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Introduction to the Model for Improvement How to Get Started with Quality Improvement Teams The Quality Academy Tutorial 12
Learning Objectives: You Will Learn About… • The Model for Improvement • Steps towards starting a team • Measuring the impact of improvement work
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Learning Objectives
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Model for Improvement
Food For Thought
“By what method could new leaders bring improvement in living?”
W. Edwards Deming The New Economics, 1993
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Model for Improvement
Key Question
Now that we’ve identified an area we want to improve and set up a team to work on it, what do we do next?
Answer: You Do Three Things
1. Set the aim
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Model for Improvement 2. Measure 3. Make changes
Model for Improvement
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Model for Improvement
Model for Improvement
Aim statement contains: • Explicit description • Specific actions • Time specific • Measurable • Specific patients
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Model for Improvement
• • • Aim Statement For a Broader Improvement Effort Aim The clinic will improve care of HIV/AIDS patients by focusing on education, prevention, and early intervention. Our goals include: • 80% of patients with at least one visit every three months • 85% of patients with documented medication education/adherence counseling • 90% of applicable patients with PCP/MAC prophylaxis Guidance The clinic will focus on the current active caseload of HIV/AIDS patients who are seen in the HIV/AIDS Early Intervention Services program at three of the center’s sites (approximately 350 patients).
Team • System/ Team Leadership: Primary Care Physician and Nursing Director • • • Technical Expertise: Senior Physician Day-to-Day Leadership: Program Manager Additional team members: Community Health Nurse, Case Manager, Clerical staff
Source: “HIV/AIDS Disease,” produced by the Institute for Healthcare Improvement in partnership with HRSA/HAB, 2002
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Model for Improvement
• • • Aim Statement for a Broader Improvement Effort Aim The clinic will improve care of HIV/AIDS patients by focusing on education, prevention, and early intervention. Our goals include: • 80% of patients with at least one visit every three months • 85% of patients with documented medication education/adherence counseling • 90% of applicable patients with PCP/MAC prophylaxis Guidance The clinic will focus on the current active caseload of HIV/AIDS patients who are seen in the HIV/AIDS Early Intervention Services program at three of the center’s sites (approximately 350 patients).
Team • System/ Team Leadership: Primary Care Physician and Nursing Director • • • Technical Expertise: Senior Physician Day-to-Day Leadership: Program Manager Additional team members: Community Health Nurse, Case Manager, Clerical staff
Source: “HIV/AIDS Disease,” produced by the Institute for Healthcare Improvement in partnership with HRSA/HAB, 2002
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Model for Improvement
In Setting the Aim, Be Sure To:
• Involve the organization’s senior leaders • Base the aim on both data and organizational needs • State the aim clearly and use numerical goals • Include appropriate guidance on approaches and methods
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Model for Improvement
Helpful Tool: The Improvement Project Memo • Problem/Aim statement • Improvement goal • Team leader and team members • Other (resources, authority, frequency of reporting, ground rules)
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Model for Improvement
Improvement Project Memo
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Model for Improvement
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How Will We Know That a Change is an Improvement?
• If the percentage of patients with at least one visit every three months increases • If the percentage of patients with documented medication education/adherence assessment increases • If the percentage of patients with CD4 counts < 200 who receive PCP prophylaxis increases
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Model for Improvement
Model for Improvement
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Model for Improvement
Improvement Requires Action
“While all changes do not lead to improvement, all improvement requires change.”
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Model for Improvement
Test Question
Which goal best completes this aim statement? "The clinic will improve care of HIV/AIDS patients” Our goal is to: A) Get the ophthalmology clinic to be more cooperative B) Increase the percentage of patients receiving an annual dental exam to 95% C) Add to our case management staff D) Have more patients keep their appointments
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Model for Improvement
The PDSA Cycle for Learning and Improvement
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Where to Begin?
“What Can You Do By Next Tuesday?”
• Take action • Things that matter • Things that can be fixed (given the resources you have), where success is likely • People who will be supportive • Processes that aren’t undergoing other changes • Learn from what others have done
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Starting a Team
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Starting a Team
Tips for Measurement
• Plot data over time • Use simple run charts (time series plots) of key measures directly related to your aim
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Starting a Team
Percentage of Patients With a Visit in Past 3 Months
Tips for Measurement (cont.)
• Integrate measures into routine processes • Collect useful data as part of the normal work process • Develop simple data recording forms that are integrated into the patient visit • Use both words and numbers • Sample question 1: how is adherence testing going?
• Sample question 2: how was your experience in the clinic?
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Starting a Team
HIV Improvement Collaboratives
• Sponsored by HRSA HIV/AIDS Bureau • Goals: • Working collaboratively to improve HIV/AIDS care • Committed to learning from each other • Collaborative Demonstration Projects: • Part C and D: 75 health care organizations, 2000 • Part A: 5 EMAs, 2002 • Part B: 8 States and Jurisdictions, 2005 • Part B: 18 States and Jurisdictions, 2006
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Starting a Team
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Starting a Team
Remember…
“Don’t let the perfect be the enemy of the good.”
Test Question
What's an effective first step in an improvement project?
A) Looking at the data over time to see what performance is and how it's changed B) Talking to people who work in the process to learn what they think C) Going on-line to see if another organization has tackled a similar issue D) a and b E) b and c F) a, b and c
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Starting a Team
Key Points
• The Model for Improvement provides a straightforward roadmap for improving quality • Begin with projects that matter, but also with projects where there will be support for change • Learn from others, especially from HRSA’s HIV improvement collaboratives
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Key Points
Resources
• Langley, Gerard et. al., The Improvement Guide, San Francisco: Jossey-Bass, 1996.
• • • Improving HIV Care: A Modular Quality Improvement Curriculum. Available on the National Quality Center’s website at: http://nationalqualitycenter.org/index.cfm/5838/13732
HIV/AIDS Bureau Collaboratives: Improving Care for People Living with HIV/AIDS
Disease Training Manual. Download at the NQC web site at: http://nationalqualitycenter.org/index.cfm/5838/13548
HIV/AIDS Bureau Technical Assistance Manual for Quality Management for Ryan White
CARE Act Part A Programs. Download at the NQC web site at: http://nationalqualitycenter.org/index.cfm/5908/13579
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Resources
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Related Tutorials
• To learn more about the PDSA cycle, study Tutorial 13 • To learn more about teams and teamwork, study Tutorial 11 • To learn more about ideas for change, study Tutorial 15 • To learn more about choosing improvement projects, study Tutorial 10
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Related Tutorials
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In Closing
The Quality Academy
For further information, contact: National Quality Center New York State Dept. of Health 90 Church Street, 13 Work: 212.417.4730
Fax: 212.417.4684
th floor New York, NY 10007-2919 Email: [email protected]
Or visit us online at NationalQualityCenter.org