Rapid Cycle Quality Improvement
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Transcript Rapid Cycle Quality Improvement
Rapid Cycle Quality
Improvement
Course Outline
The Quality Journey
Rapid Cycle Improvement Model
Change Concepts
Teams
Tools
Barrier Busters
1
Group’s Prior Experience with
Quality Improvement
Participant Survey Results
Very Little
1-2 yrs
3-5 yrs
5-10 yrs
10+yrs
2
What is Quality?
Quality is a never-ending
cycle of continuous
improvement.
-Deming
3
Quality Alphabet Soup
CQ
SA
QA
M
Q
T
P
QI R
CQ
IO
A
C
D
P
I
PI
PD
I
4
Group’s Tools for Quality
Improvement
Participant Survey Results
5
Quality Improvement Program
Vision, Goals, Objectives
Quality Indicators – Monitoring
Quality Project
Continuous Improvements
Solve Problems
Change Systems
Sentinel Events
6
The Quality Journey
Quality Assurance
Quality Improvement
Rapid Cycle Quality Improvement
7
QA vs. QI
Quality Assurance
Conform to
standards
Relies on
inspection
Focus on items
Quality is separate
function
Departmental
function
Quality Improvement
Improved
performance
Monitor over time
System orientation
Quality integrated
in organization
Interdisciplinary
function
8
Malcolm Baldrige
National Quality Award
Patient / Customer and Health Care
Market Focused Strategy and Action Plans
2
5
Strategic
Planning
Staff
Focus
1
7
Organizational
Performance
Results
Leadership
3
6
Focus on Patients,
Other Customers,
and Markets
Process
Management
4
Information and Analysis
9
PDSA Cycle
10
AIM Statement
What are we trying to accomplish?
The Aim
Statement articulates the
goals, guides the improvement effort,
and keeps the team focused.
Specific
Measurable
Challenging
11
Measurement
How will we know that a change is an
improvement?
What
to measure - what will be
different?
What are the guidelines
12
Cycles of Improvement
What changes can we make that will
result in an improvement?
It’s your opportunity to brainstorm:
Possible changes
People that are needed
Required resources
Potential for collaboration
Necessary leadership support
13
Cycles of Improvement
Continuous improvements of
multiple changes.
PD
PD
PD
PD
SA
SA
Change 1
SA
SA
PD
PD
PD
PD
SA
SA
Change 2
SA
SA
PD
PD
PD
PD
SA
SA
SA
SA
Change 3
14
Rapid Cycle Improvement
Model
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in an improvement?
Cycle 1
Cycle 2
Cycle 3
15
Potential EMSC Monitors:
Timely management
Wait time to see an MD in the ER
Time to initiate antibiotics in fever management
Use of an intraosseous line when needed
Transfer within 2 hours when appropriate
Use of the Broselow, or similar, system
Pain management in the non verbal child
Asthma management
Obtaining a patient height
Peak flow measurement
Abuse recognition
Provision of injury prevention education
16
What Quality Improvement
activities are you working on at
your hospital?
Participant Survey Results
17
An Example of Rapid Cycle
Planning
Where do we begin?
18
Change Concepts
Change
concepts are generic ideas that
can be applied to your situation to spark
an idea for a specific change in your
situation
Not all change concepts apply to all aims
Brainstorm ways to apply these concepts
to the problem at hand
19
Change Concepts
Enhance
the Producer /Customer
relationship
Listen to patients
Coach customers to use product/service
Reach agreement on expectations
Mass
customize services to patient
20
Change Concepts
Change
the work environment
Reduce demotivating aspects
Implement cross training
Clarify roles & expectations
Improve
work flow
Synchronize
Find and remove bottlenecks
Do tasks in parallel
Adjust to peak demand
21
Change Concepts
Manage
Time
Reduce the setup or startup time
Optimize maintenance
Reduce wait time
Manage
Variation
Eliminate waste
Reduce or eliminate overkill
Recycle or reuse
22
Change Concepts
Optimize
inventory
Match inventory to demand
Use pull systems - proactive
Reduce multiple brands
Design systems to avoid mistakes
Use reminders
Use differentiation
Use constraints
Minimize handoffs
23
Team
Composition
Sponsor
Leader
Team member(s)
Helpful hints
Be Multidisciplinary
Assure available
leadership
Include hands-on
expertise & variety of
skills, e.g. computer skills
Recognize progress
Clarify roles &
responsibilities
Handle conflict
constructively
Maintain core group for
consistency
24
Essential Tools
Meeting Agenda (every meeting)
Meeting Summary (every meeting)
Project Work plan (create 1, post & update)
Project Report Form (Internal - External)
25
Other Helpful Tools
Brainstorming
Run Charts
Flow Charts
Cause & Effect Diagram
Pareto Diagram
Nominal Group Technique
Force Field Analysis
Refer to Section 12 - Tab “QI Tools & Techniques”
26
Example – Run Chart
Self Administered Med Project
DRG 372 & 373
Percent of Pts Receiving Medication
50.0%
46%
45.0%
40.0%
44%
42%
41%
38%
Percent of Pts
35.0%
37%
35%
34%
33%
34%
32%
30.0%
30%
29%
26%
25.0%
23%
22%
20.0%
22%
22%
21%
21%
24%
25%
19%
16% 17%
15.0%
15%
15%
15%
13%
13%
12%
10.0%
11% 11%
10%
8%
8%
5.0%
24%
23%
6%
5%
7% 7% 7%
6% 5% 5% 5%
3%
2%
7%
5%
6%
6%
3%
0.0%
Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun99
99
99
99
99
99
00
00
00
00
00
00
Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun00
00
00
00
00
00
01
01
01
01
01
01
Jul- Aug- Sep01
01
01
Month
% Pts Rec'd Darvocet
% Pts Rec'd Tylenol 3
27
Example – Control Chart
Self Administered Med Project
DRG 372 & 373
Percent of Pts Receiving Darvocet
Pre Project
Project Implemented
60%
Percent of Pts
Mean: 39.4%
40%
Mean: 23.8%
20%
0%
28
Barrier Busters
Barrier
- Problems with Setting an Aim
Is there sponsorship for the project?
Does project fit with organizational
mission?
Does project conflict with our values?
Is Aim Statement clear and precise?
29
Barrier Busters
Barrier
- Problems with Teams
Is your leader available and empowered?
Are you meeting weekly?
Does everyone know their responsibilities?
If you have conflicts, who can you request
to facilitate your team?
30
Barrier Busters
Barrier
- Problems with Resources
Suggestions:
Keep your team small at first
Use volunteers and champions
Collect just enough data
Set a dedicated meeting time
Huddle if needed (15 minutes is all you need!)
Involve senior leadership if resources are a
problem
31
Barrier Busters
Barrier - Resistance :
“No one thinks there is a problem”
Take the high ground...
“We are different”
Share information and challenge assumptions...
“It’s too difficult”
Look at others (internally & externally) that have successfully
made a change
Break ideas for change into small components
Present changes as a “test” - that can be accepted, refined, or
abandoned
Use just enough data
Post results of the small test from the outset as proof that it can
happen
Engage senior leadership - it is a must
32
Resistance – How people
respond to change…
– 2.5%
Early Adopters – 13.5%
Early Majority – 34%
Late Majority – 34%
Laggards – 15%
Innovators
33
Barrier Busters
Barrier
- Problems with Ownership
Be sure to include all impacted areas
Collaborate with staff at all levels
Involve the people that DO the work
Find champions in several disciplines
Keep sponsors informed and involved
34
Next Steps: Action List
What
is one problem in your work
setting where you think Rapid Cycle
Quality Improvement would help you?
What is one thing that you can do by
next Tuesday?
35