Karen Bos San Mateo Residency QI Course November 12, 2013 Identifying projects Karen Bos San Mateo Residency QI Course November 12, 2013

Outline Review PDSA cycle, setting aims, and establishing measures Complete PDSA worksheet individually/in project groups Share and discuss project ideas with the whole group Wrap-up and review

Outline Review PDSA cycle, setting aims, and establishing measures Complete PDSA worksheet individually/in project groups Share and discuss project ideas with the whole group Wrap-up and review

PDSA cycle AIM MEASURES CHANGES ACT PLAN STUDY DO What are we trying to accomplish? MEASURES How will we know that a change is an improvement? CHANGES What change can we make that will result in improvement? PLAN DO STUDY ACT Objective Questions and predictions How to carry out cycle: who, what, when where Plan for Data Collection Carry out plan Document problems/ observations Begin data analysis Complete data analysis Compare results with predictions Summarize what learned Adopt, Adapt, or Abandon What change to test in next cycle? Adapted from Institute for Healthcare Improvement, www.ihi.org

Setting aims Aims (specific) vs. vision (general, longterm) Components of an aim statement for QI project: Define the population you are working with Determine something specific you want to improve Identify how much you want to improve it Identify by when you want this to happen Example: Vision: Improve care for patients on antipsychotic medications Aim: Metabolic screening panel done within the past 12 months in 80% of patients being prescribed antipsychotic medications in psychiatry resident outpatient clinic by May 2014 Adapted from Institute for Healthcare Improvement, www.ihi.org

Choosing “SMART” aims Specific: aim should be clearly stated, include numerical goals Measureable: consider baseline data and how to measure progress or determine project outcomes Achievable: less is more! Feasible, focused project Relevant: residents are in a good position to identify relevant, meaningful clinical challenges Time-framed: set a realistic time frame Arbuckle MR and Cabaniss DL. Columbia Quality Improvement Curriculum.

Establishing measures Outcome Measures How does the system impact the values of patients, their health and wellbeing? What are the impacts on other stakeholders such as payers, employees, or the community? Process Measures: Are the parts/steps in the system performing as planned? Are we on track in our efforts to improve the system? IHI recommends using a balanced set of measures for all improvement efforts Adapted from Institute for Healthcare Improvement, www.ihi.org

Establishing measures Outcome Measures Process Measures For diabetes: Average hemoglobin A1C level for population of patients with diabetes Percentage of patients whose hemoglobin A1C level was measured twice in the past year For access: Number of days to next available appointment Average daily clinician hours available for appointments Adapted from Institute for Healthcare Improvement, www.ihi.org

Establishing measures Balancing Measures (looking at a system from different directions/dimensions): Are changes designed to improve one part of the system causing new problems in other parts of the system? Example: For reducing patients’ length of stay in the hospital: Make sure readmission rates are not increasing Adapted from Institute for Healthcare Improvement, www.ihi.org

Establishing measures Tips for effective measures: Plot data over time Seek usefulness, not perfection Use sampling Integrate measurement into the daily routine Use qualitative and quantitative data Adapted from Institute for Healthcare Improvement, www.ihi.org

Selecting Changes Examples of change concepts: Eliminate waste Improve work flow Optimize inventory Change the work environment Producer/customer (provider/patient) interface Manage time Focus on variation Error proofing Focus on the product or service A change concept is a general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement. Creatively combining these change concepts with knowledge about specific subjects can help generate ideas for tests of change. After generating ideas, run Plan-Do-Study-Act (PDSA) cycles to test a change or group of changes on a small scale to see if they result in improvement. If they do, expand the tests and gradually incorporate larger and larger samples until you are confident that the changes should be adopted more widely. Adapted from Institute for Healthcare Improvement, www.ihi.org

Continuous qi (CQI) IMPROVEMENT TIME ACT PLAN STUDY DO Once you have decided on your change, you will implement it, study it, decide if it works and then begin again with a new change or modification. The idea is to be continually testing small changes to achieve improvement over time. Hanson E, Rosenbluth G, McPeak K. QI Olympics: A Game-Based Educational Activity in Quality Improvement. MedEdPORTAL; 2013. Available from: https://www.mededportal.org/publication/9421

Outline Review PDSA cycle, setting aims, and establishing measures Complete PDSA worksheet individually/in project groups Share and discuss project ideas with the whole group Wrap-up and review