GETTING STARTED WITH QUALITY IMPROVEMENT

CLeAR Kick Off Event October 2013

Improvement Basics

• Know your system – map it out

• Collect baseline data – how much of a problem is this?

• Get leadership awareness and approval – use data

• Form a multidisciplinary team – people in the process

Improvement Basics

• Use the Improvement Model to find out what works – SMALL TESTS of CHANGE

• Communicate widely your learning

• Spread proven changes/change principles to other areas

• Never stop learning and improving

Know Your System – How?

• Collect baseline data• Complete a process map with your

team • Understand your resident population

– Diagnosis – Behaviors – Others?

• Ask those you work with where are the biggest areas of concern?

Team Members• Identify team members–Process map • Who is a part of the process you are working to

change/improve?–Roles and Responsibilities–Don’t forget about the resident/caregiver!• Valuable insight and input

–Mental Health team

Team Members

Model for Improvement

What are we trying to accomplish?

How will we know that a change is animprovement?

What changes can we make that will result in improvement?

Act Plan

Study Do

Thinking

Doing

The Improvement Guide, 2nd ed.

Model for Improvement

What are we trying to accomplish?

How will we know that a change is animprovement?

What changes can we make that will result in improvement?

Act Plan

Study Do

Thinking

Doing

The Improvement Guide, 2nd ed.

AIM

CLeAR’s Aim Statement

To achieve a reduction in the number of seniors in residential care on antipsychotic medications

by 50% across BC by December 31, 2014 through a province-wide, voluntary initiative that

supports participating sites.

Model for Improvement

What are we trying to accomplish?

How will we know that a change is animprovement?

What changes can we make that will result in improvement?

Act Plan

Study Do

Thinking

Doing

The Improvement Guide, 2nd ed.

AIM

Measures

Model for Improvement

What are we trying to accomplish?

How will we know that a change is animprovement?

What changes can we make that will result in improvement?

Act Plan

Study Do

Thinking

Doing

The Improvement Guide, 2nd ed.

AIM

Measures

Test Ideas

“Plan Do Study Act” Cycle

• Power of the model – learning in action

• Trial and learn format• Small test of change• Increases degree of belief• Helps prevent resistance

PDSA• Plan– Be innovative– Develop ideas– Make predictions

• Do– Test the idea– Involve front-line staff• Use the 1:1:1 rule – one provider, with one

resident, on one day• Failure IS an option!

PDSA

• Study– Was the outcome as expected?– What did you learn?

• Act– Adopt, Adapt or Abandon

• Leads to implementation of successful ideas

Examples

• Test a transfer Medication Reconciliation form with the next resident who is sent to the ER

• Have an RCA attend a care review

• After an incident with harm – try a debrief on one case

Why Develop an AIM Statement?• Helps everyone to think through all

aspects of the work• Helps in team selection to make the

improvements• Keeps team efforts focused

What Makes a Good AIM Statement?

• Clear and Concise• Results oriented• Align aim with organization goals• Set numerical targets• Deadline• Include what will keep the team focused

Components of an AIM Statement

Direction

Process

Measure

Timeline

Focuses the team on improvement

Keeps the team on topic

Defines what success looks like

Ensures an urgency to continue

Examples

• Decrease the number of residents on a regularly scheduled antipsychotic by 50% by December 31, 2014.

• Decrease the % of residents on an antipsychotic to a target of 30% by December 31, 2014.

Information YOU Need – Setting Your AIM

• Understand your local facility/unit resident population– Diagnosis – Who it may be “appropriate” to be on

antipsychotics• Baseline % of residents who are on

antipsychotic (tied to CLeAR measures)

Questions?

After the Break:Your Team…Your Turn…Take Aim and Charter Your Course!