Learning Session 2 · 2018-07-10 · Workbook p28 . Last Session Global Aim 1 2 3 5 P Assessment Theme Global Aim Change Ideas Specific Aim Measures SDSA P S D A P S D A P S D A

Learning Session 2

MCA Ward Collaborative

Steve

9.00 – 9.15

Welcome Back & Agenda

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart or Process Map

Cause & Effect

The Microsystem

Improvement Ramp

Effective Meeting Skills

Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Dartmouth Microsystem Improvement Curriculum

Workbook p28

Last Session Global

Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


P

a

r

t

i

c

i

p

a

n

t

P

a

r

t

i

c

i

p

a

n

t

P

a

r

t

i

c

i

p

a

n

t

L

e

a

d

e

r

F

a

c

i

l

i

t

a

t

o

r

R

e

c

o

r

d

e

r

T

i

m

e

-

k

e

e

p

e

r

P

a

r

t

i

c

i

p

a

n

t

Rol

es

Rot

ate

Participant Participant

Participant

Leader

Facilitator

Recorder

Time -

keeper

Participant

Roles

Rotate

5P Assessment

Last Session Global

Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


Purpose

5 Ps

Purpose

5 Ps

P

a

r

t

i

c

i

p

a

n

t

P

a

r

t

i

c

i

p

a

n

t

P

a

r

t

i

c

i

p

a

n

t

L

e

a

d

e

r

F

a

c

i

l

i

t

a

t

o

r

R

e

c

o

r

d

e

r

T

i

m

e

-

k

e

e

p

e

r

P

a

r

t

i

c

i

p

a

n

t

Rol

es

Rot

ate

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

Progress Reports from

Wards – Throughout

the day

Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


Osborn

3

Brearley

5&6

Hadfield

3&4

E1&2

F1

Cardiology

Osborn

2

Time Topic Where Who

9.00 Welcome back & Agenda Lecture Theatre Steve

9.15 Progress Report from E1 & E2 Lecture Theatre

9.25 Themes and Global Aims Lecture Theatre Claire

9.45 Progress Report from Cardiology Lecture Theatre

9.55 Break Post Grad Room

10.10 Progress Report from Osborn 3 Lecture Theatre

10.20 Specific Aims & Fishbone Lecture Theatre Jo, Maria

11.00 Progress Report from Brearley 5 & 6 Lecture Theatre

11.10 Change ideas – Brainstorming and Multi-voting Lecture Theatre Nicola

11.50 Progress Report from Hadfield 3 & 4 Lecture Theatre

12.00 Progress Report from Osborn 2 Lecture Theatre

12.10 Lunch Post Grad Room

13.00 Story from the field – Hadfield 6 Lecture Theatre Steve

13.50 Measurement Basics Lecture Theatre Maria, Tim

14.30 Progress Report from F1 Lecture Theatre

14.40 PDSA & Activity Post Grad Room Steve

15.25 Break Post Grad Room

15.40 Planning Time – Next steps Post Grad Room Maria

16.20 Final Reflections, next steps and close Post Grad Room All

Template

INFECTIOUS DISEASES

E1 & E2

9.15 – 9.25

Progress Report

INFECTIOUS DISEASES E1 & E2 What progress have you made since the last

session?

· Staff survey analysed

· Commenced/distributed patient surveys

· Agreed purpose/process map/patterns

· Meetings - weekly & set time

· Board-round

What’s going well?

What are your challenges? What are your plans and next steps?

· Receiving responses from patient surveys

· Staffing levels

· Impact from Trust (new innovations with

strict time-frames)

· Daily pressures/variable

· Representative from medical team

· Feedback from meetings to rest of team

· Holding regular weekly meetings

· Ownership

· Board-round (positive feedback in a short

time-frame)

· New shift times commencing 3rd August

· Raised profile on the microsystems work

· To display feedback on progress plans in E3

training room

· Agree themes for improvement

Claire

9.25 – 9.45

Themes & Global Aims

Learning Outcomes

By the end of this session you will be able to…

- Describe to other members of staff on the ward, what

happens after you have completed your 5Ps poster

- Explain what it will be used for

- Write your own aims

Workbook p60

Example:

We aim to improve patient flow in the midwifery booking

clinic. The process begins when the woman books in at

reception and ends when she books out at reception.

By working on this we expect to improve patient

experience, reduce waiting times, organise our

resources effectively and make the department look

less chaotic. It is important to work on this now because

women are dissatisfied with the time they spend here,

they become lost in the department and we are

frustrated and embarrassed about this”

Your turn to have a go…

This family of 4 are struggling to leave the house in the morning on time

(Mondays to Fridays). They monitored their leaving time and realised they

leave their house late 50% of the time.

What could their Global Aim be?

6 years old, goes to school

goes to work

goes to work

2 years old, goes to nursery

Workbook p60

Learning Outcomes

By the end of this session you will be able to…

- Describe to other members of staff on the ward, what

happens after you have completed your 5Ps poster

- Explain what it will be used for

- Write your own global aim

CARDIOLOGY

9.45 – 9.55

Progress Report

OSBORN 3

10.10 – 10.20

Progress Report

OSBORN 3 What progress have you made since the last

session?

• Staff Survey

• Patient Survey

• Significant amount of data

collected

• Started work on emerging

themes



• Variable ward participation

• Staff time outside meetings to

carry out actions

• Maintaining staff motivation in the

light of ward vacancies

• Some ideas link with other wards

and pathways

• Weekly meetings

• Improved recording of meetings

and actions

• Growing list of car park ideas

• Using effective meeting skills and

timekeeping

• Evaluating sessions

• Complete work on picking themes—to

discuss at the next meeting and decide

on key themes for wider discussion

• Continue to look at some patterns data

• Whole ward to vote on prioritising

themes

• Start testing some ideas—likely to be

based around communication

Jo & Maria

10.20 – 11.00

Specific Aim

Fishbone

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures


Cause & Effect

The Microsystem

Improvement Ramp


Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


What is a specific aim?

• At its simplest its what you want to achieve & by

when

• Allows you to make a start on comparing now

with a future improved state

• Gives you a detailed & clear focus for planning

changes

• Its measurable

Why do we use them?

Specific Aim

Global Aim

Theme Data

Specific aim

Increase

Reduce

Numbers

or %

Numbers

or %

Specific aim

By when? By August

2014 The next 10 clinics

Some principles

Clear & precise

Use numerical goals

Stretch goals

Avoid drift but be adaptable

You don’t need permission to

do

You can work on now

Set a specific target date

Examples

“We aim to reduce to the number of central line

infections in the intensive care ward from 12 per

year to zero by 1st July 2013.”

Measure: The number of central line infections

recorded on the intensive care ward

IHI Collaborative Specific Aims re:

Reducing Adverse Drug Events.

34

Examples

“We aim to decrease the amount of nursing

overtime worked within the Anticoagulation Clinic

from an average of 22.5 hours per week by 50%

by 31 May 2015

&

to 0 hours by 31 October 2015”

Measure: The total number of hours overtime

worked by nursing staff in the clinic per week

.

Examples

“We aim to decrease the length of waiting time

from referral to first appointment

from a current maximum of 17 weeks wait

to a wait of 9 weeks or less

by December 2015”

Measure: The number of weeks wait from patient

referral to attending first appointment

.

From “Global” to “Specific” Aim

- Antenatal Clinic

“We aim to improve patient flow in the midwifery booking clinic.

The process begins when the woman books in at reception.

The process ends when the woman books out at reception.

By working on this we expect to improve patient experience,

reduce clinic waiting times, organise our resources effectively

and make the department look less chaotic.

It is important to work on this now because women are

dissatisfied with the time they spend here, they become lost in

the department and we are frustrated and embarrassed about

this”

37

From “Global” to “Specific” Aim

- Antenatal Clinic

“We aim to improve patient flow in the midwifery booking clinic.

The process begins when the woman books in at reception.

The process ends when the woman books out at reception.

By working on this we expect to improve patient experience,

reduce clinic waiting times, organise our resources effectively

and make the department look less chaotic.

It is important to work on this now because women are

dissatisfied with the time they spend here, they become lost in

the department and we are frustrated and embarrassed about

this”

38

Antenatal Clinic

“We aim to decrease patient waiting in the

midwifery booking clinic by 50% by 1st August 2015”

Measure: The time in minutes that patients wait in

the waiting room

39

Global/Specific Aim Worksheet

Write a Theme for Improvement: _________________________________________

Global Aim Statement Create an aim statement that will help keep your focus clear and your work productive:

We aim to improve: ____________________________________________________ _____________ (Name the process)

In: _______________________________________________________________________________ (Clinical location in which process is embedded)

The process begins with: _____________________________________________________________ (Name where the process begins)

The process ends with: _______________________________________________________________ (Name the ending point of the process)

By working on the process, we expect: __________________________________________________ (List benefits)

It is important to work on this now because: ______________________________________________ (List imperatives)

Create Flowchart

Specific Aim Statement We will: _ improve _ increase _ decrease

The: _ quality of _ number/amount of _ percentage of ________________________ (describe what will b e measurably different)

By: ___________________________________________________________________ (percentage)

OR

From: _________________________________________________________________ (baseline state/number/amount/percentage)

To/By: ____ _____________________________________________________________ (describe the change in quality or state the number/amount/percentage)

By: ____________________________________________________________ (date)

Example: We will decrease the amount that my dog weighs from 55 pounds to 50 pounds by August 31, 2007.

Or simply

How much?

By When? Workbook p70

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures


Cause & Effect

The Microsystem

Improvement Ramp


Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


Workbook p16

• Optimised nutrition

• Optimised weekly training programmes

• Improved the ergonomics of the bike seats

• Optimised the weight of the tires

• Discovered the pillow that offer the best sleep

• Tested for the most effective type of massage gel

• Trained the riders the best way to wash their hands to avoid infection

Improving by just 1% isn’t notable, but can be

just as meaningful, especially in the long run

Team

performance

ergonomics

of the seat

nutrition

the weight of

the tires

infection

massage gel

pillows

Fishbone or Cause and Effect Diagrams

Why do we use them? • Health care is complex

• Outcomes are due to multiple causes

• Improvement requires management of the most important causes of undesirable outcomes

What is it? • An organised picture of the factors thought to produce a

result.

How do we construct one? • Put our problem or aim at end of arrow and brainstorm

major categories of contributing factors and subcategories

Fishbone Diagram

Result

/effect

Driver

Driver Driver

Driver

45 Workbook p72

Major

driver

Sub-category

driver

Fishbone Diagram

Result

/effect

People

Materials Process

Equipment

Workbook p72

This family of 4 are struggling to leave the house in the morning on time

(Mondays to Fridays). They monitored their leaving time and realised they

leave their house late 50% of the time.

Global Aim: To improve the process of getting out of the house in

the morning on time


goes to work

goes to work


Your 10 min challenge:

• To write a SPECIFIC AIM for this family

• To create a CAUSE AND EFFECT DIAGRAM for this specific aim

‘the problem’

primary cause

secondary

causes

What?

How much?

By when?

GSM - BREARLEY 5 & 6

11.00 – 11.10

Progress Report

Progress Since the Last Session

• ‘Give it a go week’ – board rounds PDSA

• Work on noise monitoring

• Finished 5Ps

• Posters inviting people to get involved

• Changed meeting time & date to improve

attendance

• Going to view V4 and B2 board rounds

Purpose

We provide truly holistic patient-centred care; we

treat and support our patients to achieve the best

outcome they can with dignity and without delay.

We promote a collaborative learning environment

where we can support each other and develop new

skills, work as a team and have good job

satisfaction. We strive to continuously improve our

service, make a difference and work together to

provide care for patients and carers that looks after

our patients in the way we would wish for members

of our own family.

‘Give it a go’

What’s going well

• Positive meeting evaluations

• Already tested using PDSA

• Working together positively

• We have themes to work on

‘It’s encouraging

and inspiring to

find that this work

is going on’

GSM SHO

Themes

Ward Processes

Falls

Communication (Board Rounds,

Handovers, referrals)

Noise

What are your challenges

• Attendance, Busy-ness and Staffing issues

• Encouraging regular attendance from

representation from all the MDT

• Communication – getting information and

awareness out (Info doesn’t ‘cascade’)

What are your plans and next steps

• Collect data on ‘noise’

• Continue to work and test board-rounds

–develop an ‘ideal’ structure

• Work on the themes – progress up the ramp

Change Ideas

Brainstorming & Multivoting

Nicola

11.10 – 11.50

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures


Cause & Effect

The Microsystem

Improvement Ramp


Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


Workbook p16

How do we generate change ideas to test?

Map out the process and look at the gap between

current and ideal.

Workbook p68


Use other investigative tools eg Fishbone

Lengthy

Appointments

People Equipment

Materials Process

Clinical staff inconsistent Support staff not

trained

No one responsible for patient flow Patients arrive with more

needs than originally

stated

Providers are lateSupport staff unprepared

for patient visits

Equipment

broken

Not enough computers

Equipment missing

Inventory low

Missing exam

room supplies

Charts are missing

Information, e.g. test

results missing

No standard

registration processMA does paper flow and patient flow

Variation in rooming process

Check out

process delays

Poor communication between all

staff on patient status

Fishbone (Cause and Effect) of Lengthy Appointments


Tap into local knowledge

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

Osb

orn 3

Brearl

ey

5&6

Hadfi

eld

3&4

E1&

2

Cardiol

ogy

Osb

orn 2

F1

How do we generate ideas to test? Using benchmarking - searching for best practice in

other organisations.

63

Average Length of Stay for HRG xyz

0

2

4

6

8

10

12

14


Langley and Nolans Change Concepts

• Change concepts are stimulants to develop and design

detailed and specific tests of change

• A change concept combined with your knowledge of the

process will help lead to new thinking about the process

• Use change concepts to “jump start” your thinking

65

Creativity: The connecting and rearranging of

knowledge — in the minds of

people who will allow themselves

to think flexibly — to generate

new, often surprising ideas that

others judge to be useful.


Brainstorming

66

Edward De Bono’s Mental Valleys Model of Thinking

“Creative thinking involves breaking out of

established patterns (valleys) in order to look at

things in a different way.” de Bono

67

Attention…..Escape……Movement

Movement Play imaginatively with this suggestion and generate ideas from

it without judgement or critiscism. Encouraging mental

movement.

“Let’s try to generate at least 10 ideas for ways to manage

patients arrivals in outpatients without a receptionist or a desk”

Attention Looking closely, observing with fresh perspective and really

noticing current rules and assumptions.

“patients who come to outpatients must first come to reception”

Escape Challenge or block an existing rule is encouraging escape from

the current mental valley.

“the Trust has made it illegal to have a receptionist and a desk in

outpatients”

68

Brainstorming

Successful

brainstorming:

•Encourage creativity

• Involve everyone

•Generate excitement

and energy

•Levels out hierarchy

Workbook p76

69

Brainstorming Steps

1. Review the topic, clarify as needed

2. Take a minute or two of SILENT thinking

3. Go around the table for each person to give

an idea.

4. After the first round, members can pass.

5. Once one member passes, let all members of

the group shout out ideas.

When ideas start to flow…let them come!

Workbook p77

70

Brainstorming cont.

-Go for Quantity….NO DISCUSSION at this

stage.

-NO CRITICISM of ideas…not even a groan or a

grimace….or even ‘that’s a great idea’!

-Build on each others ideas

-Encourage wild ideas.

-One conversation at a time.

-Write ALL ideas on flipchart for all to see

Workbook p78

This family of 4 are struggling to leave the house on time in the morning (Monday

to Friday) resulting in Mum and Dad frequently being late for work, the children

being late for school/nursery and the environment being pressured and stressful.

Their specific aim is to increase the proportion of days (Monday to Friday)

when they leave the house on time from 50% to 100% by 31 October 2015


goes to work

goes to work


72

EXERCISE.

- Get into groups of at least 8?

- Brainstorm for 5 minutes.

‘Generate at least 20 ideas that could help

the family get to work/nursery/school on time

and be happy!’

Get

clothes

ready

Have a

sock

strategy

Make

lunch night

before

Play

speedy

music

Army

routine

Clock in

the

shower

Kids

checklist

Bags

ready at

door

Get a

nanny

Socks in

basket

by door

Ring a 5

min bell

Check

traffic

reports

Dress

rehearse

schedule

Make a

robot Do stuff in

the car

Do

routine

stuff first

Hire a

helicopte

r

Have

loads of

alarm

clocks

Allocate

jobs

Have an

emergency

pack

74

Affinity Grouping and Multivoting

• Affinity grouping is a brainstorming method in

which participants organise their ideas and identify

common themes. In the brainstorming all ideas

need to be recorded on Post ITs and posted up

onto the flip chart.

• Multi-voting is a structured series of votes by a

team, in order to narrow down a broad set of

options to a few.

Workbook p79

75

1. Clarify and remove duplicates.

2. Start by choosing two ideas.

3. Agree with the group whether they are related.

If they are related put them together.

4. At the end of the exercise there should be less

than 10 groups of post it notes.

5. Give a short descriptive header to each group.

Affinity Grouping

Get

clothes

ready

Have a

sock

strategy

Make

lunch night

before

Play

speedy

music

Army

routine

Clock in

the

shower

Kids

checklist Bags

ready at

door

Get a

nanny

Socks in

basket

by door

Ring a 5

min bell

Check

traffic

reports

Dress

rehearse

schedule

Make a

robot

Do stuff in

the car

Do

routine

stuff first

Hire a

helicopt

er

Have

loads of

alarm

clocks

Allocate

jobs

Have an

emergency

pack

Night

before

plan

Morning

strategy

Schedulin

g process

Time

reminders Others do

the jobs

Travel

method

Increase

pace

77

Multi-voting Steps

-Number each idea.

-Each person can have 1/3rd of the ideas to vote on.

eg if 21 ideas were generated, each person gets 7 votes. They can not

vote on one idea more than once.

-Tally votes.

-Eliminate ideas with few votes.

- If this identifies 3 -4 ideas to work with stop here.

Otherwise repeat with the remaining items.

Selection Criteria

Add some criteria to help the voters

Suggestions might be depending on the change -

Ideas that can be started fast

The change is reasonably low cost

The effort is small compared to the impact

The idea can be tested without getting ‘permission’

from others

78

Workbook p80

79

Multi-voting Steps

Voting methods:

-Colored sticky dots

- Individually write choices on piece of paper

-Go to the list and indicate your choice w/marker

-A show of hands as each number is called out.

-Remember selection criteria

Get

clothes

ready

Have a

sock

strategy

Make

lunch night

before

Play

speedy

music

Army

routine

Clock in

the

shower

Kids

checklist Bags

ready at

door

Get a

nanny

Socks in

basket

by door

Ring a 5

min bell

Check

traffic

reports

Dress

rehearse

schedule

Make a

robot

Do stuff in

the car

Do

routine

stuff first

Hire a

helicopt

er

Have

loads of

alarm

clocks

Allocate

jobs

Have an

emergency

pack

Night

before

plan

Morning

strategy

Schedulin

g process

Time

reminders Others do

the jobs

Travel

method

Increase

pace

Have a

sock

strategy

Play

speedy

music

Kids

checklist Bags

ready at

door

Get a

nanny

Ring a 5

min bell

Hire a

helicopt

er

Have an

emergency

pack

Night

before

plan

Morning

strategy

Schedulin

g process

Time

reminders Others do

the jobs

Travel

method

Increase

pace

GASTROENTEROLOGY –

HADFIELD 3 & 4

11.50 – 12.00

Progress Report

Progress Since the Last Session

• Completed 5P poster and reviewed data

• Identified 3 themes.

• Strong patient voice through Patient Governor help.

• Doing PDSA for Board Rounds looking at attendance,

timings etc. Data collected by Occupational Therapist.

• Collected data on TTO’s by Pharmacist.

• Patient Governor doing surveys about food.

5Ps to Themes

Patient Flow Patient

Nutrition Patient

Entertainment

Global Aims written for all themes. We aim to improve patient flow on

Robert Hadfield 3 and 4.

The process begins with admission to the ward.

The process ends with the patient discharge home.

By working on the process we expect to; provide patients with a timely

safe discharge without delay, reduce patient readmissions, reduce patient

length of stay on the ward and improve the patient and staff experience of

the ward.

It is important to work on this now because; staff feel this would have

the biggest impact for patients and staff, patient feedback found that

patients experienced delays getting on the ward, it builds on the work we

have started already by introducing Board Rounds and it is a priority for the

Gastroenterology and Hepatology directorate

What’s going well

• Having regular weekly meetings.

• Good wide core representation

• Improved communication

• Progressing through the Microsystem improvement ramp.

• Using effective meeting skills

What are your plans and next steps

• Attend a directorate consultant meeting to share what

we have been doing and seek engagement in mapping

patient discharge processes.

• Review information from food related surveys

• Process map - organising patient meals

• Brainstorm about patient entertainment

OSBORN 2

12.00 – 12.10

Progress Report

What progress have you made since the last session?

More people attending meetings

Since last time completed 5Ps including:

Typical patients

Patient and staff feedback

Process mapping

Discussed patterns

Identified common themes

OSBORN 2 PROCESS MAPS FOR TYPICAL PATIENTS

What is going well? (1/2)

Identified THEMES

Time management

and organisation

Communication

Staffing level

Keeping patients occupied

What is going well? (2/2)

Improved staff representation

Improved on all points from 15/05/2015:

People talking about it

New members each meeting

Commitment

Effective meeting skills

Supporting each other

Transparency

Good posters – eye catching and more powerful

Level of enthusiasm is high

What are your challenges?

Staff off ward to meetings

Consistency of MDT staff to meetings

Due to building work- difficulties to meet / view posters

Getting action started from last meeting

What are your plans and next steps?

Plan occasional odd days for meetings (ward clerk,

domestic staff etc)

Collecting data

Work on handover (outside representation)

Look on themes split into sections

All to get email to meetings

SharePoint site – add our info to it

Looking at global aims and themes

Story From the Field

GSM Ward - Hadfield 6

13.00 – 13.50

Maria & Tim

13.50 – 14.30

Measurement Basics

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures


Cause & Effect

The Microsystem

Improvement Ramp


Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


Workbook p16

Why do we need to measure?

If you wanted to reduce your calorie intake,

which food should you give up?

If we don’t measure, how will we know that

the change is an improvement?

all food here is 200 kcal

If we don’t measure, how will we know if

what we are observing is not due to chance?

103

2020? 2014 2015

Welcome to Royal

Hallamshire Hospital

What can we measure?

Time

• Length of stay

• Length of ward rounds

• Length of drug rounds

• Time of discharge

Proportion / percentage / rate

• x% of staff would recommend this ward

as a place to work

• X% of patients would recommend this

hospital to friends and family

• Infection rate

• X% of our admissions fall on a Monday

Number / frequency

• Number of admissions

• Number of accidents

• Number of falls

• Number of time you are

interrupted during the drug

round

Value / cost

• Cost of delayed discharge

(extra bed nights)

• Cost of extra staff

• Cost of re-work

• Cost of extra kit

• Value of saved staff time

SOME EXAMPLES:

When do we need to measure?

Global AimThe ‘big picture’

Specific Aim The ‘component

parts’

Change Idea

Conceptual Definition

‘The Measure’

Operational Definition ‘Specify & Quantify’

Measurement Plan

‘The How’

Workbook p88

Global Aim

Specific Aim

Change Idea


Measurement

Plan

‘The How’

Operational

Definition

“The Big Picture”

“The Component

Parts”

“How you will do it”

The Measure (Abstract Idea)

The Measure

(“Specify and Quantify”)

The “How, What, Where, When and

Who”

Workbook Page 90

We aim to improve the

discharge process and make

it more efficient and patient-

centred

We will improve patient

waiting time for ambulance

by 30% by August 2015

We will book an ambulance

as soon as the decision to

discharge is made

We will improve patient waiting time for

ambulance by 30% by August 2015

Global AimThe ‘big picture’

Specific Aim The ‘component

parts’

Change Idea


‘The Measure’

Operational Definition ‘Specify & Quantify’

Measurement Plan

‘The How’

Conceptual Definition Tells WHAT will be measured

Patient Waiting for an ambulance

Operational Definition Tells HOW it will be measured

Time elapsed from the time the ambulance was

booked by the ward clerk until the ambulance

crew arrives to collect the patient in hrs (or min)

or

How many times in a week do our patients wait

for an ambulance for over 2 hours?

or What proportion of patients (%) wait over 2 hours

every week?

Exercise: What is a clean room?

• Conceptual Definition (what) = Clean

• What is the operational definition (how) in the following contexts?

-A teenager’s bedroom

-The presidential suite at a five star hotel

-An operating room at a hospital

110

Collecting your data

Global Aim

Specific Aim

Change Idea


Measurement

Plan

‘The How’

Operational

Definition

“The Big Picture”

“The Component Parts”

“How you will do it”

The Measure (Abstract Idea)

The Measure

(“Specify and Quantify”)

The “How, What, Where, When and

Who”

Data Collection Plan

“If you fail to plan, you are planning to fail”

Benjamin Franklin, 1706-1790

• What data will be collected?

• How will the data be collected?

• Who will collect this data and how will they be trained?

• Where will the data be collected

• When will data collection start and stop?

Data Collection Plan

“What, How, Who, Where, and When”

• We will measure the time between when the ambulance is

booked until the time when the ambulance crew arrives to

collect the patient in hours

• We will gather data from database X (time of request) and

medical records (time of crew arrival)

• We will collect the data on ward Y for all patients requiring 2-

men ambulance

• We will collect data for all days and shifts in July 2015

What is missing?

Data Collection Plan Example

• We will measure the time between when the ambulance is

booked until the time when the ambulance crew arrives to

collect the patient in hours

• We will gather data from database X (time of request) and

medical records (time of crew arrival)

• We will collect the data on ward Y for all patients requiring 2-

men ambulance

• We will collect data for all days and shifts in July 2015

Who is going to collect the data?

Data Collection Plan Example

What will help us make sense of the data?

• Frequently used

• Compare categories of data

• Useful for: visual display of data at

any one point in time (e.g. results of

staff and patient surveys)

• Less useful for: tracking the changes

over time

Bar Charts

What was the Best Thing About your visiti to the Clinic?

0 2 4 6 8 10 12 14 16 18 20

Clean environment

Familiar Expert Doctor

Friendly and Caring Staff

Going Home

Information and Advice

Meeting fellow patients

Ongoing monitoring of

condition

Reassurance

Well Organised

Responses

I would recommend this clinic as a great place to

work

0

2

4

6

8

10

12

Strongly Agree Agree Disagree Strongly Disagree

Nu

mb

er

of

resp

on

ders

• Simple to construct

• Show changes over time

• Useful for: Measuring

changes over time, or for

consecutive patients. Helps

to identify whether the

change led to improvement.

• Less useful for: when

poorly annotated (e.g. no

title or axis labels)

Run Charts

• Show proportions of data

within a group

• Useful for: visual display of

data at any one point in time

(e.g. results of staff and

patient surveys)

• Less useful for: tracking

the changes over time, data

can be skewed by the

number of survey responses

Pie Charts

9

2

11

Which staff group best describes you?

Administration, Clerical & Secretarial Staff Medical Staff Nursing/Therapy Staff

• Show differences between

elements of categories as well

as categories

• Actual numbers lost

• Useful for: visual display of

data and focusing the team on

areas to improve

• Less useful for: tracking the

changes over time, data can be

skewed by the number of

survey responses

Proportional Bar Charts

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Duration of vis it

Staff working patterns/opening hours

Waiting time for patients

Appointment scheduling

Transport

Hospital environment

Information available for patients/carers

What would you change about your service

0 - No change required 1 2 3 4 - Large change required

• Shows relationship between

two sets of data

• Can add trend line

• Useful for: showing the

relationship between two

parameters (e.g. height and

weight), shows

abnormalities in data

prompting question


changes over time and

putting data into categories

Scatter graphs

0

20

40

60

80

0 5 10 15 20

He

igh

tAge

Height vs Age

• Shows patient journey

through a clinic

• Quickly shows wait

• Useful for: visually showing

delays in patient journey

• Less useful for:

understanding the reasons

for delays or total wait time

at a glance

Patient Flow Charts

Patient 1

Obs &Swabs Patient 2

Assessment Patient 3

ECG Patient 4

Bloods Patient 5

Xray Patient 6

Additional Obs Patient 7

Examination Patient 8

Wait Patient 9

Unknown Patient 10

Review Notes Patient 11

Patient 12

Patient 13

Patient 14

Patient 15

Patient 16

Patient 17

Patient 18

Patient 19

Patient 20

Patient 21

Patient 22

Patient 23

Patient 24

Patient 25

Patient 26

Patient 27

Patient 28

Patient 29

Patient 30

Patient 31

Patient 32

Patient 33

Patient 34

Patient 35

Patient 36

Patient 37

Patient 38

RHH Pre-Op Clinic

10/05/12 13:4008:2008:0007:40 12:0011:4011:20 14:00 14:4014:2013:2013:0012:4012:2011:0009:2009:0008:40 10:4010:2010:0009:40

• Shows themes from

free text responses

• Useful for: visual

display of qualitative

data (free text surveys)

and its thematic

analysis

• Less useful for:

numerical data

Wordle

What would improve your working day?

• Shows different types of

data

• Useful for: understanding

precise data


changes over time, showing

co-relation between data or

data trends

Tables

Day of Clinic Number of

Patients

Number of

DNAs

Cost of

Clinic

Monday 15 3 £1504

Tuesday 13 1 £1367

Wednesday 10 0 £1243

Friday 16 4 £1794

• It doesn’t have to be technical

• Use tally charts and hand

drawn graphs

Measurement Top Tips

Patterns Patterns can be found through tracking the volumes and types of telephone calls. Review the categories on the telephone

tracking list to ensure they reflect the general categories of calls your practice receives. Ask clerical staff to track the telephone calls over the course of a week to find the patterns of each type of call and the volume peaks and valleys.

Put a tally mark each time one of the phone calls is for one of the listed categories. Total the calls for each day and then total the calls in each category for the week. Note the changes in volume by the day of the week and am/pm.

Primary Care Practice Telephone Tracking Log

Week of Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Week Total

AM PM AM PM AM PM AM PM AM PM AM PM AM PM

Appointment for Today

\ \\ \ \ \\ \\ \\\ 12

Total

Appointment for Tomorrow

Total

Appointment for Future

Total

Test Results

Total

Nurse Care \\\ \\\\\

\\\\ \\\\ \\\\\

\\ \\\\\ \\\\ \\\\\

\\\\ \\ \\\\\

\\ \\\ 52

Total

Prescription Refill

\\\ \\\\\\\\\\\

\\\\ \\\\\\\

\\\\\ \\\\ \\\\\\\\\\\\

\\ \\\\\\\

\\\ 55

Total

Referral Information

Total

Need Information

Total Message for

Provider

Total

Talk with Provider

Total

DAY TOTAL

• Make sure the graphs help

• If it doesn’t, try something

else


02468

101214161820

What was the best thing about your visit to the clinic?



else


3

15

6

5 6 4

19

12 3


Well organsied

Reassurance

Ongoing montoring of condition


Information and advice

Going Home

Friendly and Caring staff

Familiar expert Doctor

Clean Environment



else


0 2 4 6 8 10 12 14 16 18 20

Well organsied

Reassurance

Ongoing montoring of condition


Information and advice

Going Home

Friendly and Caring staff

Familiar expert Doctor

Clean Environment


• Make it easy, is the data already being collected

somewhere?

• Make sure everyone knows what they’re collecting. It’ll

only be useful if everyone collects the same thing.

Remember your operational definition.


Operational Definition Tells HOW it will be measured

Time elapsed from the time the ambulance was

booked by the ward clerk until the ambulance crew

arrives to collect the patient in hrs (or min)

or

How many times in a week do our patients wait for

an ambulance for over 2 hours?

or What proportion of patients (%) wait over 2 hours every

week?

Definition of a clean… (3 min)

Teenager’s

bedroom

Presidential suite

at a five star hotel

Operating room

at a hospital

Cardiology E1 & 2 F1

Osborn 3 Gastro Osborn 2

Brearley 5 & 6

Report back – 1 min for each team

ORTHOPAEDICS – F1

14.30 – 14.40

Progress Report

Orthopaedics F1 What progress have you made since the last

session?

• Patient demographic survey (joint school)

• Staff survey

• Process map

• Meetings - weekly & set time

• Patient property PDSA

• Drug card audit



• Not enough patients!

• Difficult to work on our microsystem when

we’re being pulled off the ward and not in

our usual pattern of work

• Keeping momentum when we have

different people at each meeting

• Moving on/ closing down conversations

• Representative from social work

• Holding regular weekly meetings

• Getting more of the MDT to the meetings

• Making and measuring improvements

• Finish our 5Ps

• Discharge planning theme

Steve

14.40 – 15.25

PDSA & Activity

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures


Cause & Effect

The Microsystem

Improvement Ramp


Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


Workbook p28

Plan

Do Study

Act

Specific Aim

Measurement Plan

Change Ideas

Workbook p120

Plan

•Objective

•Questions and

predictions (Why)

•The plan – who what

where when

Do

•Do the Plan

•Document problems,

observations

•Begin analysis

of the data

Study

•Complete analysis of

data

•Compare data to

predictions

•Summarise the

learning

Act

•What changes

are to made now?

•What is the next

cycle

PDSA

PDSA - experimentation • Always start with a specific aim - What are we trying to accomplish?

• How will know if this is an improvement? – Data.

• Small tests of change over a short time

• Debrief frequently

• Communicate results

• Repeated Cycles

• When we meet our aim? –

SDSA = Standardise

SDSA

1

3

2

P

DS

A

P

DS

A

P

DS

A

P

DS

A

P

DS

A

P

DS

A

4

5

6

PDSA Cycle: Deciding on Scale of Test

Current Situation Resistant

(No commitment)

Indifferent

(some

commitment)

Ready

(strong

commitment)

Low Degree of Belief that

change idea will lead to

Improvement

Cost of

failure large

Very Small Scale

Test

Very Small Scale

Test

Very Small Scale

Test

Cost of

failure small

Very Small Scale

Test

Very Small Scale

Test Small Scale Test

High Degree of Belief that

change idea will lead to

Improvement

Cost of

failure large

Very Small Scale

Test Small Scale Test Large Scale Test

Cost of

failure small Small Scale Test Large Scale Test Implement

Engagement, Readiness to Change

Source - The Improvement Guide

Co

nfi

den

ce

Workbook p82

Workbook p84

Workbook p84

PDSA Exercise

14.55 – 15.25

Maria

15.40 – 16.20

Planning Time

Template

Steve

16.20 – 16.30

Final Reflections

Next Steps

Close

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures


Cause & Effect

The Microsystem

Improvement Ramp


Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


Ward Collaborative Overview

Workbook p15

Learning Session Overview

Session 1 Session 2 Session 3 Session 4

Introduction to the

collaborative.

QI and

microsystem

fundamentals,

Effective meeting

skills,

understanding

your system using

the 5Ps

Process mapping,

Patient

involvement.

Story from the

field. (CHANGE

room).

Progress reports

from all teams,

Feedback and

sharing on the

5Ps,

Themes and Aim

statements,

Change Ideas and

PDSA,

Measurement

basics.,

Story from the

field. (Hadfield 6)

Planning Time

Progress Reports

from all teams,

Psychology for

improvement

Run charts and

Variation,

5s,

SDSA and

sustaining

improvement.

Planning Time

Progress Reports

from all teams as

posters and

presented case

studies.

Capacity and

demand basics.

Planning multiple

improvements

using driver

diagrams

Ward Collaborative Overview

Workbook p15

MCA Connect

• 11 September 2015, 9am - 4pm

• R Floor, Royal Hallamshire Hospital

• Ward Collaborative Session is planned– come

and share your work!

• If you are interested speak to your coach & email

Jess

Documents

Learning Session 2 · 2018-07-10 · Workbook p28 . Last Session Global Aim 1 2 3 5 P Assessment Theme Global Aim Change Ideas Specific Aim Measures SDSA P S D A P S D A P S D A