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Promoting quality for better health services QI Presentation: Skills and Examples Dr David Gozzard Senior Fellow, Institute for Healthcare Improvement,

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Presentation on theme: "Promoting quality for better health services QI Presentation: Skills and Examples Dr David Gozzard Senior Fellow, Institute for Healthcare Improvement,"— Presentation transcript:

1 Promoting quality for better health services QI Presentation: Skills and Examples Dr David Gozzard Senior Fellow, Institute for Healthcare Improvement, Boston US

2 Objectives of the Session Understanding of relationship between structure and process Introduction to process mapping Driver diagram development PDSA worked examples

3 System Design Every system is perfectly designed to achieve exactly the results it gets

4 The Healthcare System The Patient 133 People to take care of the patient

5 STRUCTURE + PROCESS = OUTCOME

6 DGCL PROCESS MAPPING

7 Why Map Processes?

8 A Simple Flowchart Dealing with a non- functioning lamp

9 Waking up in the morning Another Simple Flowchart

10 Process Maps

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12 A New Tool – Driver Diagrams 12 A tool to help us understand the messiness of life!

13 What changes can we make? Primary Drivers – System components which will contribute to moving the primary outcome Secondary Drivers – Elements of the associated Primary Driver. They can be used to create projects or a change package that will affect the Primary Driver.

14 Stroke Driver Diagram Improve the outcome for people following stroke First hours bundle Rapid recognition tool e.g. ROSIER Confirmation of diagnosis Start aspirin First day bundle CT scan Admission to co-located beds Swallow screen First 3 days bundle 36h continuous monitoring Manual handling assessment Nutritional assessment Physiotherapy assessment First 7 days bundle OT assessment commenced MDT goal setting meeting Information sharing with patients/carers Reduce the number of episodes of avoidable harm Interventions identified by the Global Trigger Tool analysis

15 Driver Diagram Exercise Establish stakeholder group Objectives Discussion regarding concerns (group) Flipchart exercise (smaller groups) Sticky notes exercise (individual) Coffee!! –Whilst this is taking place the notes are “themed” Stakeholders view themes (primary drivers) Group exercise to format driver diagram

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19 Better anaemia management EducationTraining packagesCommunication Core Processes Disseminating pathway guidelines Hospital Referral pathway Guidelines/Protocols Treatment options Finances Commissioning Business cases Patient Involvement Satisfaction/outcome Service design Primary care Engagement Responsibilities Anaemia Management Driver Diagram

20 How Will We Know We Are Improving? Understanding the System for Weight Loss with Measures Measures let us Monitor progress in improving the system Identify effective changes

21 Group Work Working in pairs, for an improvement aim arising from a national audit define the following: Primary drivers Secondary drivers Possible projects Allow 10 minutes for this exercise 21

22 Guidance for testing a change concept A test of change should answer a specific question! A test of change requires a theory and a prediction! Test on a small scale and collect data over time. Build knowledge sequentially with multiple PDSA cycles for each change idea. Include a wide range of conditions in the test sequence. Don’t confuse a task with a test! 22

23 The Model for Improvement Define the question Gather information and resources (observe) Form hypothesis Perform experiment and collect data Analyze and interpret data Generate new hypothesis and retest

24 Why Test? Why not just implement then spread? Increase degree of belief Document expectations Build a common understanding Evaluate costs and side-effects Explore theories and predictions Test ideas under different conditions Learn and adapt 24

25 Repeated Use of the PDSA Cycle Hunches Theories Ideas Changes That Result in Improvement AP S D A P S D AP SD D S P A DATA Very Small Scale Test Follow- up Tests Wide-Scale Tests of Change Implementation of Change What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement

26 The Sequence for Improvement 26 Spreading a change to other locations Developing a change Implementing a change Testing a change ActPlan StudyDo Theory and Prediction Test under a variety of conditions Make part of routine operations

27 Group Work Working in pairs, devise a PDSA cycle to test an idea based upon a problem arising from a national audit. Note – your driver diagram exercise will have developed some ideas for testing! Allow 10 minutes for the exercise

28 Promoting quality for better health services Thank You Any Questions?


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