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Quality Improvement Methodology
Beth Hickerson
Quality Improvement Advisor
September 18, 2017
WHAT IS QUALITY IMPROVEMENT?
What is Quality Improvement?
3Value Driven. Health Care. Solutions.
Quality Improvement is systematic and continuous
action that lead to measurable improvement in:
Outcomes Cost
Efficiency Experience
What Quality Improvement is NOT
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Quality Improvement is NOT Quality Control
Quality Improvement Quality Control
Better Perfect
“What could we do?” “What should we do?”
Real, messy world Controlled environment
How does it relate to GLPTN?
Milestone 19 PCP/ 14 SPEC of the PAT
“Practice uses an organized approach (e.g. use of PDSAs,
Model for Improvement, LEAN, Six Sigma) to identify and
act on improvement opportunities.”
Phase 2 – The practice is beginning to incorporate regular
improvement methodology to execute change ideas but the
methodology has not been implemented in all areas.
Phase 4 – The practice fully incorporates regular
improvement methodology to execute change ideas.
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How does it relate to GLPTN?
Milestone 20 PCP/ 15 SPEC of the PAT
“Practice builds QI capability in the practice and empowers
staff to innovate and improve.”
Phase 2 – Practice is actively building QI capability within the
practice through approaches such as including QI skills in
orientation for all new staff and ensures that all staff participate in
QI training.
Phase 3 – Practice has developed QI capability within the
practice and empowers staff/providers to participate by allocating
time for QI activities, including QI within defined job duties,
recognizing and rewarding innovation and improvement.
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WHY IS QUALITY IMPROVEMENT
METHODOLOGY IMPORTANT?
Quality Improvement gone wrong
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QUALITY IMPROVEMENT PRINCIPLES
The Building Blocks
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“Where there’s a WILL there’s a way.”
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No will = the hard way
Resistance to Change is Human
The greatest reason for resisting change is the human
need for certainty.
Change brings uncertainty, which leads to anxiety.
Anxiety suggests that my existing paradigm is in
danger.
Our paradigms create our reality and we feel safe
there.
Source: www.derekhendrikz.com
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Building (Good) Will
Start with leadership (aka YOU!)
Explain what – problem and vision
Explain why – make the status quo uncomfortable and
the possible attractive
Identify and acknowledge objections
Share WIIFM
Clarify expectations
Avoid punishment
Acknowledge effort
Reward innovation
Share achievements
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The QI Secret
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“IDEAS come from curiosity.” –Walt Disney
Ideas
Thoughtful conversation
Most powerful tool in QI
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=
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Why you need a QI Team
Create good will and ownership with team members
Team members become “buy-in” ambassadors
“No decisions about me without me.” (not just for
patients!)
Many minds are better than one
“Out of the box” ideas usually come from outsiders
Good leaders know when to delegate
Engage your “changers”
Minimize discomfort on your “maintainers”
Minimize and spread the work of execution
“EXECUTION is everything.” –Jeff Bridges
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Step I – What needs improvement?
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Step II – How can we improve it?
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Small Tests of Change Framework
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Adopt, Adapt or Abandon
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Repeat as Needed
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Smaller is Better
Small test change cycles are short:
• A single patient encounter
• An hour
• A day
• A week
Small tests of change increase the speed and impact
of improvement work
• People are less resistant to “testing” than “changing”
• Fewer logistics and people to manage
• Problems can be corrected earlier and easier
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Record your Progress
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SUMMARY – IMPROVE THE WAY YOU IMPROVE
Change is hard…when it’s done wrong
OLD WAY NEW WAY
Rush to solve Question the problem
Leadership decides on solution Team discusses issue
Run with first logical solution Gather ideas and analyze options
Throw $ at the problem Invest time in a solution
Spend as little $ as possible Research pros and cons
Rollout full (theoretical) solution Run small tests of change
Course-correct immediately Pause and learn from failure
Throw baby out with bathwater Run, pause, learn, repeat
Revert to original state Implement new solution
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Final Thoughts
Improvement can be a game rather than a burden
• Promotes communication, collaboration, problem-solving
Blame processes, not people
• Every system is perfectly designed to achieve the results
it achieves
Always better, never perfect
• “Perfection is the enemy of progress” – Winston
Commit to the process, not the outcome
• Avoid the tyranny of the urgent
Improvement is a journey, not a destination
• You can rest, but you can’t stop
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QUESTIONS? COMMENTS?
Contacts
Beth Hickerson, Quality Improvement Advisor
29Value Driven. Health Care. Solutions.
NEXT MONTH
Creating Joy in the Workplace
October 17, 2017 at 11:30 a.m. at Soin Hospital, Kumar Conference Center