kidney quality improvement partnership (kquip) #kquipyh · • engage you team to agree the problem...
TRANSCRIPT
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Kidney Quality Improvement
Partnership (KQuIP) #KQuIPYH
Quality Improvement
Training Day Two – Sharing and
Learning
14th August 2019
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Housekeeping and survival
Fire alarms
and exits… Car Park … Toilet location…
Mobiles Photos… Breaks…
2
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Kidney Quality Improvement
Partnership (KQuIP) #KQuIPYH
Welcome
Julia McCarthy, Regional Lead
(for today)
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Today’s aims and objectives
• Informal sharing and learning
• Cross pollination of knowledge and
improvement ideas
• Applying the proposed QI tools to
the project MAGIC
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Kidney Quality Improvement
Partnership (KQuIP) #KQuIPYH
KQuIP Update
Ron Cullen, KQuIP CEO
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Kidney Quality Improvement
Partnership (KQuIP) #KQuIPYH
Process Maps
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Process maps - instructions
• Has any one attended a poster session during a conference?
• One key person stands and presents their process map to others
• Lets get moving around the room.
• Try and get to see as many process maps as you can
• Your opportunity to ask questions and explore possibilities
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Kidney Quality Improvement
Partnership (KQuIP) #KQuIPYH
Baseline data – next steps
Leeanne Lockley, KQuIP
Programme Manager
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Open discussion
• How easy is it to collect the data and input into Life QI?
• What do you do with your data once you’ve entered it into Life QI?
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Example of Improvement on Life QI
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Improve AVF and AVG rates through preserving live span of existing AVF/ AVG
• Missed cannulation (weekly)
• Ropeladder/ Buttonhole use (weekly)
• AV access use (monthly)
• Lost AVF/ AVG (monthly)
• New AVF/ AVG (monthly)
• Infections (monthly)
MAGIC AIMS to …
Improve patient experience of needling
• PREM score for needling (weekly)
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Mean PREM Score for Needling
Operational definition:
Patients are asked about their needling experience, using the PREM needling question:
‘How often do the renal team insert your needles with as little pain as possible?’.
Patient rate this on a score of 1 to 7.
1 means they ‘Never’ make an effort to insert needles with as little pain as possible, 7 means they ‘Always’ make an effort to insert needles with as little pain as possible
The scores are then collated into a mean.
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Kidney Quality improvement Partnerships (KQuIP) #KQuIPYH Revisiting Driver Diagrams Leeanne Lockley, KQuIP QI Programme Manager
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Driver Diagrams
A driver diagram illustrates a “theory of change” that can be used to plan improvement activities.
A visual display of a team’s theory of what drives or contributes to achievement of a project aim
Translates a high level goal into a logical set of related goals and sub-projects
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Driver Diagram Template
Baxter Confidential — Do not distribute without prior approval | 16
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Driver Diagram - AIM
What is it?
An aim statement is documentation of what you want to achieve form your project.
How to develop an AIM statement?
• Is it SMART? Specific; Measurable; Achievable; Relevant; Time bound
• Define your population and scope
• Don’t include solutions in your statement
• Be fluid with your AIM as it can change over time
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Driver Diagram – AIM Examples
We aim to reduce harm and improve patient safety for all of our internal and external customers
By June 2020, we will reduce the incidence of pressure ulcers in the critical care unit by 50%
To promote good cannulation practice and improve the patient experience of cannulation
95% of all CKD5 patients will have a documented transplant decision by March 2020
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Driver Diagram
Primary Driver – The HOW
• Big topic areas
• Key areas of the system that you need to influence within your project
Secondary Driver – The WHAT
• What needs to be in place to positively influence primary driver
• Help to identify change ideas
Change ideas – The DO
• What you and the team are going to do, test and measure
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Driver Diagram - your turn
For the next 40 mins work on your driver diagram
Think about the:
• AIM – is it Specific, Measureable, Achievable, Relevant, Time bound
• The PRIMARY DRIVERS (the HOW) needed to achieve your aim?
• The SECONDARY DRIVERS (the WHAT) that will achieve the primary drivers?
• What IDEAS do you have to make the aim reality?
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Kidney Quality Improvement
Partnership (KQuIP) #KQuIPYH
Identifying where to start
Ranjit Klare, KQuIP Programme
Manager
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Date for the diary
QI Training Day 3 – 11th December
• Sharing and Learning
• How to maintain momentum
• Measurement
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Kidney Quality Improvement
Partnerships (KQuIP) #KQuIPYH
Fishbone Diagram
Ranjit Klare, Quality Improvement
Programme Manager
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What is the Fishbone Diagram & Why do we use it?
• It is a tool/visual diagram to review the cause and effect
of any problem we need to resolve
• Look at the problem
• Look at the possible causes
• Generate ideas into categories to consider an outcome
• It is a Root Cause analysis of the problem
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An example – How to develop your own fishbone diagram
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Tips
• Engage you team to agree the problem statement, include as
much information as possible in the “what” “when” “where”
and “how much” of the problem. Use date to specify the
problem if possible.
• Aim to construct the diagram with the people involved in the
project.
• You can use the cause and effect diagram as a working
document that is updated as and when you collect more data,
or to test possible solutions.
• Produce your diagram on paper so that it can be transported.
• Ideally, causes should appear in only one category although
some causes may overlap.
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Team exercise – Create your own fishbone
• Start with the problem
• Choose a category for each bone e.g. People
• Choose sub-categories e.g. ideas/possible causes
• Discuss why these problems occur
• You can add and remove problems as you dig deep
into them to determine their probability.
• Focus on the problem not the symptoms of the
problem
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Kidney Quality Improvement Partnership (KQuIP)
Thank you for listening
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Kidney Quality Improvement
Partnerships (KQuIP) #KQuIPYH
5WHY’s?????
Julia McCarthy
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Kidney Quality Improvement
Partnerships (KQuIP) #KQuIPYH
PDSA Cycles
Leeanne Lockley, KQuIP
Programme Manager
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Fundamental rule
All improvement will require change,
but not all change will result in improvement
Therefore we need to ‘test’ change
It is more efficient to ‘test’ change in small scale rapidly
PDSA Video
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PDSA on Life QI
• Supports shared learning • Allows links to driver diagram and measures • Supports with extracting reports
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PDSA Group work
For the next 50 mins plan your PDSA cycle.
Think about:
• The aim of the cycle
• Predict what you want to see happen
• Who will collect the data
• Who will lead and be responsible
• When will it happen and how long will the test
take?
• What tasks do we need to do
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Project phase
Launch event
•Agree a project plan - Co-design outcomes and measures
•Launch project - Co-design methods
Introduction to QI
1 day
•Quality improvement and tools
•Measurement
•Project Model and NHS Change Model
Sharing and learning
1 day
•Reflection on progress and overcoming challenges
•PDSA
•Sign posting to tools and information
•Sustainability
Maintaining momentum
1 day
•Review of progress
•Sustainability
MARCH
APRIL
TODAY
11TH December
2019
P-D-S-A Measure Share learning Collaborate Peer assist
Mo
nth
ly sup
po
rt visits to u
nits o
ffere
d fro
m K
Qu
IP
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Kidney Quality Improvement
Partnership (KQuIP)
Thank you for coming today
Travel safe