Transcript Slide 1

Applying Process Tools
to Common Quality
Program Challenges
Co-Facilitators
Nanette Brey Magnani, EdD
Kevin Garrett, MSW
Funded by HRSA
HIV/AIDS Bureau
Objectives
• Create an awareness of how process tools
can be used for different purposes
• Identify common problems faced by Part D
programs in managing Quality Programs
• Apply process tools for problem solving in
Part D environments
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National Quality Center (NQC)
Agenda
10 min.
10 min.
30 min.
10 min.
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Overview
Brainstorm common and most
crucial problems
Practice tools
Report back/wrap-up
National Quality Center (NQC)
Overview
What are process tools?
• Brainstorm
• Priority setting
• Cause and effect diagram (fishbone)
• Flow chart
• Force Field Analysis
• Organizational chart/diagram
Who uses these tools?
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National Quality Center (NQC)
Process tools
What is the purpose?
To make more informed and effective decisions
to:
 improve the quality of patient care and
 improve the quality program
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National Quality Center (NQC)
Guiding Principles
Teams that utilize a systematic problem solving
approach are more:
 likely to implement solutions that work
 efficient with their time, and
 monitor improvements over time
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National Quality Center (NQC)
Steps in QI Project Planning
Collect and present data
Set improvement goals
Investigate the Process and Causal analysis
 Flow diagrams
 Brainstorm
 Cause and effect diagram (fishbone)
PDSA
Sustain and spread gains
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National Quality Center (NQC)
Other Applications –
Improving Your Quality Program
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National Quality Center (NQC)
Examples of When to Use Process Tools
Annual planning meeting
 Goal setting and establishing priorities
 Analyze goals strategically – forces for and
against
 Helps in identifying key activities in work plan
Understand roles and lines of accountability
Break down problems to better understand next
steps
Understand how to influence change
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National Quality Center (NQC)
Process Tools for Involving Others
Brainstorm
 Generates lots of ideas before decisions are made
 Can also use to get feedback (Itemized Response -
What went well, what needs improvement)
Priority setting
 Need to determine priorities and to involve others
Cause and effect diagrams (fishbone)
 Identifies causal factors that give rise to the effect
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National Quality Center (NQC)
Process tools
Flow chart (QI)
 To better understand a series of steps or actions
needed to produce something or to achieve an end
and identify problem steps to improve
Force Field Analysis
 Use when there is a need to examine opposing forces
in a situation and
 helps to identify barriers and problems
 can be used in gap analysis, i.e., to understand the
difference between where we are and where we want
to go
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National Quality Center (NQC)
Process tools
Quality Program Accountability Diagram
 Visual Depiction of relationships that your Quality
Program has with other groups and individuals in
your organization and external to your organization
Types of relationships:
•
•
•
•
•
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Reporting
Supervisory
Working
Partnership
Sub contractor
National Quality Center (NQC)
Examples of Process Tools
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National Quality Center (NQC)
QI Fishbone Diagram (Univ. of Pittsburgh MC)
Procedure
Patients
Patients cancel
appointments
Pt menstruating
& unable to
complete exam
If RN doesn't
check, pt. May
not know of apt.
Pt refuses or is
reluctant to have gyn
exam
Pap, etc. done
elsewhere & no
reports sent to PACT
Some providers may
not prefer to do a gyn
exam/testing
MD available to do
pap, but staff
unavailable to assist
Staff
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Documentation
is not
standardized
Cumbersome procedure for
identifying who needs a
pap/gyn
Identification at 12th
month apt. doesn't allow
for delays
Lack of systematic
tracking of
anniversary dates
Pt with lack of understanding
of importance of periodic
paps/gyn exams
Rushed during
routine HIV care
appointment, no time
for pap/gyn exam
Lack of patient
reminder/trigger system
Multiple patient clinics
with less time to review
records
Limited
Comprehensiveness of
Women's Health Care
Exam, with decreasing
percentage of women
having an annual pelvic
examination
Seating is limited
in the exam room
Supplies are not
easily accessible in
the exam room
No flow in
room set-up
Privacy issues
during gyn exam
Room set up is
unworkable for patients
and staff
Supplies
Place
National Quality Center (NQC)
QI Flow chart – Pap
I. New Patient:
1st Visit
PCP visit
PCP documents need
for GYN exam @ next
visit
Pt. needs
GYN
exam/visit
Next appointment is
scheduled
yes
GYN exam completed
during PCP visit
no
Possible chart review in the
future & assessed again
II. Return Visit
Need for GYN
determined
via: chart
review, excel
no
Possible chart review in
the future & reassessed
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yes
PCP
Appointment
visit kept
no
a. If patient cancelled,
reschedule appointment
b. If no show, check again
at next PCP visit
yes
GYN
testing
completed
yes
Test/s completed
and sent to lab
no
Determine reason: new OB,
GYN care elsewhere, PCP
not comfortable doing GYN
exam, or patient scheduled
for exam at a future
appointment
National Quality Center (NQC)
Force Field Analysis: A Planning Session
Develop a Common QM System
Helping
Restraining
Limited funding for QM
Each system has a bureaucracy
Dedicated staff
Unstructured meetings-lose interest
Understanding of what QM entails
Lack of understanding of QI to bring in
stakeholders
Grant writing and Federal requirements
Distrust of intent/motives
History of collaboration
Lack of infrastructure for collaboration
Information to support movement
Competing work loads/priorities
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National Quality Center (NQC)
How to Use the Results in a Quality Program
Improvement Work Plan
Situation: Lack of understanding of QI
Goal: To expand QI knowledge and skills throughout the network
Activities
1.
Identify current training resources, prospective participants, and needs
2. Hold a meeting with key staff to develop a training strategy and plan (identify
supporters and resisters)
3. Send additional staff to NQC TOT and join HIVQUAL
4. Develop training component of quarterly Part D meetings
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National Quality Center (NQC)
MDCH – Ryan White Part D Quality Management
Accountability Chart
Part D
MDCH Program Coordinator
Ryan White Cross Part
Quality Committee
Part D Executive Committee
Quality Mgmt Committee
Members & Representatives from
Funded Agencies
(Meets Quarterly)
Part D Sub-Contractor Quality Mgmt
Meetings/Trainings
DMC
Horizons
UHC
Quarterly Evaluation Mtg
Bi-Monthly Mgmt Team Mtgs
APM
PIDC
CHM
QI Group
Project Challenge
Monthly Team Meetings,
Includes QI
Immunology Clinic
Bi-Monthly Mgmt Team Mtgs
VNA
Care Services Monthly
Team Meetings
Wellness
Monthly Quality
Committee Meeting
Weekly Case Mgt Mtgs
DHWP
CARES
Quarterly Quality Mgt
Team Meetings
Monthly Mgmt Team Mtgs
Bi-Monthly Case Mgr Mtgs
Quarterly QM Committee Mtg
**All subcontracted agencies minimally participate in contractual Quality Improvement activities.
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National Quality Center (NQC)
Immunology Center – Teaching Hospital
Quality Program Accountability Diagram
External
-HRSA/HAB
-CDC


Division of ID
Director
Sub Contractors
CAB
Immunology
Center Meetings
Clinical Team
Meetings
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Clinical Faculty
Research Fellows
Clinic
Co-Directors
Fellows
Weekly
HIV Quality
Committee
CQI
Only
Clinical
Fellowship
Program
QI Project
Teams
National Quality Center (NQC)
Part D Quality Program Challenges
Task: What challenges do you currently face in
your Part D Quality Program
Steps:
1.
2.
3.
4.
5.
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Write topic on flip chart paper
Review general rules of brainstorm; no judging
Write what person says
Generate ideas
Review and combine ideas, cross off repeats
National Quality Center (NQC)
Adding Priority Setting to Brainstorm
6. Establish criteria
 Most frequent, most important, doable, few resources,
low cost, address quickly
7. Vote: n/3
 Total number of items/3 = number of votes each
person has
8. Negative poll
9. Check for agreement
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National Quality Center (NQC)
Common QM Problems, Goals, Situations
Examples:
Lack of staff training in QI
Build staff capacity in QI
No buy-in and participation of medical providers
Low consumer involvement
Poorly run meetings
Limited or no access to medical data
Lack of accountability for QI
Different stages of QI culture development
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National Quality Center (NQC)
Small Group Work – How do you want to
divide yourselves?
Groupings: type of Part D structure, problem,
process tool
Task: To apply one of the process tools to better
understand a problem
Steps:
1.
2.
3.
4.
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Select a group facilitator
Decide your problem and select a process tool to try
Practice the tool
Change facilitators
National Quality Center (NQC)
Wrap-up
• Report out
• Questions/Comments
THANK YOU
For Your Participation
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National Quality Center (NQC)
Resources
For detailed description of process tools:
“HIVQUAL Workbook – Guide for Quality Improvement in HIV Care,”
The National HIVQUAL Project, NYSDOH AIDS Institute.
September 2006.
One of top 10 downloads at:
www.nationalqualitycenter.org
Bens, Ingrid. “Facilitation at a Glance! A Pocket Guide of Tools and
Techniques for Effective Meeting Facilitation.” AQP/Participative
Dynamics/GOAL/QPC, 1999. To order: 1-800-643-4316.
email: [email protected]
web: www.goalqpc.com
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National Quality Center (NQC)
Process Tools and Examples
• Definitions
• How to create one
• Examples
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National Quality Center (NQC)
The Cause-and-Effect Diagram
Organizes and displays theories about causal
factors
• Allows constructive use of anecdotes
• Encourages a balanced view
• Demonstrates complexity of the problem
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National Quality Center (NQC)
Constructing a Cause-and-Effect Diagram
•
•
•
•
•
Write down the effect
Decide on major areas
Brainstorm possible causes
Ask “why?” 3 to 5 times
When ideas run low, ask for “just one
more”
• Check for logic, completeness and
balance
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National Quality Center (NQC)
Possible Causes of Delayed Test Results
Source: Institute for Healthcare Improvement
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National Quality Center (NQC)
Flowcharts to Understand Processes
A flowchart is a picture of the steps of a process
to:
 Understand the process
 Identify potential sources of problems
 Outline the ideal process steps
 Enable communications with others
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National Quality Center (NQC)
Creating a Flowchart
1.
2.
3.
4.
5.
6.
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Agree on use and level of detail
Define starting and ending points
Document each step
Follow each branch to the end
Review the chart
Assign action items to fill in blanks and verify
accuracy
National Quality Center (NQC)
Most Commonly Used Flowchart Symbols
Activity
Connecting lines
Terminator
Decision
A
Page connector
Wait symbol
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National Quality Center (NQC)
Flow Chart: Is This an Efficient Process?
Patient arrives
at front desk
Staff asks name,
searches database for file
Patient in
system?
Yes
Staff asks
patient to
be seated
No
Staff asks
patient to
provide
information
Patient
waits
Nurse takes
patient to
exam room
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National Quality Center (NQC)
Force Field Analysis
Steps:
1. Write your goal or problem statement at the top of
the paper
2. Divide the paper vertically. At the top left write
Helping Forces and at the top right, write
Restraining Forces
3. Brainstorm a list of forces on one side first and then
move to other side
4. Set priorities as in brainstorm
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National Quality Center (NQC)
Quality Program Accountability Diagram
Purpose
• To understand how parts of a system make up the whole
system
• To understand reporting and accountability relationships
• To help build buy-in
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National Quality Center (NQC)
Quality Program Accountability Diagram
Steps
1. Agree on a starting point, generally with a Quality
Management Committee or program staff
2. Then, repeat “Who does this group report to and is
accountable to?” to the highest level of
accountability for quality
3. Then, repeat “Who reports to this group or is
accountable to this group?” to the level of who is
accountable for planning and implementing Quality
Improvement Projects
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National Quality Center (NQC)
Facilitator Information
Nanette Brey Magnani, EdD, Quality Consultant
for NQC and HIVQUAL-US
[email protected], 508-875-0290
Kevin Garrett, MSW, National Quality Center
[email protected], 212-417-4541
www.nationalqualitycenter.org
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National Quality Center (NQC)
Contact Information
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National Quality Center
(NQC)
HIVQUAL-US
212-417-4730
NationalQualityCenter.org
[email protected]
212-417-4620
HIVQUAL.org
[email protected]
National Quality Center (NQC)