1 Rapid Cycle Quality Improvement Course Outline  The Quality Journey  Rapid Cycle Improvement Model  Change Concepts  Teams  Tools  Barrier Busters

2 Group’s Prior Experience with Quality Improvement Very Little10+yrs 3-5 yrs5-10 yrs1-2 yrs Participant Survey Results

3 What is Quality? Quality is a never-ending cycle of continuous improvement. -Deming

4 Quality Alphabet Soup

5 Group’s Tools for Quality Improvement Participant Survey Results

6 Quality Improvement Program  Vision, Goals, Objectives  Quality Indicators – Monitoring  Quality Project  Continuous Improvements  Solve Problems  Change Systems  Sentinel Events

7 The Quality Journey Quality Assurance Quality Improvement Rapid Cycle Quality Improvement

8 QA vs. QI Quality Assurance  Conform to standards  Relies on inspection  Focus on items  Quality is separate function  Departmental function Quality Improvement  Improved performance  Monitor over time  System orientation  Quality integrated in organization  Interdisciplinary function

9 Malcolm Baldrige National Quality Award

10 PDSA Cycle

11 AIM Statement What are we trying to accomplish?  The Aim Statement articulates the goals, guides the improvement effort, and keeps the team focused. Specific Measurable Challenging

12 Measurement How will we know that a change is an improvement?  What to measure - what will be different?  What are the guidelines

13 Cycles of Improvement What changes can we make that will result in an improvement?  It’s your opportunity to brainstorm: Possible changes People that are needed Required resources Potential for collaboration Necessary leadership support

14 Change 3 Change 2 Change 1 Continuous improvements of multiple changes. P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A P D S A Cycles of Improvement

15 Rapid Cycle Improvement Model What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? Cycle 1Cycle 3Cycle 2

16 Potential EMSC Monitors:  Timely management  Wait time to see an MD in the ER  Time to initiate antibiotics in fever management  Use of an intraosseous line when needed  Transfer within 2 hours when appropriate  Use of the Broselow, or similar, system  Pain management in the non verbal child  Asthma management  Obtaining a patient height  Peak flow measurement  Abuse recognition  Provision of injury prevention education

17 What Quality Improvement activities are you working on at your hospital? Participant Survey Results

18 An Example of Rapid Cycle Planning Where do we begin?

19 Change Concepts  Change concepts are generic ideas that can be applied to your situation to spark an idea for a specific change in your situation  Not all change concepts apply to all aims  Brainstorm ways to apply these concepts to the problem at hand

20 Change Concepts  Enhance the Producer /Customer relationship  Listen to patients  Coach customers to use product/service  Reach agreement on expectations  Mass customize services to patient

21 Change Concepts  Change the work environment  Reduce demotivating aspects  Implement cross training  Clarify roles & expectations  Improve work flow  Synchronize  Find and remove bottlenecks  Do tasks in parallel  Adjust to peak demand

22 Change Concepts  Manage Time  Reduce the setup or startup time  Optimize maintenance  Reduce wait time  Manage Variation  Eliminate waste  Reduce or eliminate overkill  Recycle or reuse

23 Change Concepts  Optimize inventory  Match inventory to demand  Use pull systems - proactive  Reduce multiple brands  Design systems to avoid mistakes  Use reminders  Use differentiation  Use constraints  Minimize handoffs

24 Team  Composition  Sponsor  Leader  Team member(s)  Helpful hints  Be Multidisciplinary  Assure available leadership  Include hands-on expertise & variety of skills, e.g. computer skills  Recognize progress  Clarify roles & responsibilities  Handle conflict constructively  Maintain core group for consistency

25 Essential Tools  Meeting Agenda (every meeting)  Meeting Summary (every meeting)  Project Work plan (create 1, post & update)  Project Report Form (Internal - External)

26 Other Helpful Tools  Brainstorming  Run Charts  Flow Charts  Cause & Effect Diagram  Pareto Diagram  Nominal Group Technique  Force Field Analysis XRefer to Section 12 - Tab “QI Tools & Techniques”

27 Example – Run Chart

28 Example – Control Chart Jul-99 Aug-99 Sep-99 Oct-99 Nov-99Dec-99 Jan-00 Feb-00Mar-00Apr-00 May-00 Jun-00 Jul-00 Aug-00 Sep-00 Oct-00 Nov-00Dec-00 Jan-01 Feb-01Mar-01Apr-01 May-01 Jun-01 Jul-01 Aug-01 Sep-01 0% 20% 40% 60% Percent of Pts Self Administered Med Project DRG 372 & 373 Percent of Pts Receiving Darvocet Pre Project Project Implemented Mean: 23.8% Mean: 39.4%

29 Barrier Busters  Barrier - Problems with Setting an Aim  Is there sponsorship for the project?  Does project fit with organizational mission?  Does project conflict with our values?  Is Aim Statement clear and precise?

30 Barrier Busters  Barrier - Problems with Teams  Is your leader available and empowered?  Are you meeting weekly?  Does everyone know their responsibilities?  If you have conflicts, who can you request to facilitate your team?

31 Barrier Busters  Barrier - Problems with Resources  Suggestions:  Keep your team small at first  Use volunteers and champions  Collect just enough data  Set a dedicated meeting time  Huddle if needed (15 minutes is all you need!)  Involve senior leadership if resources are a problem

32 Barrier Busters Barrier - Resistance :  “No one thinks there is a problem”  Take the high ground...  “We are different”  Share information and challenge assumptions...  “It’s too difficult”  Look at others (internally & externally) that have successfully made a change  Break ideas for change into small components  Present changes as a “test” - that can be accepted, refined, or abandoned  Use just enough data  Post results of the small test from the outset as proof that it can happen  Engage senior leadership - it is a must

33 Resistance – How people respond to change…  Innovators – 2.5%  Early Adopters – 13.5%  Early Majority – 34%  Late Majority – 34%  Laggards – 15%

34 Barrier Busters  Barrier - Problems with Ownership  Be sure to include all impacted areas  Collaborate with staff at all levels  Involve the people that DO the work  Find champions in several disciplines  Keep sponsors informed and involved

35 Next Steps: Action List  What is one problem in your work setting where you think Rapid Cycle Quality Improvement would help you?  What is one thing that you can do by next Tuesday?