Chapter 1 Introducing Quality Improvement

Chapter 1: Introducing Quality Improvement S.A.F.E uses quality improvement (QI) as a core methodology. This chapter will focus on understand QI methods.

Resources Plan Do Study Act Checklist and Log Driver Diagram Measurement Plan Stakeholder Map

Domains of Quality CROSSING THE QUALITY CHASM: A New Health System for the 21st Century INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Person centred What matters to me Safe Do we harm patients? Effective Do we give the right treatment every time all the time? Equitable Are the services and outcomes equal for all Timely Is there good access? Efficient Do we get value?

What is Quality Improvement? Quality Improvement can be defined as the: “combined and unceasing efforts of everyone – healthcare professionals, patients and their families, researchers, payers, planners and educators – to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development” Batalden and Davidoff

Deming’s Profound Knowledge System where you work Variation in the system Psychology - the people Theory of knowledge One needs to understand the system in which one works – usually called the clinical micro system. Variation within processes is the major problem and one needs to study what is good variation and what is unneeded variation People make up systems and one should look at the beliefs and attitudes which drives behaviours Finally the theory of knowledge is the change methodology one uses. Deming

Microsystems Staff Patients Performance Leadership Strong Leadership Great Organizational Support Focus on Staff (Professionals) Education and Training of Staff Interdependence of Care Team Performance Result Focused Process Improvement Focused Patient-Centered (Patient Focus) Community and Market Focus Information & Information Technology Orientation Reference Nelson et al 2008 The Clinical Micro-system is where improvement occurs – the doctor, nurse and patient or the ward or the clinical team. One needs clinical leadership to drive improvement, staff engagement and ownership of the problem to be solved One also needs to measure one’s performance so one can continually improve. Reference Dartmouth

Theory to method to measurement Systems Variation Psychology Theory of knowledge Theory Method Measure The interaction between theory method and measurement

The Model for Improvement What are we trying to accomplish? How will we know if the change is improvement? What changes can we make that will result in improvement? Plan Do Study Act

Change in the Microsystem The individual Clinical skills Self management Personal development Clinical Micro system Individual team and patient Where improvement takes place Meso system Supports micro system Macro organisation Connects meso systems and micro systems Network district regional Whole patient journey Across organisations

5 Ps to Assess Improvement in a Microsystem Purpose - Our aim and mission. Patients - Our reason for doing our work. People - Our staff who take care of patients. Processes - Our interrelated process that make up the micro system. Patterns – The way we work and measure what we do (Measurements, Data, Run Charts) The 5 Ps allows for the assessment of how a microsystem is functioning Reference Dartmouth

What change can we make that will result in an improvement ? Model for Improvement What change can we make that will result in an improvement ? The PDSA Cycle The PDSA cycle allows for the testing of ideas one patient at a time Langley Nolan et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2nd Edition April 2009, Jossey-Bass P 89

Where to start? Implement changes Test changes Establish measures Define area for change Set aims Establish measures Test changes Implement changes

S.A.F.E Driver Diagram

PDSA Paper Aeroplane Activity Quality Improvement in Action Aim: Design a paper plan that will fly the furthest distance Think of the areas you need to consider: Design Construction Measurement Run your tests a few times: What are you learning? How will you factor your learning into the next test? Did your change result in improvement ?

Spreading Change through Collaboration The success of S.A.F.E has been in establishing, encouraging, and supporting networks to share learning, experiences, and ultimately, change. What networks can you engage with to help spread your improvements?