quality improvement methodology – next steps

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Quality Improvement Methodology – Next Steps. Purpose of this Session. Consider the components of a learning system in your own improvement activity : 4. Sequential testing of new theories 6. Planning for spread at scale - PowerPoint PPT Presentation

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  • Quality Improvement Methodology Next Steps

  • Purpose of this SessionConsider the components of a learning system in your own improvement activity :

    4. Sequential testing of new theories 6. Planning for spread at scale

    What stage are you at in relation to these aspects of the improvement journey? What do you need to do next to ensure that your tests are scaled up and spread correctly?

  • The Improvement Guide, APIAimMeasuresChangesTesting & Implementation

  • Cycles of Tests Build ConfidenceProposals, theories, hunches, intuitionChanges that will result in improvementLearning from data

  • 1 child1 day1 family1 setting

    Move to 3,5,7. as confidence grows

    Start small

  • YearsQuartersMonthsWeeksDaysHoursMinutesDrop down next two levels to plan test cycle!You can only learn as quickly as you test!

  • Components of a Learning System System level measuresExplicit theory or rationale for system changesSegmentation of the populationLearn by testing changes sequentiallyUse informative cases: Act for the individual learn for the population Learning during scale-up and spread with a production plan to go to scalePeriodic reviewPeople to manage and oversee the learning system

    From Tom Nolan PhD, IHI

  • Sequential Testing & Scale UpHunch/TheoryA structured handover will ensure accurate information sharing between prof teamsData/learning/adaptingCycle 1: Test developed handover form 1 HV/1 SW 1 family (Mon)Cycle 2: Test with 3 family handovers/ same HV (Wed) Cycle 3: Test with 5 more families/ same HV (Mon/Tu) Cycle 4:Test with all handovers-1 HV/1weekAimAchieve improved communication process for HV and SW handovers using standardised format Cycle 5: other team HVs/SWs- 1 dayCycle 6: Test all handovers-1 week Implement

  • Learning Through Sequential Testingat your tables discussion timeWhere are you currently?Can you describe an example of the following?

    Multiple tests with different people/under different conditions?Learning/data captured to describe your testing journey?

  • Testing v ImplementationTesting Trying and adapting existing knowledge on small scale. Learning what works in your system. Multiple tests in a variety of conditions

    Implementation Making the change a part of the day-to-day operation of the system. Permanent change Would the change persist even if its champion were to leave the organisation?

    Avoid implementation until confident that processes are robust

  • How Many Tests?

  • Components of a Learning System System level measuresExplicit theory or rationale for system changesSegmentation of the populationLearn by testing changes sequentiallyUse informative cases: Act for the individual learn for the population Learning during scale-up and spread with a production plan to go to scalePeriodic reviewPeople to manage and oversee the learning system

    From Tom Nolan PhD, IHI

  • LeadershipTopic is a key strategic initiativeGoals and incentives alignedExecutive sponsor assignedDay-to-day managers identifiedA Framework for SpreadInstitute for Healthcare Improvement

  • Things to ConsiderChecklists For Spread

    Leadership, Better Ideas & Set Up

    General Communication & knowledge transfereveloping Measurement, Feedback and Knowledge Management Systems

  • Take a strategic approach to scaling up

    Level of testingStrategy 1525125250

  • Increasing uptake of Healthy Start Vitamins

    Level of testingStrategy 11 EY practitioner gives vits to 1 mum525125250Free vitamins in Asda with every pregnancy kit

  • Are You Ready for Scale up & Spread?Table discussion timeIn the context of your current improvement activity:

    Have you been testing a theory so that it could be considered ready for implementation in the area you are working? and/orDo you have a strategy for moving to scale up and spread to other sites/teams?

  • The Seven Spreadly Sins

    Step 1Start with large pilots

    Step 2Find one person willing to do it all

    Step 3 Expect vigilance and hard work to solve the problem

    Step 4 If a pilot works then spread the pilot unchanged

    Step 5 Require the person and team who drove the pilot to be responsible for system-wide spread

    Step 6 Look at process and outcome measures on a quarterly basis

    Step 7 Early on expect marked improvement in outcomes without attention to process reliabilityInstitute for Healthcare ImprovementTo be clear DO NOT DO THIS AT HOME!!!

  • Sustaining Improvement Having the correct measures to provide assurance that new processes are reliable

    Measuring compliance or satisfaction through regular and random sampling of the population

    Understanding the variation that exists in your data

  • What measures?

    Outcome measures directly relates to the overall aim what is the result? how is the system performing?

    Process measures are the processes that contribute to the aim performing as planned?

    Balancing measures assessing from different dimensions unanticipated consequences, other factors influencing the outcome

  • If we dont understand the variation that lives in our data, we will be tempted toDeny the data as it doesnt fit with our view of realitySee trends where there are noneTry to explain natural variation as special eventsBlame and give credit to people for things over which they have no controlDistort the process that produced the dataKill the messenger!VRAIATION

  • Common Cause Variation

  • Define measures that will measure the impact of theImprovement work over time

    They will guide your progress through and beyond testing to implementation and monitoring for continuous improvement. Different ways of measuring e.g.,Percent compliance with processA count of correct attempts/number of attendances Verbal feedback /surveys

    Measurement of Improvement

  • HC Data Guide Why a run chart and not just a graph or table?MonthMedian = 84%Run ChartTesting with all FamiliesPrompt sticker tested in case referral Testing screening tool with 1 familyTesting screening tool with 5 familiesPrompt sticker used on all referrals Testing screening tool with 3 Families

    MonthJanFebMarAprMayJunJulAugSepOctNovMeasure8380818483856887899291

  • Source: The Data Guide by L. Provost and S. Murray, Austin, Texas, February, 2007: Non-Random Rules For Run ChartsA Shift: 6 or moreA Trend:5 or moreAn astronomical data pointToo many or too few runs

  • MonthWhat is this data telling you? Data 11 1 3 4 5 9 10 4 11 7 10 10 7 6 22 4 2 2 1 3 4

    Chart1

    11

    1

    3

    4

    5

    9

    10

    4

    11

    7

    10

    10

    7

    6

    22

    4

    2

    2

    1

    3

    4

    Number

    Subgroup

    wksDatabase01

    CCT_660671

    ChartTypeRun_Chart

    SourceDataAddress40299

    FirstRowHeadings

    Extend

    SubgroupSize0

    RateBase0

    DataInColumns

    ForceLowerLimitZero

    ForceUpperLimitOne

    Index0

    Values1

    Phase 1121

    AutoIndexMonthSubgroupMedian

    1Sep-08115.0

    2Oct-0815.0

    3Nov-0835.0

    4Dec-0845.0

    5Jan-0955.0

    6Feb-0995.0

    7Mar-09105.0

    8Apr-0945.0

    9May-09115.0

    10Jun-0975.0

    11Jul-09105.0

    12Aug-09105.0

    13Sep-0975.0

    14Oct-0965.0

    15Nov-09225.0

    16Dec-0945.0

    17Jan-1025.0

    18Feb-1025.0

    19Mar-1015.0

    20Apr-1035.0

    21May-1045.0

    Sheet1

    MonthNumber of Infections

    Sep-0811

    Oct-081

    Nov-083

    Dec-084

    Jan-095

    Feb-099

    Mar-0910

    Apr-094

    May-0911

    Jun-097

    Jul-0910

    Aug-0910

    Sep-097

    Oct-096

    Nov-0922

    Dec-094

    Jan-102

    Feb-102

    Mar-101

    Apr-103

    May-104

    111345910411710107622422134

    11 1 3 4 5 9 10 4 11 7 10 10 7 6 22 4 2 2 1 3 4

    Sheet1

    11

    1

    3

    4

    5

    9

    10

    4

    11

    7

    10

    10

    7

    6

    22

    4

    2

    2

    1

    3

    4

    Number of Infections

    Subgroup

    Sheet2

    Sheet3

  • MonthWhat is this data telling you? Median 1 1 2 2 3 3 4 4 4 4 5 6 7 7 9 10 10 10 11 11 22 Median = 5ShiftShiftTrendAstronomicalPoint

    Chart1

    11

    1

    3

    4

    5

    9

    10

    4

    11

    7

    10

    10

    7

    6

    22

    4

    2

    2

    1

    3

    4

    Number

    Subgroup

    wksDatabase01

    CCT_660671

    ChartTypeRun_Chart

    SourceDataAddress40299

    FirstRowHeadings

    Extend

    SubgroupSize0

    RateBase0

    DataInColumns

    ForceLowerLimitZero

    ForceUpperLimitOne

    Index0

    Values1

    Phase 1121

    AutoIndexMonthSubgroupMedian

    1Sep-08115.0

    2Oct-0815.0

    3Nov-0835.0

    4Dec-0845.0

    5Jan-0955.0

    6Feb-0995.0

    7Mar-09105.0

    8Apr-0945.0

    9May-09115.0

    10Jun-0975.0

    11Jul-09105.0

    12Aug-09105.0

    13Sep-0975.0

    14Oct-0965.0

    15Nov-09225.0

    16Dec-0945.0

    17Jan-1025.0

    18Feb-1025.0

    19Mar-1015.0

    20Apr-1035.0

    21May-1045.0

    Sheet1

    MonthNumber of Infections

    Sep-0811

    Oct-081

    Nov-083

    Dec-084

    Jan

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