initiatives that involve trainees as active or

passive participants.

Med Educ. 2012 Jan;46(1):107-19.


Academic Medicine October 2015


EVALUATING YOURSELF


ITEM

My dictated notes don’t

reach the GP soon enough!!!

WE gotta

get this

under

control!

What would

being

‘in control’

look like?

OK: Get started.

OUR precise goal:

What? by how much?

Where?

by when?


Leadership styles


QI IN RESIDENCY

Culture + Persistence


http://www.hqontario.ca/portals/0/documents/qi/qi-quality-improve-guide-2012-en.pdf


SETTING AIMS

quality improvement: essential leadership improvement: essential leadership anne matlow, september...

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