1. Academic Pediatric Association QUALITY IMPROVEMENT TRAINING: Module #3 Initiating a QI project This work is supported by a grant from The Centers for Disease Control & Prevention.

2. Module 3 Objectives After viewing this segment, you will be able to: 1. Identify roles and responsibilities of QI team members 2. Draft an Aim Statement (Describe your problem, timeline, scope, and target population) 3. Complete a charter 4. Build a driver diagram

3. 1. Identify roles & responsibilities of QI team members “Including the right people on a process improvement team is critical to a successful improvement effort.” Institute for Health Improvement

4. When putting together a QI team… How to choose team members: Review the general mission  What system(s) will be affected by the improvement efforts? Invite members familiar with different parts of the relevant process Size: 5-7 people at most Executive sponsor: takes responsibility for the success of the project

5. Possible Team Members & Their Roles Project sponsor/champion – oversee QI project (e.g., goal setting, data collection & analysis), advocate for & find resources to get project done Clinical technical expert -- knows the subject intimately, understands the processes of care Day to day leader – plan & deliver all training needed to implement the project; managing the implementation and testing the change System leader -- advocate Other team members – “voice of experience” Outsider? QI expert if available

6. Some characteristics that make a good team member: Good knowledge of process, product, and customer Access to data about the process or product Willingness to work cooperatively with other team members Ability to devote 3-4 hours/week to data collection and team meetings Ability to challenge the status quo From The Six Sigma Way: Team Fieldbook PS Pande, RP Neuman, RR Cavanagh

7. 2. Draft an Aim Statement

8. AIM Statement What are we striving to accomplish (measurable goal(s))? When will this occur? (what is the timeline)? How much? What is the specific, numeric improvement we wish to achieve? For whom? Who is the target population? Why is it important? See Jean Meeks on “Developing Clear Aim Statements” at http://positive-eye.com/2008/12/developing-clear-aim-statements/

9. A Sample AIM Statement for HPV Vaccination What HPV vaccine series completion (i.e., all recommended doses, properly spaced) WhenBy June 30 of this year How much We will achieve coverage of >70% overall (>65% males, >75% females) For whom Our patients who were 11-17 years of age as of our start date and who had a visit or rx refill phone call within 2 yrs of our start date; MOGE Importance Knowing that we can prevent cancer – even one case of cancer – makes our teamwork seem very worthwhile

10. From http://tipqc.org/qi/jit/methods/developing-an-aim-statement/ Not so high that it paralyzes people because they know they can’t succeed But it shouldn’t be so low that it just barely exceeds the status quo “The measure of goodness is as much improvement as you can possibly accomplish.” How high should we set our goals?

11. 3.Complete a charter for the project committee

12. What is in a project charter? AIM Statement (includes goal, timeline, etc.) Members and their responsibilities Meetings --Timing (e.g., every Tuesday 12:00-12:50, expectation to start & end on time) --Who will take notes, document decisions Signatures (see template based on http://quality.wisc.edu/project-management-charter.htm)

13. Why use a project charter? Defines the project and organizes critical pieces of info about a project in one place Emphasizes approval by leadership Builds understanding, consensus, and clarity Is a living document that evolves using a structured approach

14. 4. Build a driver diagram

15. Driver Diagram The system can be described through a graph called a driver diagram. Purpose: to show the factors that cause an outcome The outcome we are interested in is our Aim, so let’s start there.

16. Improve HPV immunization rate from 45% to 75% in 12 months Desired Outcome (Aim)

17. Improve HPV immunization rate from 45% to 75% in 12 months System: The providers have to remember to order the HPV vaccine Variation: The providers all use different HPV vaccination schedules and the nurses can’t keep them straight Knowledge: Physicians don’t know how they are doing and tend to assume the best Psychology: A lot of the team members believe that it’s better to give HPV vaccine right before college Desired Outcome Primary Drivers (Aim)

18. Improve HPV immunization rate from 45% to 75% in 12 months Desired Outcome Primary Drivers2ndary Drivers (Aim)

19. Improve HPV immunization from 45% to 75% in 12 months Providers forget to order it Use standing orders Add vaccination to check list Use EMR prompt Nurses can’t remember/guess who will order what, when Agree on standard schedule Post standard in clinic “I’m sure I vaccinate 90% of my patients.” Monthly data reviews “Let’s wait.” Education Desired Outcome Primary Drivers Changes (Aim)

20. Improve HPV immunization from 45% to 75% in 12 months Providers forget to order it Use standing orders Add vaccination to check list Use EMR prompt Nurses can’t remember/guess who will order what, when Agree on standard schedule Post standard in clinic “I’m sure I vaccinate 90% of my patients.” Monthly data reviews “Let’s wait.” Education Desired Outcome Primary Drivers Changes (Aim)

21. Driver diagrams are just one way to help understand your system. There are many other ways to understand your system – e.g., flow diagrams, 5 whys The point is simply this: After you have a clear Aim Statement and project charter, the next step is gathering & organizing information  testable theories  PDSA The more tools you have to gather & organize information, the better!

22. Summary QI teams should include 5-6 people familiar with different parts of the problem plus an executive sponsor. An Aim Statement should explicate the measurable goal, the timeline, the numeric improvement you plan to achieve, the target population and why the issue is important. Your team charter should include the AIM Statement, team members and their responsibilities, and details of meetings such as timing and note taking. A driver diagram depicts the problem, the primary drivers, possibly the secondary drivers, and potential interventions to address the drivers.

23. The End of Module #3 IHI. Science of Improvement: How to Improve http://www.ihi.org/knowledge/Pages/HowtoImprove/ ScienceofImprovementHowtoImprove.aspx