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

2. 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

3. 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

4. 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,

5. 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,

6. 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.

7. 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,

8. 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,

9. 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,

10. 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,

11. 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,

12. 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; Available from:

13. 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