1. Healthcare Quality Improvement Dr. Nishan Sharma nishan.sharma@ucalgary.ca University of Calgary, Canada October 2015 1

2. What is Quality Improvement? your ideas? 2

3. What is Quality Improvement? making changes to a system to improve outcomes 3

4. What improvements could you make? let’s hear your ideas on what you might improve in the healthcare system 4

5. Why do Quality Improvement? make care safer, less harm to patients – e.g. few hospital-acquired infections give patients and families better experience – e.g. increase satisfaction with care make care faster – e.g. see more patients in one day in the clinic less money – e.g. test a different treatment that might cost less less waste – e.g. reduce the amount of medication that expires before it can be used by tracking how much you use 5

6. The Model will we use 6 Part 1. Think about the change you want to make Part 2. Small cycles of change before you make a big change This Model has 2 Parts { }

7. 7 Most people start here - wrong Should start here

8. Goals for Workshop 1.Finding a good problem to solve 2.Making a good plan for change 8

9. Before You Start Making a Plan 1.Make sure your hospital or group wants to make a change 2.Make sure you have help (you cannot always do it yourself) – Doing quality improvement together is good for team building, too 9

10. Step 1 – Writing your Problem Find a problem you want to solve There are lots of places to look for a problem: – What is a problem you see everyday? – What is a complaint your patient has, or you have? – Where do things take too long to happen? – What is an issue in your community? – What seems to work in other hospitals, but not your hospital? – Do you have any communication problems with your team, or your patients? – How are supplies being used, or where can waste be reduced? 10

11. Activity 1 – Write your Problem Divide into groups On the top of Worksheet 1, write down a problem you want to improve (My Example: “I want to lower infection rates”) – don’t make the problem too big – don’t try and make your idea perfect right now Pick one from your team, then we will talk about ideas (10 minutes) 11

12. Step 2 – Focusing your Problem now that your wrote down a problem for quality improvement, we are going to ask some questions to make a better plan think of your problem as a mountain you want to climb before you climb the mountain, you need a plan 12

13. Your Ideas If you were going to go up a mountain, what are some things you need to think about? 13

14. Things to Think About If I was planning a trip up a mountain, I would think: – Who is going? – When am I going? – How long will it take? – What things will I need? – What path will I take? – What jobs will people have? 14

15. Let us focus on your problem Look at your problem from Activity 1, and answer these 6 questions: 1.What do you really want to improve? 2.Who do you want to improve it for? 3.Where do you want the change to happen? 4.By when do you want to see the change? 5.What change do you want to see? 6.Who is going to be helping? 15

16. My Example First, I had “I want to lower infection rates” Now – What do I really want to improve: Infection rates – Who do I want to improve it for: Patients who stay overnight – Where do I want to see the change: In the maternity ward – By when do I want the change to happen: In one month – What change do I want to see: I want to lower infection rates by half – Who is going to be helping: All staff in the ward 16

17. My Example First, I had “I want to lower infection rates” Now: “Our staff want to lower infection rates for patients admitted to our maternity ward by 50% by next month” This is called an Aim Statement 17

18. Activity 2: Write your Aim Statement Worksheet 1, Activity 2, create your Aim Statement, talk with your team (10 minutes) We will then talk about your Aim Statements 18

19. Where we are in the Model for Improvement we have addressed the first two questions, and created an Aim Statement we are ready to think about the changes you want to make, and doing the change through the PDSA cycle 19

20. How PDSA Works Plan (P) – Do (D) – Study (S) – Act (A) cycles 1.Plan - look at your system, understand how it is working right now 2.Do - make a small change 3.Study - measure if change worked 4.Act - planning the next change – then 1, 2, 3, 4 again, and again 20

21. Why make small changes? Why not try and make a BIG change? – small changes can make big differences – if you make a small change, and it does not work, you have not wasted too much time, or money, or energy – if you make a small change, you have more confidence that the change you made was what made the difference 21

22. Small changes lead to bigger changes 22 Try one small change, with one patient Same change, more patients Same change, all patients Make standard practice

23. Activity 3 – PDSA Game in your group, set up a system where you: – roll the ball off the table – have ball bounce one time, and – have ball land in the cup – we will see who can get most in a row you have 10 minutes we will then test and talk about it 23

24. Activity 3 – PDSA Game this game was PDSA cycles – big plan was to have ball go in many times – you planned your system – you saw how system worked (try one time) – you made one small change for each test (you did not try, then make a bunch of changes, then try again) – measured if it works – make another small change – tested until it worked 24

25. First step in the cycle - Plan pick one quick change you might make to get you to your goal – In my example infection rates can be reduced by better hand washing, or different way to clean room, or training the cleaners, or different cleaning products - pick one – you want to test each change on its own, so you know what actually made a difference 25

26. Plan in your plan for a small change, you need to know what success would look like, so you need to have research data – in my example, we would have to know the current infection rates to know if our change made a difference 26

27. Plan – My Example – What small change are you going to make? we are going clean the delivery room before and after each delivery – When are you going to do it we will change to this procedure next Tuesday – Who will do it? cleaning staff – How long are you going to do it for? We will do this for one month 27

28. Plan – My Example – Where will you do it? in our delivery room – Who needs to know about it? All cleaning staff – Who is going to collect the research data? Nurses – How will the data be collected and shared? Track number of infections, post on bulletin board or share in weekly meeting 28

29. Activity 4 – Detail Plan Fill out Worksheet 2 with details for your plan (15 minutes) – Discuss at your table if you like 29

30. Do, Study, and Act we will talk about rest of PDSA cycle quickly Do – make your changes small! try with 1 patient, or 1 location, 1 day or 1 hour – remember, small change can make big differences – do it by Tuesday – write down problems you have – look at your research data as you get it 30

31. Study what happened? what effects did your change have on your outcome? did outcome match plan? find out if change worked – did clinical outcome change? – observe the effect on the system – ask the people (provider, patients) questions 31

32. Act What permanent (small) change do you want to make? What other parts of the system will be affected by the change? Help people make the change, communicate – the change that was made – how to make the change – when to make the change 32

33. Thank you - Your feedback on this workshop 1.What did you learn? 2.What did you enjoy? 3.How can workshop be improved? 4.Any other comments 33