Transcript Quality Improvement: Overview of Principles and Techniques

Quality Improvement: Overview
of Principles and Techniques
Phavinee Thongkhong-Park, PhD, RN
Adjunct Faculty, The University of Michigan School of Nursing
Project Director, Department of Standards, JCAHO
Quality Improvement
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Performance Improvement as a
Management Philosophy
– Data driven
– Focuses on changing critical process steps
– Bottom up decision making as well as top
down
– Teams as organizational unit
Quality Improvement
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Plan-do-check-act (PDCA) cycle
– model is easy to use and understand
– underlying philosophy is to continually
raise the quality bar
– Measurement continues until tools,
techniques and behavior patterns part of
daily practice
Quality Improvement
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It starts with values…..
– Vision
– Mission
– Goals
– “What are we trying to accomplish and how
does the action support that?”
Quality Improvement
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Identify important processes
– relates to and support the mission and
goals
– attach indicators to each important process
– outcome data
• special indicators that measure the end of a
process
Quality Improvement
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Process Indicator Selection
– Locate the points of variability and
measure them
– Indicator Examples:
• Left without being seen
• Patient wait times
• Medication errors
Quality Improvement
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Selection of Improvement Projects
– Which indicator or outcome data tells you
to act because it exceeds thresholds?
– Do you have new processes to put in
place?
– Do you have imperatives preselected by
management to improve?
Quality Improvement
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Improvement Project Characteristics
– Clearly defined and measurable objectives
– Utilizes a minimum of one indicator with a
known baseline
– Rearranges or restructures the basic
process steps
– Trials the process redesign before full
implementation
Quality Improvement
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Teams as organizational unit
– Two types
– Product or output teams (permanent
teams)
– Process Improvement Teams (project
teams)
Quality Improvement
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Essential elements for team success
– Training, training, training
– Common vision
– Data and measurable goals
– Facilitation
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Formation of improvement teams
– Team is assigned one project
– Team is trained
– Team establishes ground rules, objectives,
and timetables
– Team reports progress
Quality Improvement
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Team Roles
– Facilitator does not make decisions or
affect the output of the team
– Leader is a team member who chairs
meetings and coordinates activities
Quality Improvement
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Plan
– Assess the current indicator information
– Analyze the process to be improved
– Identify the steps in the process to be
eliminated or changed
Quality Improvement
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Plan
– Look for variation
– Flow chart important processes as a group
– Generate multiple options for improvement
– Select one
– Select evaluation tool
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Do
– Set up and initiate the pilot phase of the
change
– This is the experimental phase
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Check
– At the end of the pilot (or sooner)
– Did this work the way we thought it would?
– Evaluate the whole process to ensure that
the change did not negatively impact
another process
Quality Improvement
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Act
– Fully implement the selected change
– Continue to monitor the process