qi powerpoint
DESCRIPTION
Ppt for QI Tools and techniquesTRANSCRIPT
22670 Haggerty Road, Suite 100, Farmington Hills, MI 48335 ~ www.mpro.org
Quality Improvement Tools and Techniques: 2007
An MPRO Self-Instructional Module
Patricia L. Baker, RN, MS
2
Tools for the Continuous Quality Improvement Journey
3
Objectives
• Identify common quality improvement (QI) tools used to focus on important problems
• List tools for identifying problem causes
• Recognize tools for defining solutions
• Review tools used to develop QI plans
• Plan to display QI data
4
Reference: Langley, G.J.; Nolan, K.M.; Nolan, T.W.; Norman, C.L.; and Provost, L.P. (1996).The Improvement Guide, San Francisco, CA: Jossey-Bass Publishers
MODEL forIMPROVEMENT
5
Continuous Quality Improvement
PPAA
SSDD
6
Tools to Identify the QI Focus
• Define the problem areas
• Compare the current state with the desired state
• Check alignment with organizational mission and goals
7
Tools to Identify Focus
• Brainstorming
• Idea writing
• Impact analysis
• Pareto Diagram
• Problem statement
• Selection grid
8
Brainstorming
• A focused creativity technique designed to collect multiple ideas about an issue
• Benefits Encourages creative thinking Generates a large number of ideas Gets all team members involved Eliminates fear of criticism Increases the number of options
9
Brainstorming Rules
• No criticisms or compliments• No discussion• No questions• Speed is important• Think broadly• Develop wild, outrageous ideas• Build on ideas of others• Listen• Do not interrupt• Quantity is important
10
Brainstorming Steps
1. Clarify the brainstorming objective
2. Write the objective at the top of the flip chart
3. Review brainstorming rules
4. Determine process: free flow or take turns
5. Record each idea on the flip chart
6. Continue until all ideas are exhausted
7. Clarify each idea after all ideas are listed
8. Group like ideas together
11
Idea Writing
• Individual brainstorming on paper
• Benefits Idea notes may be written before the team
meeting Protects anonymity Idea notes shared at the meeting Includes those who cannot attend
12
Impact Analysis
• Survey technique to discover the impact or effect of a situation or problem
• Benefits Confirms the problem or project is worthwhile Indicates the severity of the problem Often uncovers new information Allows for sharing of thoughts, opinions, and
ideas
13
Pareto Diagram
• Bar chart that demonstrates the distribution of issues that cause most of the problems
• Benefits Applies the 80/20 rule Focuses on the 20% of the work that cause
80% of the problems Gives the biggest return for your efforts Helps explain problem to others
14
Pareto Diagram
Reasons women do not get mammograms May, 2003
12
8 7
3
0
5
10
15
Fear No insurance Forgot Test not ordered
Total
15
Problem Statement
• Defines and summarizes the issue or problem• Benefits
Spells out the impact of the current state Defines the opportunities of the desired state Explains the expected impact of correcting the
situation Delivers a consistent message
16
Define Goals
• What are we trying to accomplish?
• SMART Goals Specific Measurable Attainable Realistic Timely
17
Tools to Understand the Cause
• Clarify the process Flow chart the process
• Determine cause Fishbone or Cause and Effect Diagram Impact analysis Data Pareto Diagram
18
Flowchart the Process
• A diagram of the sequence of steps in a work effort• Benefits
Clarifies current knowledge of process Demonstrates the work flow Examines parts of a process and their relationship
to each other Identifies the sources of variation for each step
from start to finish Points out unnecessary complexity, inefficiency, and
redundancy Develops a common understanding
19
Flowchart Steps
• Involve those most knowledgeable about the process
• Define the boundaries (beginning and end)
• List the work activities, decisions, and documents
• Place the activities, decisions, and documents in the order that they occur
• Connect the activities with arrows
20
Diabetic Patient Registers
A1C due?
Nurse/MA reviews the diabetic flowsheet
Nurse/MA obtains blood sample and documents results
Patient escorted to exam room
NO
YES
21
Patient Leaves Office
Physician/PA/NP reviews documentation
Patient checks out at receptionist
Diabetic Foot ExamNeeded
YES
Nurse/MA conducts foot examand documents on foot exam form
NO
Physician/PA/NP enters exam room
Physician/PA/NP examines patient and completes documentation
22
Fishbone or Cause & Effect Diagram
• Explores and displays the identified causes and relationships leading to a specific outcome
• Benefits Involves multiple team members Allows grouping of information Displays related causes Gives ideas for goals Points out data needs Provides ideas for solutions Presents big picture of the problem Easy to understand
23
Fishbone or Cause & Effect Steps
1. Agree on the problem statement or outcome
2. Identify major cause categories
3. Brainstorm reasons for each of the major causes
4. Clarify the diagram
5. Post for others to review
24
Fishbone or Cause & Effect Diagram
Employees Materials Equipment
Environment Methods
Outcome
25
Examine Solutions
• Tools to generate solutions Brainstorming Impact analysis Pareto Diagram Flowchart Fishbone Collaboration with others Literature
26
Select a Change Option
• What change can we make that will result in improvement?
• Tools Decision matrix Selection grid Multi-voting Cost-benefit analysis Force Field Analysis
27
Decision Matrix
Easy to Do
HighPay Off
Hard to Do
LowPay Off
A. B.
C. D.
28
Selection Grid
Criteria
OptionsWorthwhile Cost
Admin
Support
Criteria
#4
Criteria
#5
A
4 yes
2 no
3 yes
3 no
3 yes
3 no
B
3 yes
3 no
5 yes
1 no
4 yes
2 no
C
5 yes
1 no
2 yes
4 no
3 yes
3 no
D
2 yes
4 no
yes
4 no
3 yes
3 no
Z 6 yes
4 yes
2 no
29
Multi-voting
• A group decision-making technique designed to reduce a large list of ideas to a manageable number.
• Benefits Eliminates peer pressure Equal participation Allows for consensus Gains “buy-in” among the team
30
Multi-voting Steps
1. List ideas or options on flip chart or chalk board2. Each team member votes for their top three
choices3. Clarify among the team and eliminate choices
with one or zero votes4. Each team member selects top two choices
from the remaining list5. Repeat the process until the top one or two
ideas have been selected
31
Cost-benefit Analysis
• Determine the financial impact by comparing the costs and benefits
• Benefits Evaluates the cost of a change Supports decision-making Provides supporting documentation for QI
team’s recommendation
32
Force Field Analysis
• Identify and discuss forces that support or interfere with a change
• Benefits Identifies obstacles Lists supporting elements Suggests action steps
33
Force Field Analysis
Driving Forces Restraining Forces
DesiredState
CurrentState
34
Determine Measures
• How will we know that a change is an improvement?
• What are the data needs?
• Consider: Data collection methods Data analysis plan Accountable persons
35
Check List
• A method to systematically record data from observations or historical sources
• Benefits Easy-to-use form Minimal data collector training Efficient and fast data collection Detects patterns and trends
36
Check List
Steps• Decide on data to collect• Clarify definitions• Decide on time period for collection• Select sample size• Decide who will collect data• Design and test the check list• Distribute form and collect the data• Tally and evaluate
37
Develop Action Plan
• Brainstorm
• Force Field Analysis
• Political action plan
• Presentation
38
Action Plan
Action Plan Project Name: _________________________________ Project Lead: ________________ Date: ________________ Goal (s) What are we trying to accomplish?
Steps What needs to be done?
Accountability Who will do it?
Deadline When will it be done?
Monitoring How is it going? What progress has been made?
1.
2.
3.
4.
5.
39
Political Action Plan
• A communication strategy designed to inform and gain support
• Benefits Share information Build support Receive feedback Build consensus Eliminate “surprises”
40
Presentation
• A communication technique to share information and obtain feedback
• Benefits Deliver a consistent message Gain understanding Elicit support Teach and share Receive ideas
41
Presentation Strategies
• Be prepared
• The three “tells”
• Use visual aids Storyboard Slides Diagrams, charts, and graphs
• Practice
42
Continuous Quality Improvement
PPAA
SSDD
43
Continuous Quality Improvement
PPAA
SSDD
44
Pie Chart
• A picture depicting parts of the whole
• Benefits Easily understood Draws interest Good visual
45
Bar Chart: Aspirin at Arrival for AMI Patients
80.5 80.0
95.2
0.0
20.0
40.0
60.0
80.0
100.0
Michigan National Benchmark
Perc
ent (
%)
46
Run Chart
Number of Foot Exams performed per M onth
0
10
20
30
40
JULY AUG SEP OCT NOV DEC
Total Foot Exams
New flow sheet
47
Continuous Quality Improvement
PPAA
SSDD
48
May your QI journey be fun, interesting, and successful!
49
QI References
• Brassard M, Ritter D. The Memory Jogger II. GOAL/QPC, Methuen, MA, 1994.
• Brassard M, Joiner BL. The Team Memory Jogger. GOAL/QPC and Joiner Associates Inc, Methuen, MA, 1995.
• Langley GJ, Nolan KM, Nolan TW, Norman CL, and Provost LP. The Improvement Guide. Jossey-Bass Publishers, San Francisco, 1996.
• Scholtes PR. The Team Handbook. Joiner Associates, Inc. Madison, WI. 1988.
50
Creativity References
• DeBono E. Serious Creativity. New York: Harper Collins, 1993.
• Higgens JM, 101 Creative Problem Solving Techniques, Winter Park, FL: New Management Publishing Company, 1994.
• Plsek PE, Creativity, Innovation, and Quality. Milwaukee, WI: ASQC Quality Press, 1997.
• Van Oech R, A Whack on the Side of the Head. New York: Warner Books, 1983.
51
Continuing Education (CE) Contact Hours
• Answer the post test questions • Minimum passing score = 76%
• Minimum correct answers = 19/25
• Complete the evaluation
• Print your certificate
Thank You for Reading This SIM
52
Additional Information
Patricia L. Baker RN, MS
Director, Staff Development
248-465-7324
Carol J. Grubba, RN, MSN, BC
Project Manager, Continuing Education
248-465-7337
This material was prepared by MPRO, the Medicare Quality Improvement Organization for Michigan, under contract with the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services.
22670 Haggerty Road, Suite 100, Farmington Hills, MI 48335 ~ www.mpro.org 53
7SOW-MI-CE-05-05