quality improvement breakout neil korsen, md, msc mainehealth april 16-17, 2009

Quality Improvement Breakout

Neil Korsen, MD, MScMaineHealth

April 16-17, 2009

Objectives

• Describe a basic structure for running an effective meeting

• List some of the reasons that small tests of change (PDSA cycles) are useful in quality improvement

• Design an appropriate small test of change as part of an improvement activity

Effective Meetings

• A simple approach to making the best use of the time we spend in meetings– Organizing the agenda– Meeting roles– Ground rules

Team Meeting Date: Tuesday March 27, 2009

Time: 11:00 – 12:00

Participants: Leader: Recorder: Time Keeper: Facilitator: Aim/ Purpose of this meeting: Time

I tem Aim/ Action Action

Steps 1 min

Assign roles

15 min

Topics

10

Updates

5 min Review Next Steps

What do we plan to accomplish by next week’s meeting?

2 min Evaluate Meeting

What went well? What can we do to improve for the next meeting?

Meeting Roles• Leader

– Prepares agenda, moves thru agenda, elicits participation

• Recorder– Minutes, list of action items at the end

• Timekeeper– Monitors time on each item and lets leader know if

over time• Facilitator

– Manages group process to balance participation and keep on task

Meeting Ground Rules

• Agreed to by the group

• Reviewed at the beginning or posted to remind all of what was agreed to.

Ground RulesClinical Integration Staff Meetings

– Begin and end the meeting on time– Speak only to the agenda item on the table– No interruptions– Be sure there is a parking lot for additional items– Work to includes others’ ideas– Commit to decisions– Come prepared– Have fun

– If you are opposed, try to propose

Rhythm of Improvement

• Daily huddles – Which patients coming in today are candidates for mental health assessment? (5-10 min)

• Weekly check-ins – What small tests of change are we working on and what are we learning? (15-30 min)

• Monthly partnership meetings – How are we doing in implementing integrated services? (60 min)

Model for Improvement

1. What are you trying to accomplish? (Aim Statement)

2. How do you know if a change has resulted in an improvement? (Measurement)

3. What changes can you make in a process to promote improvement? (PDSA cycles)

A PS D

PDSA Cycle

PlanIdentify: -the problem-the most likely causes-potential solutions

DoImplement solutions

and collect data

StudyAnalyze data

and develop

conclusions

ActRecommend

action/further study

PDSA Cycles

Hunches Theories

Ideas

Changes That Result in

Improvement

A PS D

APS

D

A PS D

D SP A

DATA

Why Test Changes?

• Increases belief that the change will result in improvements in your setting

• Learn how to adapt the change to conditions in your setting

• Evaluate the costs and “side-effects” of changes• Minimize resistance when spreading the change

throughout the organization

Designing PDSA’s

• Think small at first:– One clinician– A few patients– A day or two

• Think creatively – use your team• Learn from initial tests, then gradually

enlarge• Work on one thing at a time

Exercise

• Think about a PDSA that your team has developed.– How could you make that PDSA smaller and

more focused?• Talk to people around you