1. Quality Improvement For more see the Course in Quality Course in Quality Farrokh Alemi Ph.D. hhttp://gunston.gmu.edu/708/EmailAlemi.htm 703 993 1929

2. Getting Ready for Change Why some change easily and others suffer unnecessarily? What does it take to be ready for change? –We claim the task at hand is unique –We claim we can beat the odds

3. Does Continuous Quality Improvement Work? In a randomized controlled trial of 15 clinics (95 providers, 4995 patients) both CQI and academic detailing when correctly implemented increased by 17% number of hypertensive patients adequately controlled. By themselves or when inadequately implemented, CQI or accademic detailing had no effect. Jt Comm J Qual Improv 98; 24 (3): 130 -142

4. Does It Work (Continued)? Numerous department wide improvement efforts led to statistically significant improvement in patients’ satisfaction with the Department over 4 years. Arch Otolaryngology Head Neck Surgery 96; 122 (10): 1045-1048

5. Does It Work (Continued)? Patients and providers were randomly assigned to two inpatient wards, one of which engaged in continuous quality improvement. The unit with CQI reduced the mean length of stay from 6.06 to 5.46 days. Total charges were reduced from $8,090 to $6,681. Medical Care 98; 38 (8S): AS4-AS12

6. Does It Work (Continued)? Reduced cost Client satisfaction Market share Care outcomes Employee work life Percent of 92 projects targeting this area 36%76%21%56%50% Percent of 92 projects reporting measured success 2%12%8%Up to 13%Up to 30%

7. Continuous Quality Improvement Can Help If... Correctly implemented. Over long time periods. Focused on significant problems.

8. 10 Steps to Improvement

9. 10 Steps in Improvement (Continued)

10. 10 Steps to Improvement (Continued)

11. Farrokh Alemi Ph.D. Falemi@gmu.edu 703-748-1629 This lecture focuses on: Leading Change

12. Steps Taken by Leaders 1. Set Mandate Have a vision Set example Speak up Question? Does change need to start from top?

13. Steps Taken by Leaders to set culture 2. Keep the customer in mind Customer mindedness –Who is the customer –Is the customer aware? Question? What do fish talk about?

14. Steps Taken by Leaders 2. Avoid blaming people Blame the system not people –What is a system? –How to deal with problem people? Do you like team work? Question? Can you not blame the individual ?

15. Steps Taken by Leaders 2. Rely on data Question the obvious and trust data –What can you measure? –What is the advantages of measurement Question? Is measurement counter productive?

16. Steps Taken by Leaders 2. Use teams Encourage teamwork & empower employees –Is empowerment a myth? –How could teams be made more productive Question? Is teamwork counter productive

17. Steps Taken by Leaders 3. Allocate Resources Training resources Improvement resources Employee time Contractor’s time Question? Should organizations create new departments or pay existing ones?

18. Steps Taken by QI Unit 4. Identify Problems Gather data Benchmark against peer State problems Assign teams Tip No solutions. No blame. Describe customer’s experience. + & - perspectives

22. Take Home Lesson So Far Effective change starts from top and needs a supportive environment