Quality Improvement: Overview of Principles and Techniques Phavinee Thongkhong-Park, PhD, RN Adjunct Faculty, The University of Michigan School of Nursing Project Director, Department of Standards, JCAHO

Quality Improvement Performance Improvement as a Management Philosophy Data driven Focuses on changing critical process steps Bottom up decision making as well as top down Teams as organizational unit

Quality Improvement Plan-do-check-act (PDCA) cycle model is easy to use and understand underlying philosophy is to continually raise the quality bar Measurement continues until tools, techniques and behavior patterns part of daily practice

Quality Improvement It starts with values….. Vision Mission Goals “What are we trying to accomplish and how does the action support that?”

Quality Improvement Identify important processes relates to and support the mission and goals attach indicators to each important process outcome data special indicators that measure the end of a process

Quality Improvement Process Indicator Selection Locate the points of variability and measure them Indicator Examples: Left without being seen Patient wait times Medication errors

Quality Improvement Selection of Improvement Projects Which indicator or outcome data tells you to act because it exceeds thresholds? Do you have new processes to put in place? Do you have imperatives preselected by management to improve?

Quality Improvement Improvement Project Characteristics Clearly defined and measurable objectives Utilizes a minimum of one indicator with a known baseline Rearranges or restructures the basic process steps Trials the process redesign before full implementation

Quality Improvement Teams as organizational unit Two types Product or output teams (permanent teams) Process Improvement Teams (project teams)

Quality Improvement Essential elements for team success Training, training, training Common vision Data and measurable goals Facilitation

Quality Improvement Formation of improvement teams Team is assigned one project Team is trained Team establishes ground rules, objectives, and timetables Team reports progress

Quality Improvement Team Roles Facilitator does not make decisions or affect the output of the team Leader is a team member who chairs meetings and coordinates activities

Quality Improvement Plan Assess the current indicator information Analyze the process to be improved Identify the steps in the process to be eliminated or changed

Quality Improvement Plan Look for variation Flow chart important processes as a group Generate multiple options for improvement Select one Select evaluation tool

Quality Improvement Do Set up and initiate the pilot phase of the change This is the experimental phase

Quality Improvement Check At the end of the pilot (or sooner) Did this work the way we thought it would? Evaluate the whole process to ensure that the change did not negatively impact another process

Quality Improvement Act Fully implement the selected change Continue to monitor the process