Quality ImprovementQuality Improvement

For more see the Course in Quality

Farrokh Alemi Ph.D. hhttp://gunston.gmu.edu/708/EmailAlemi.htm 703 993 1929

Getting Ready for ChangeGetting Ready for Change

• Why some change easily and others suffer unnecessarily?

• What does it take to be ready for change?– We claim the task at hand is unique

– We claim we can beat the odds

Does Continuous Quality Does Continuous Quality Improvement Work?Improvement Work?In a randomized controlled trial of 15 clinics (95 providers, 4995 patients) both CQI and academic detailing when correctly implemented increased by 17% number of hypertensive patients adequately controlled. By themselves or when inadequately implemented, CQI or accademic detailing had no effect.

Jt Comm J Qual Improv 98; 24 (3): 130 -142

Does It Work (Continued)?Does It Work (Continued)?

Numerous department wide improvement efforts led to statistically significant improvement in patients’ satisfaction with the Department over 4 years .

0

20

40

60

80

0 2 4

Time periods

% r

ati

ng e

xce

llent

Arch Otolaryngology Head Neck Surgery 96; 122 (10): 1045-1048

Does It Work (Continued)?Does It Work (Continued)?

Patients and providers were randomly assigned to two inpatient wards, one of which engaged in continuous quality improvement. The unit with CQI reduced the mean length of stay from 6.06 to 5.46 days. Total charges were reduced from $8,090 to $6,681.

Medical Care 98; 38 (8S): AS4-AS12

Does It Work (Continued)?Does It Work (Continued)?

 Reduced

costClient

satisfactionMarket share

Care outcomes

Employee work life

Percent of 92 projects targeting

this area36% 76% 21% 56% 50%

Percent of 92 projects reporting measured success

2% 12% 8% Up to 13% Up to 30%

Continuous Quality Continuous Quality Improvement Can Help Improvement Can Help If ...If ...

• Correctly implemented.

• Over long time periods.

• Focused on significant problems.

10 Steps to Improvement10 Steps to Improvement

Who? Does what?

1 Leaders Set mandate forchange

2 Leaders Set new culture

3 Leaders Allocate resources

4 QI unit Gather data, defineproblems

10 Steps in Improvement 10 Steps in Improvement (Continued)(Continued)

Who? Does what?

5 QI unit Select teams

6 Teams Describe process

7 Teams Select solutions

8 Teams Evaluate successTry again

10 Steps to Improvement 10 Steps to Improvement (Continued)(Continued)

Who? Does what?

9 LeadersTeams

Tell storyCelebrate success

10 Leaders Spread improvement

Farrokh Alemi Ph.D. Falemi@gmu.edu 703-748-1629

This lecture focuses on:This lecture focuses on:Leading ChangeLeading Change

Steps Taken by LeadersSteps Taken by Leaders1.1. Set MandateSet Mandate

• Have a vision

• Set example

• Speak up Question?

Does change need to start from top?

Steps Taken by LeadersSteps Taken by Leaders to set cultureto set culture

2. Keep the customer in 2. Keep the customer in mindmind

• Customer mindedness– Who is the customer

– Is the customer aware? Question? What do fish talk about?

Steps Taken by LeadersSteps Taken by Leaders2. Avoid blaming people2. Avoid blaming people

• Blame the system not people– What is a system?

– How to deal with problem people?• Do you like team work?

Question?Can you not blame

the individual ?

Steps Taken by LeadersSteps Taken by Leaders2. Rely on data2. Rely on data

• Question the obvious and trust data– What can you

measure?

– What is the advantages of measurement

Question? Is measurement

counter productive?

Steps Taken by LeadersSteps Taken by Leaders2. Use teams2. Use teams

• Encourage teamwork & empower employees– Is empowerment a

myth?

– How could teams be made more productive

Question? Is teamwork

counter productive

Steps Taken by LeadersSteps Taken by Leaders3. Allocate Resources3. Allocate Resources

• Training resources

• Improvement resources

• Employee time

• Contractor’s time

Question? Should organizations create

new departments or pay existing ones?

Steps Taken by QI UnitSteps Taken by QI Unit44. Identify Problems. Identify Problems

• Gather data

• Benchmark against peer

• State problems

• Assign teams

Tip No solutions. No blame.

Describe customer’s experience.+ & - perspectives

Exercise: Linguistics 101• Write a sentence stating a

problem you have noticed at work.

• Is this a good problem statement? How would you know?

Exercise: Linguistics 101• Here is an example of a problem

statement that I have received in the past:– The therapists arrive too late and

thus we are not able to serve food on time

– The computers broke down during admission process

– It takes too long to discharge the patient because the doctors tell to the patient that they can go home before we are ready

• What is wrong with these problem statements?

Exercise: Linguistics 101• The therapists arrive too late and

thus we are not able to serve food on time– Blames a group of employees

– Focuses on the gap and not the opportunity

– Does not tell us of the customer’s experience

• Most patients complain that their food arrives too late and cold. Some find that food arrives just in time.

Take Home Lesson So FarTake Home Lesson So Far

Effective change starts from top and needs a supportive environment