1 Quality Improvement Series Session 5- FOCUS! Windy Stevenson

2 Today’s Agenda

3 Problem statement The DCH ambulatory clinic problem lists are incomplete and inaccurate

4 Why do we care? Why?

5 Last session’s “Ah-Ha!” moment  Residents are extremely busy  Residents are highly motivated to understand their patients  Residents are manually reviewing charts for fear of missing a major diagnosis…  And Residents won’t necessarily STOP this behavior just because we say our system is “fixed.”

6 The Problem List “System”  Our current system is designed to produce chaos (failure in >80% attempts)  Even if we say we “fix” it, our culture is such that we won’t trust it unless we are very focused in WHAT we fix.

7 Where do you start? Problem statement: The DCH ambulatory clinic problem lists are incomplete and inaccurate.

8 Known resident preferences  The purpose of the problem list is generally not well understood  An “ID sentence” including chronic diagnoses is desirable  Documenting health maintenance (wcc) information doesn’t have the bang for the buck  There are varying opinions about the value of acute care info  Residents WANT this to work for providers and for patients  Can’t the system drive us toward success? Shouldn’t we be directed toward the list?

9 Start somewhere…  Institutional or leadership priorities –Clinical –Fiscal  Safety risk  Most annoying (therefore most motivation to fix?)  Most easily solved  Most easily measured  Most meaningful to customers

10 Being here today comes with POWER  Diagnosis Based? –All patients with asthma –All obese patients –All patients who have been seen by genetics –All former preemies  Age Based? –Start with all newborns –Target a certain WCC  Exclusion based? (The Sarah Green effect) –Should we focus on the kids who are normal??  Other ideas?

11 How do you create a SMART aim?  Specific we are intentional and focused  Measurable we can prove we’ve had an impact  Actionable there are no known insurmountable barriers  Realistic it’s within our scope  Timely we’ll do it within a time frame

12 Where to go from here  What do we want to do first? –Success begets success  What can we ACTUALLY accomplish? –What patient population(s) or problem type(s)? –To impact what time point (before the visit?)  What is our AIM?

13 Take Home Points (review) Real (sustainable) change comes from changing systems, not changing within systems Be specific about what you want to accomplish, and why; be intentional Focus on patients Start before you think you are ready; don’t get paralyzed

14 Challenges (ie barriers)  Time  Culture –Ownership  Definition of accuracy  Lack of natural error identification  Lack of natural rewards  Need for manual audits