1. Quality Improvement Processes
A Rose By Any Other Name…

2. Basic Concept Quality Improvement Processes
come in many shapes and sizes
go by many different names
are marketed by many different sources
With a common goal…
To improve and assure the safety, quality, and cost efficiency of health care

3. Today’s Goal
Our goal today is to lay the groundwork for future training sessions regarding quality improvement
We will get a taste of numerous methodologies and approached to quality improvement
One size does not fit all
Quality improvement is a journey taken in baby steps – not giant leaps

4. Common Quality Improvement Processes
Model for Improvement
Rapid Cycle Quality Improvement
PDSA
Human Factors
Lean Methodology 5S
Failure Modes and Effects Analysis
Root Cause Analysis

5. Exercise
Let’s make the perfect peanut butter and jelly sandwich!

6. Learning Do we all define the process in the same way?
Did we assume steps without spelling them out?
Did we all address the problem in the same way, or were there variations in our processes?

7. Rapid Cycle Process Improvement
A process improvement approach to evaluate change
This model allows for integration of new and existing systems.
This model promotes small scale rapid cycle change over short periods of time.

8. WHAT is the PDSA Cycle?
A process improvement approach to evaluate change
This model allows for integration of new and existing systems.
This model promotes small scale rapid cycle change over short periods of time.

9. The PDSA Cycle for Learning and Improvement

10. The PDSA Cycle for Learning and Improvement
Plan
- Objective
- Questions and
predictions (Why?)
- Plan to carry out
the cycle
(who, what, where, when)

11. What Do We Mean by Rapid Cycle Improvement?
Let’s PLAN The Perfect Peanut Butter and Jelly Sandwich!!!!
What do we want to improve?
What change should we test?
What is our anticipated outcome?
Theorize

12. The PDSA Cycle for Learning and ImprovementDo
- Carry out the plan
- Document problems
and unexpected
observations
- Begin analysis
of the data

13. What Do We Mean by Rapid Cycle Improvement?
Let’s DO The Perfect PB & J Sandwich!!!
Put the theory into practice
Map the new plan
Carry out the change on a small scale or pilot basis
Evaluate change with qualitative and quantitative data

14. The PDSA Cycle for Learning and Improvement
Study -
- Complete the analysis
of the data
- Compare data to
predictions
- Summarize what
was learned

15. What Do We Mean by Rapid Cycle Improvement?
Let’s STUDY The Perfect PB & J Sandwich!!!
Evaluate and determine the degree of success.
Determine what, if any, modifications are required.

16. What Do We Mean by Rapid Cycle Improvement?
Let’s ACT ON The Perfect PB & J Sandwich!!!
Adopt
by testing on a larger scale in a new cycle
Adapt
based on lessons learned from the test
Abandon
By trying something different

17. The PDSA Cycle for Learning and Improvement

18. Repeated Use of the Cycle
Changes That Result in Improvement A P S D
DATA D S P A A P S D A P S D
Hunches Theories Ideas 31

19. PDSA Allows you to test your theory on a few patients
It may take several PDSA cycles and several months to get your process manageable.
That’s OK!

20. Use the PDSA Cycle for: Testing or adapting a change
Implementing an improvement
3. Spreading the improvements to the rest of your organization

21. PDSA Cycles Must Be: Active Quickly plan and make process changes
Iterative
Cycle after cycle
Learning
Take time to study effects of your actions

22. Human Factors
Human Factors is about how features of our tools, tasks, and work environments continually influence what we do and how we do it.

23. In Other Words…
Human Factors is about how the design of things impacts how well we do any task.
Design of our workplace
Design of the tools we use
Design of processes (how we do things around here)

24. Is This the Same Old Thing?
No!
Human Factors is complementary to what you are already doing to improve health care
Human Factors will make your improvement efforts more efficient and effective
There is a Human Factors concept behind every successful improvement effort

25. Talk About Human Factors!!!
Each line represents the RN’s movement from one location to another.
For example, RN moves between patients 14A and 14B twice.

26. Human Factors and the Model for Improvement
What are we trying to accomplish?
How do we know that a change is an improvement?
What changes can we make that result in an improvement?
Human factors can help answer this question!
Act
Plan
Study Do

27. Lean Methodology It’s all about: Waste and Value
Always challenging processes to
Produce better outcomes for customers
Create more value with less wasted time, effort, and resources
Speed delivery while reducing cost
Lay less burden on the people doing the work.

28. 5S
5S is a philosophy and a way of organizing and managing the workspace.
The key impacts of 5S is upon workplace morale and efficiency.
By ensuring everything has a place and everything is in its place then time is not wasted looking for things and it can be made immediately obvious when something is missing.
The real power of this methodology is in deciding what should be kept and where and how it should be stored

29. 5S Seiri Seiton Seiso Seiketsu Shitsuke
Sort Set In Order Shine Standards Sustain
Based on Japanese words that begin with ‘S’, the 5S Philosophy focuses on effective work place organization and standardized work procedures.
5S simplifies your work environment, reduces waste and non-value activity while improving quality efficiency
and safety.

30. Failure Mode Analysis
Failure Modes and Effects Analysis (FMEA) is a systematic, proactive method for evaluating a process to identify where and how it might fail, and to assess the relative impact of different failures in order to identify the parts of the process that are most in need of change.

31. Failure Mode Analysis FMEA includes review of the following:
Continued
FMEA includes review of the following:
Steps in the process
Failure modes (What could go wrong?)
Failure causes (Why would the failure happen?)
Failure effects (What would be the consequences of each failure?)

32. Root Cause Analysis
A way of looking at unexpected events and outcomes to determine all of the underlying causes of the event and recommend changes that are likely to improve them.

33. RCA Tools The 5 Whys? Appreciation Drill Downs
Cause and Effect Diagrams (Fishbone Diagrams)

34. Success
“There are no secrets to success. It is the result of preparation, hard work, and learning from failure.”
General Colin L. Powell

35. is a Process, not an Event
Quality Improvement
is a Process, not an Event
Anonymous