5 QI in Our Terms“QI is the use of a deliberate and defined improvement process, such as Plan-Do-Study-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.”Bialek, R., Beitsch, L. M., Cofsky, A., Corso, L., Moran, J., Riley, W., & Russo, P. (2009).Proceedings from Accreditation Coalition Workgroup: Quality Improvement in Public Health.
6 QA and QI are Not the Same Quality AssuranceQuality ImprovementGuarantees qualityRaises qualityRelies on inspectionEmphasizes preventionUses a reactive approachUses a proactive approachLooks at compliance with standardsImproves the processes to meet standardsRequires a specific fixRequires continuous effortsRelies on individualsRelies on teamworkExamines criteria or requirementsExamines processes or outcomesAsks, “Do we provide good services?”Asks, “How can we provide better services?”
7 QI Can… Reduce cost and redundancy Eliminate waste Streamline processesEnhance ability to meet service demandIncrease customer satisfactionImprove outcomes!
8 QI - Four Basic Principles Develop a strong customer (client) focusContinually improve all processesInvolve employeesMobilize both data and team knowledge to improve decision-making
9 QI – Three Key Questions What are we trying to accomplish?How will we know that a change is an improvement?What changes can we make that will result in improvement?
10 Where do we begin? The Plan-Do-Study-Act (PDSA) Cycle PDSA (also known as Plan-Do-Check-Act (PDCA), was made popular by Dr. W. Edwards DemingIs widely used by quality professionals, process improvement engineers, & health care professionalsScience based, data driven, iterative process improvement methodologyTurns ideas into action and connects that action to learning
11 PDSA – An Overview Four Stages Nine Steps Repeatable Steps Can be used by one person, a team, or an agencyUsed to improve existing processes
12 Step 1 Step 2 Step 3 Step 4 Step 5 Stage One - PLAN Getting Started Assemble the TeamStep 2Examine the Current ApproachStep 3Identify Potential SolutionsStep 4Develop an Improvement TheoryStep 5
15 Step 8 Step 9 Stage Four - ACT Standardize the Improvement or Develop a New TheoryStep 8Establish Future PlansStep 9
16 QI Toolbox for the PLAN Stage Team Charter - A Tool to Keep You OrganizedAim Statement - A Tool to Define the GoalProcess Mapping - A Tool to Examine Current Process FlowFishbone Diagram - A Tool for Identifying Root CausesAffinity Diagram - A Tool to Identify Potential Solutions
18 QI Team Charter What is it? One to two page document that describes the team’s purpose and targeted improvement.Serves as your team’s roadmapHelps reduce the “now what?” feelingHelps the team come to agreement regarding:CommunicationAccountabilityDelivery of productsEvolves over the course of the project
19 What to Include: Team sponsor Team members and roles Problem, issue, or opportunity statementDescription of the process improvementAim statementCustomers and their needsTimeline for completing each stage of the PDSA cycleTimeline and frequency of team meetingsInternal and external stakeholdersImprovement theories (If…Then)
20 A Tool to Define the Goal: Aim Statement A concise, specific, written statement that defines precisely what the team hopes to accomplish with its QI efforts.Remember the three fundamental questions when writing your aim:What are we trying to accomplish?How will we know that a change is an improvement?What changes can we make that will result in improvement?
21 Aim Statements Include a numerical measure for the target Are time specific and measurableDefine the specific population that will be affected
22 A Tool to Examine Process Flow: Process Mapping Analyze and improve processesIdentify areas of complexity and re-workGenerate ideas for improvementIllustrate process improvements
23 Preparing to Process Map 1.Assemble your QI team2.Determine which process needs to be documented3.Agree on where the process begins and ends4.Agree on the level of detail that will be displayed5.Create a list of the steps taken in the current process6.Construct your process map by ordering the steps7.Identify additional staff to review or provide input on your process map
24 Symbols used to Process Map Start & End: An oval is used to show the materials, information or action (inputs) to start the process or to show the results at the end (output) of the process.Activity: A box or rectangle is used to show a task or activity performed in the process. Although multiple arrows may come into each box, usually only one arrow leaves each box.Decision: A diamond shows those points in the process where a yes/no question is being asked or a decision is required.Flow: An arrow shows the direction or flow of a process.
26 A Few Hints and Tips Map the current process! It’s okay if team members have different ideas about how the process works.Keep steps simple; begin each step with an action verb.Process mapping is dynamic!Post-it notes, dry-erase markers, & pencils are your friend!
27 A Tool for Root Cause Analysis: Fishbone Diagrams
28 Fishbone Diagrams - Purpose To identify and examine underlying or root causes of a problemTo identify a target for your improvement that is likely to lead to changeTo explore possible causes of a problem
29 Fishbone Diagrams: Construction Step 1Write the Problem/Effect in a box on the far right side of your paper, dry erase board, etc.Step 2Draw an arrow (backbone) leading to that boxStep 3Draw smaller arrows (bones) leading to the backbone, and label these arrows with your major causesStep 4For each cause, brainstorm minor causes related to each major cause and note them on the diagram by placing lines on each of the major bones.
30 A Tool to Identify Potential Solutions: Affinity Diagrams Group 1Group 2Group 3Group 4IdeaIdeaIdeaIdeaIdeaIdeaIdeaIdeaIdeaIdeaIdeaIdeaIdeaIdeaIdeaIdea
31 Affinity Diagram: Purpose Creatively generate a large number of ideas and organize them into natural groupings among them to understand possible solutions to a problem.
32 Affinity Diagrams: When to Use To generate consensusWhen you need your team to think creativelyTo breakdown communication barriersTo allow breakthroughs to emerge naturallyTo overcome “team paralysis”
33 Affinity Diagrams: Step by Step Phrase the issue under discussion as a full sentenceStep 2Brainstorm at least 20 ideas or issuesA “typical” Affinity has items, but 100 or more are not unusualStep 3Simultaneously and quickly sort ideas into 5 to 10 related groupingsStep 4For each grouping, create summary or header cards using consensusStrive to capture the essence of all the ideas in each grouping