1. QI Tools 1 Improvement Facilitator Training Session 2

2. 2 Primary Care Practices are 2.76 times more likely to adopt evidence- based guidelines through improvement facilitation. - Baskerville, Liddy and Hogg, 2012 Be curious about how things really work! Map Your Process Check for Defects Diagram Cause Effect Ask 5 Whys

3. 3 1.Why 2.Why 3.Why 4.Why 5.Why Analyse your System; Choose the Tools to Serve your Curiosity!

4. The 5 “WHYs”: Sometimes a barrier or challenge is identified that has a root cause that is not readily apparent. By asking “WHY” 5 times you can usually drill down to uncover that root cause.

5. Example: Dr. Doe chose CV Risk Assessment as part of his ASaP screening bundle. One of the required measures for the calculation is weight. Rooming staff were concerned that they could not reasonably perform this measure opportunistically to all patients of Dr. Doe. The 5 Whys are applied…..

6. Measuring weight opportunistically not “doable”: 1 st. WHY: Not enough time to weigh each patient before rooming. 2 nd. WHY: There would be a wait at the weigh scale. 3 rd. WHY: There are only 2 scales in the entire clinic. 4 th. WHY: More providers added over the years but no more weigh scales added. 5 th. WHY: Before ASaP, weight not done on many patients per day so the 2 scales were adequate. So, what was thought to be a time barrier is actually an equipment barrier.

7. Run Chart Rules There are 4 basic rules to help interpret Run Charts We will review the two that will likely be the most useful to you

8. Note: Skip all values that fall on the median and continue counting. Run Chart Rules - a SHIFT in the process is signaled by 6 or more consecutive data points all either above or below the median. Measurement Time

9. Run Chart Rules: A TREND is signaled by 5 or more consecutive data points all going up or going down, can span the median. Note: If two data consecutive points are the exact same, you only count the first one and ignore the repeating value; “like” values do not make or break a trend. 8 7 5 6 3 4 2 1 Measurement Time #6 is same value as #5 so would not be counted.

10. Fishbone, Cause & Effect or Ishikawa Diagram

11. Blue Meadow Clinic Improvement Board for Screening  What changes are we making that will lead to an improvement?  Patient Awareness :Placing posters in rooms promoting pharmacist reviews for patients on 5 or more medications.  Provider Reminders: Each day, attaching a pharmacist brochure to charts of patients on 5 or more medications who are scheduled. What have we learned about the way we currently do things?  Insert ‘cause & effect diagram’ OR ‘process map’ OR ‘pareto diagram’ OR ‘5 whys’