Quality Improvement - Massachusetts · PDF filePatient Safety- Quality Improvement: “A formal approach to the analysis of performance and systematic efforts to improve it”. MCCP

MCCP Online Orientation

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To gain an understanding of:

◦ Quality

◦ Quality improvement

◦ The Model for Improvement

◦ The PDSA cycle

Online OrientationMCCP

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Institute of Medicine: “Quality of Care” “is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”.

Institute for Healthcare Improvement (IHI): “Quality is turning into outcomes management, and involves minimizing unnecessary variation so that outcomes become more predictable and certain”.

Quality Digest: “Quality is meeting the customer's needs in a way that exceeds the customer's expectations”.


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Patient Safety- Quality Improvement: “A formal approach to the analysis of performance and systematic efforts to improve it”.


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Safe

Effective

Patient-centered

Timely

Efficient

Equitable

IHI, 2011a

How can we improve a system to achieve better results in the dimensions of quality?


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◦ You need to :

Know your customers (patients/residents).

Understand where the system is failing - Identify what is wrong.

Identify step that needs fixing.

Implement change.


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Step 1: Three questions

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Step 2: PDSA cycle

=

Model of Improvement


API, 20107

What are we trying to accomplish?

How will we know that a change is

an improvement?

What change can we make that will

result in improvement?

MODEL FOR IMPROVEMENT

The Change

The Measure

The Aim

API, 2010

Step I: Questions

Step 2: PDSA


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Plan a change

Do the change

Study the results

Act on the results

Walter Shewhart was the first person to propose a version of the PDSA cycle.

W. Edwards Deming modified Shewhart's cycle to PDSA, replacing

"check" with "study."


Eliminate Waste

Improve Work Flow

Optimize Inventory:

Change the Work Environment

Producer/Customer Interface

Manage Time

Focus on Variation

Error Proofing

Focus on the Product or Service


IHI, 2012

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All improvement will require change, but not all change will result in improvement


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To test your change use the PDSA

cycle.

Start with a PLAN

◦ Objectives

◦ Questions and predictions

◦ A Plan to carry out the cycle

who,

what,

where,

when

◦ A Plan for data collection


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Do: the action part of the

process

◦ document problems and unexpected results

◦ collecting and analyzing data

◦ meeting with involved parties


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Study◦ Analyze process improvement data◦ Compare data to prediction◦ Summarize what was learned

◦ Some focus areas of improvement are: Clinical Outcomes

Cost

Access to Care

Satisfaction

Community Service

Regular Satisfaction Surveys


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Act◦ What changes are to be made

◦ Start the next cycle?


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Start small and think ahead a few steps.

Test changes.

Continuous improvement often requires a few sequential PDSA cycles.


Ideal

Situation

Present

Situation

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Change usually comes after a series of successful tests

Educate and train everyone involved.

Make changes to job descriptions, policies, procedures, forms.

Address supply and equipment issues.

Assign day-to-day ownership for the maintenance of the new process.

(Langley, Moen, Nolan, Nolan,

Norman & Provost, 2009)


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Agency for Healthcare Research & Quality (AHRG). (2013) Quality and Safety. Retrieved

from http://www.ahrq.gov/professionals/quality-patient-safety/index.html

Associate Process Improvement (API). (2010). Model for Improvement. Retrieved from

http://www.apiweb.org/API_home_page.htm

Deming, W. E. (2000). The New Economic. Cambridge, MA: The MIT Press.

Institute of Health Improvement (IHI). (2011). Science of Improvement. Retrieved from

http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementHowtoImpr

ove.aspx

Institute of Medicine (IOM). (n.d.)Crossing the quality Chasm: The IOM Health Care

Quality Initiative. Retrieved from

http://www.iom.edu/Global/News%20Announcements/Crossing-the-Quality-Chasm-

The-IOM-Health-Care-Quality-Initiative.aspx

Institute for Health Improvement (IHI). (2011a). Across the Chasm: Six aims for changing

the healthcare. Retrieved from

http://www.ihi.org/knowledge/Pages/ImprovementStories/AcrosstheChasmSixAimsforC

hangingtheHealthCareSystem.aspx


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http://www.apiweb.org/API_home_page.htm

http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx

http://www.iom.edu/Global/News Announcements/Crossing-the-Quality-Chasm-The-IOM-Health-Care-Quality-Initiative.aspx

http://www.ihi.org/knowledge/Pages/ImprovementStories/AcrosstheChasmSixAimsforChangingtheHealthCareSystem.aspx

Institute of Health Improvement (IHI). (2012). Using Change Concepts for Improvement.

Retrieved from

http://www.ihi.org/knowledge/Pages/Changes/UsingChangeConceptsforImprovement.a

spx

Institute of Medicine (IOM). (1999). Measuring the quality of health care. IOM.

Langley, G. L., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The

Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd

ed.). San Francisco, CA: Jossey-Bass Publishers.

Lloyd, R. (2004). Quality Health Care: A Guide to Developing and Using Indicators.

Sudbury, MA: Jones and Bartlett Publishers.

Patient Safety – Quality Improvement. (n.d.). What is Quality Improvement? Duke

University Medical Center. Retrieved from

http://patientsafetyed.duhs.duke.edu/module_a/introduction/introduction.html

Quality Digest (2001). Definition of Quality: How do you define it? Retrieved from

http://www.qualitydigest.com/magazine/2001/nov/article/definition-quality.html


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http://www.ihi.org/knowledge/Pages/Changes/UsingChangeConceptsforImprovement.aspx

Documents

Quality Improvement - Massachusetts · PDF filePatient Safety- Quality Improvement: “A formal approach to the analysis of performance and systematic efforts to improve it”. MCCP