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
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Problems and remedies come from the “front line”
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Often come from frustration of seeing processes that
are:
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–
–
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Highly variable, unpredictable, not reproducible
Potentially or actually harmful
Inefficient or redundant
Different areas have different quality issues, although
some are ubiquitous
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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?
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Is it a manual process or automated?

Is there a clear definition of the outcome (or can it be interpreted
different ways)?
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Who is going to measure?

Can you sample?
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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
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Inefficient staffing (numbers or skill set)
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Poor communication
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Inadequate process or policy
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Lack of controls to keep the problem from occurring
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Poor individual performance (usually not the only issue)
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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