quality improvement - massachusetts · pdf filepatient safety- quality improvement: “a...
TRANSCRIPT
To gain an understanding of:
◦ Quality
◦ Quality improvement
◦ The Model for Improvement
◦ The PDSA cycle
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Institute of Medicine: “Quality of Care” “is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”.
Institute for Healthcare Improvement (IHI): “Quality is turning into outcomes management, and involves minimizing unnecessary variation so that outcomes become more predictable and certain”.
Quality Digest: “Quality is meeting the customer's needs in a way that exceeds the customer's expectations”.
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Patient Safety- Quality Improvement: “A formal approach to the analysis of performance and systematic efforts to improve it”.
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Safe
Effective
Patient-centered
Timely
Efficient
Equitable
IHI, 2011a
How can we improve a system to achieve better results in the dimensions of quality?
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◦ You need to :
Know your customers (patients/residents).
Understand where the system is failing - Identify what is wrong.
Identify step that needs fixing.
Implement change.
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Step 1: Three questions
+
Step 2: PDSA cycle
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Model of Improvement
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API, 20107
What are we trying to accomplish?
How will we know that a change is
an improvement?
What change can we make that will
result in improvement?
MODEL FOR IMPROVEMENT
The Change
The Measure
The Aim
API, 2010
Step I: Questions
Step 2: PDSA
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Plan a change
Do the change
Study the results
Act on the results
Walter Shewhart was the first person to propose a version of the PDSA cycle.
W. Edwards Deming modified Shewhart's cycle to PDSA, replacing
"check" with "study."
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Eliminate Waste
Improve Work Flow
Optimize Inventory:
Change the Work Environment
Producer/Customer Interface
Manage Time
Focus on Variation
Error Proofing
Focus on the Product or Service
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IHI, 2012
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All improvement will require change, but not all change will result in improvement
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To test your change use the PDSA
cycle.
Start with a PLAN
◦ Objectives
◦ Questions and predictions
◦ A Plan to carry out the cycle
who,
what,
where,
when
◦ A Plan for data collection
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Do: the action part of the
process
◦ document problems and unexpected results
◦ collecting and analyzing data
◦ meeting with involved parties
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Study◦ Analyze process improvement data◦ Compare data to prediction◦ Summarize what was learned
◦ Some focus areas of improvement are: Clinical Outcomes
Cost
Access to Care
Satisfaction
Community Service
Regular Satisfaction Surveys
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Start small and think ahead a few steps.
Test changes.
Continuous improvement often requires a few sequential PDSA cycles.
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Ideal
Situation
Present
Situation
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Change usually comes after a series of successful tests
Educate and train everyone involved.
Make changes to job descriptions, policies, procedures, forms.
Address supply and equipment issues.
Assign day-to-day ownership for the maintenance of the new process.
(Langley, Moen, Nolan, Nolan,
Norman & Provost, 2009)
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Agency for Healthcare Research & Quality (AHRG). (2013) Quality and Safety. Retrieved
from http://www.ahrq.gov/professionals/quality-patient-safety/index.html
Associate Process Improvement (API). (2010). Model for Improvement. Retrieved from
http://www.apiweb.org/API_home_page.htm
Deming, W. E. (2000). The New Economic. Cambridge, MA: The MIT Press.
Institute of Health Improvement (IHI). (2011). Science of Improvement. Retrieved from
http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementHowtoImpr
ove.aspx
Institute of Medicine (IOM). (n.d.)Crossing the quality Chasm: The IOM Health Care
Quality Initiative. Retrieved from
http://www.iom.edu/Global/News%20Announcements/Crossing-the-Quality-Chasm-
The-IOM-Health-Care-Quality-Initiative.aspx
Institute for Health Improvement (IHI). (2011a). Across the Chasm: Six aims for changing
the healthcare. Retrieved from
http://www.ihi.org/knowledge/Pages/ImprovementStories/AcrosstheChasmSixAimsforC
hangingtheHealthCareSystem.aspx
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Institute of Health Improvement (IHI). (2012). Using Change Concepts for Improvement.
Retrieved from
http://www.ihi.org/knowledge/Pages/Changes/UsingChangeConceptsforImprovement.a
spx
Institute of Medicine (IOM). (1999). Measuring the quality of health care. IOM.
Langley, G. L., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The
Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd
ed.). San Francisco, CA: Jossey-Bass Publishers.
Lloyd, R. (2004). Quality Health Care: A Guide to Developing and Using Indicators.
Sudbury, MA: Jones and Bartlett Publishers.
Patient Safety – Quality Improvement. (n.d.). What is Quality Improvement? Duke
University Medical Center. Retrieved from
http://patientsafetyed.duhs.duke.edu/module_a/introduction/introduction.html
Quality Digest (2001). Definition of Quality: How do you define it? Retrieved from
http://www.qualitydigest.com/magazine/2001/nov/article/definition-quality.html
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