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Quality Improvement SeriesSession 11

Own it!

Windy StevensonCindy Ferrell

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Today’s Agenda

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YOU are relative experts.

Quality Improvement is not magic…

It is equal parts skill, timing, luck, and willingness to be deep in the weeds

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Just to remind you what you know

What factors will you consider when you select a QI project?

Erin’s dog Pablo

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Project Selection

  Do we have a problem? What is our problem? Will fixing our problem improve quality?

– IOM Dimensions- Safety, Timeliness, Equity, Efficiency, Effectiveness, Patient Centeredness

Is the outcome important? Why do we care? Why? Why? – To providers– To patients or families

Are we likely to be able to overcome foreseeable barriers?

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Project Selection, Continued

Is the project meant to improve an actual, observable process?– Is the process relatively stable (not already undergoing other major

revision)?– Is it measureable? Numerator AND denominator?

Is it within our scope to make this change? Is this reasonable? Is it focused enough to make success

likely in our timeframe? Does the cost of effort seem to be in good balance with

likelihood of returns? Are people already passionate or curious?

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The things you already know…

Once you pick a project, what model can you use as a guide?

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The things you already know…

What is important about your AIM (purpose statement)?

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Is your Aim Statement SMART?

Specific You are focused and intentional, NARROW. Measurable You can prove you’ve had an impact Actionable There are no known insurmountable barriers Realistic It’s within your scope Timely You’ll do it within a set time frame

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The things you already know…

What do you know about measurement in Quality Improvement?

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Measurement

POWER has a different meaning here. Measure just enough to understand and take the next step

Denominators matter, and are harder to capture Maximize your system, but don’t underestimate the power of

paper and pencil

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The things you already know…

What’s a PDSA cycle?

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PDSA

Plan, Do, Study, Act (over and over and over) Fail. What can you do next Tuesday?

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The things you already know

What do you understand about the concept of SYSTEMS?

How about Culture?

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Changing behaviorBy changing motivation By making the right thing

the easy thing

Culture change

Convince every provider that this is important so that he/she REMEMBERS to change behavior

Systems change leading to eventual culture change

Reconfigure the system so it doesn’t matter in the beginning if it is important to providers

This works in a system with immediate feedback

(treats or shock collar)

This works when there is no natural consequence

(fence)

Let’s say your dog keeps running into the street

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How do we create sustainable change?

Make the right thing the easy thing Education is often necessary, but rarely sufficient Engage leadership Plan for ongoing measurement Use rewards with caution Maintenance is as importance as launch

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Quality Improvement makes the right thing for the patient

easy and cost effective. It makes your job easier!

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One big PDSA that started last summer

ACGME requires that “residents participate in a quality improvement project”

We hypothesize that residents are crucial to the design and implementation of QI projects (we were right, of course)

Cindy identifies that individual projects are not sustainable Model evolves to engage entire program in one longitudinal

effort, providing noon time sessions to learn QI basics and move forward a project simultaneously

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Next Steps

1. We envision continuing the obesity problem list project until it has run its course

2. At that point we will either move deeper into this project, or select a new project

3. In the meantime, please help us get better