1. The Internist as Quality Advocate Application of QI Tools Kim Tartaglia, MD Fall 2010

2. Objectives  Review Model for Improvement  Review steps for successful completion of QI project  Discuss additional resources and tools

3. The NY Times, Aug 21, 2010

5. Why Address QI  Professional duty to provide high quality of care  Training Requirements (ACGME)  Pay for Performance  Maintenance of Certification  Academic Medicine Niche  Publication Worthy

6. IOM: Dimensions of Quality Safety Timeliness Effectiveness Efficiency Equity Patient Centered

7. Steps of QI project Identify opportunity and assemble team Review literature and best practices Identify current practice Collect baseline data (QI dept to help) Develop strategy for improvement – Implement Model for Improvement

8. Importance of Creating Teams Stakeholder analysis Gain Buy-In Identify Champions Help Create Solutions Should be done at the beginning of a project!

9. Ideas for Developing Change Evaluate current system  Process Maps, Root Cause Analysis Review Best Practices  Benchmark to compare to current practice Technology Creative Thinking Change concepts

10. Using Process Maps  A process map is a picture of the steps in a process (in sequence)  Must understand the current process in order to make change and affect outcomes  Used to identify areas where change can be made

13. Root Cause Analysis Find and address the underlying cause of a problem

14. Steps of QI project Identify opportunity Review literature and best practices Identify current practice Collect baseline data (QI dept to help) Develop strategy for improvement – Implement Model for Improvement

16. AIM Statement  Description of what you want to accomplish  Includes the following: Quantification (How much?) Time frame (By when?) Specific patient population that is the focus (For whom?)

17. AIM Statement Should be set high enough to have impact on care but not be unrealistic Should be flexible to allow for different solutions

18. Measures  How will you know change is an improvement  Types of Measures Process (Hand-washing rates) Outcome (Rate of hospital-acq infection) Balancing (Decreased contact with patient)

19. Piloting an Improvement Idea “All improvement will require change, but not all change will result in improvement.”  PDSA cycle: – Used to test ideas for change – Framework for creating an efficient trial- and-error process Langley GL, et al,. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.

20. PDSA cycle  PLAN: – Develop interventions – Plan to carry out changes and collect data – “Who does what when?”  DO: – Implement the necessary changes – Document problems and observations

21. PDSA cycle  STUDY: – Measure the effect of the change – Complete data collection and analysis  ACT: – Discuss changes to make for next cycle – Develop a plan to hold any gain / spread the improvement

22. Linking PDSA cycles Each cycle builds on the next Cycles start out small and rapid, eventually get larger

23. Example: Linking PDSA cycles

24. Sharing Your Results SQUIRE Guidelines (Standards for Quality Improvement Reporting Exercise) – http://squire-statement.org/

25. Additional Reading/Resources Institute for Healthcare Improvement www.ihi.org (Open School QI modules www.ihi.org Langley GL, et al. The Improvement Guide Gawande, A. The Checklist Manifesto