Rapid cycle PI - Clinical Departments
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Transcript Rapid cycle PI - Clinical Departments
Rapid cycle PI
Danielle Scheurer, MD, MSCR
Chief Quality Officer
Medical University of South Carolina
Objectives
Know how and why you need to have a
disciplined approach to PI
Understand the importance of the reliability
of interventions
Understand the importance of validating
and evaluating interventions over time
Quality-Process Improvement
Improvement and standardization in processes
reduces variation (narrows the curve) and raises
quality of care for all (shifts entire curve toward
better care).
After
Before
Bell Curve:
Patient Population
worse
Quality
Tail
better
worse
worse
Quality
Quality-Process Improvement:
Bridges the Implementation Gap
Scientific
understanding
Progress
Implementation
Gap
Patient care
Time
The BEST quality is local
•
“Bottom up” approach
•
Problems and remedies come from the “front line”
•
Often come from frustration of seeing processes that
are:
–
–
–
•
Highly variable, unpredictable, not reproducible
Potentially or actually harmful
Inefficient or redundant
Different areas have different quality issues, although
some are ubiquitous
–
–
Medication errors
Infection rates
Structure approach to PI
Ensure you are narrowing the scope of the
problem to be addressed
Ensure you measure and analyze the
problem, before you jump to a remedy
Ensure the remedy will “fix” the problem you
are trying to solve
Force you to validate that the remedy was
effective
Get a team
Champion: Overcome barriers
Process Owner: The driver
Facilitator: The navigator
Front line staff: Essential team members
Identify the problem
What is the problem?
Who identified it?
When was it identified?
When and where is it occurring?
Pick something that matters to you, and
state WHY it matters
Who else cares about the problem (who are
the stakeholders?) to assist with resources
Measure it
How can the data be collected (survey, administrative data, chart
review)?
Is it valid/accurate?
Is it a manual process or automated?
Is there a clear definition of the outcome (or can it be interpreted
different ways)?
Who is going to measure?
Can you sample?
Direct observation is the best way to determine what is actually
happening
May want more than 1 type of measure:
Process, outcome, structural, balancing
Problem Analysis: What is
causing the problem?
•
Time of day, day of week
•
Department specific / system wide
•
Inefficient staffing (numbers or skill set)
•
Poor communication
•
Inadequate process or policy
•
Lack of controls to keep the problem from occurring
•
Poor individual performance (usually not the only issue)
•
Pick an appropriate process analysis tool to further
analyze the problem/process
Remedy the critical
issues
Pick a remedy based on the problem analysis.
What are the barriers?
What evidence is there that it will have an impact (has
someone tried and succeeded or failed)?
How “reliable” is the intervention?
Do you need >1 intervention to make it nearly impossible
to recur?
Remedies (in order of
reliability)
Education
Reminders
Checklists
Order sets
Protocols
Pathways
Templates
“Hard stop” order entry
Operationalize
How are you going to make it work?
How will the barriers be removed?
What assistance is required from leadership?
What is the plan to roll out and implement solutions?
Real time problem solving
Changes that
result in
Improvement
A P
S D
A P
S D
A P
S D
A P
S D
Big Idea
Time
Validate
How will we know we made a difference,
what is your goal?
What are you measuring?
How often are you measuring it?
Is the measure meaningful?
Are you measuring “unintended
consequences”?
Evaluate
How to sustain the improvement?
Who is responsible for monitoring and
measuring over time?
What is the plan to react if the
measures slip?
How will future staff be made aware
of the new process?
Summary
Have a structured and disciplined approach to PI, with
an executive summary
Always involve front line staff to determine what is
actually happening, and what is feasible for change
Figure out the stakeholders and involve them early and
often
Keep good records of what you have done and why
Example: Hand Hygiene
Recognized we had a problem
Formed a team
Determined how to measure (blended
secret shopper and unit audits)
Analyzed the problem
Education
Rewards
Medication administration
Accountability
Hand Hygiene
Remedies
Education: Massive
Reward system: Incentives for all staff
Accountability system: Reports to leaders
Defined workflow for medication
administration
Operationalized
Validate
Evaluate monthly