1. QI 1.0: Starting a QI Project
A “meme-ing” full lecture in QI
Sergio Huerta, MD

2. Goals Gain a practical understanding of the phases of a QI project
Start an outline of your potential QI project
Prepare you for your meeting with your QI mentor

3. Hospitalists and Quality Improvement
“Every system is perfectly designed to achieve the result it gets”
To improve the system we have to change the system
Hospitalists are on the frontlines seeing system failures, process errors and performance gaps
Therefore, you are in a position to improve these processes and make change

4. Where do I begin?

5. Roadmap - Four Phases of a QI Project

6. Focus on Innovation and Pilot Stages of Engineering Change

8. QI Concepts are easy…
IDEA (AIM)
TEST
(PDSA CYCLE)

9. QI Concepts are easy…
IDEA (AIM)
TEST
(PDSA CYCLE)

10. Innovation “Idea” Phase

11. Ideas for change are everywhere and you’re already testing these ideas (AIMs and PDSA cycles) 

13. I hear ideas for change all the time…

15. Your ideas for change = potential QI projects (INTERACTIVE)
What are some potential areas for improvement?
What potential QI projects can come from them?

17. Now that we have some ideas…

18. Using a Model for Improvement to Engineer Change

20. QI Concepts are easy… Innovation Stage
SMART GOAL

22. S.M.A.R.T. Goal TIPS Specific: Clearly identify your target population
Goal can focus on IOM core quality/safety tenants (Crossing the Quality Chasm)
-Safe
-Timely
-Effective
-Efficient
-Equitable
-Patient centered
Clearly identify your target population

23. S.M.A.R.T. Goal TIPS Measurement:
Good measurement is the foundation of project
Can measure different outcomes
*Data collection
-Briefly, once you complete a proposal for a QI project (Q2 form) data will be collected for you
-Important to be specific before making data request

25. General Process Outline (IN-PROCESS-OUT)

26. OUTCOME MEASURE

27. PROCESS MEASURE
OUTCOME MEASURE

28. PROCESS MEASURE
OUTCOME MEASURE
BALANCE MEASURE: Change causes unintended outcomes in other parts of the process

29. S.M.A.R.T. Goal TIPS Attainable: Relevant: Timely:
Narrow scope = better
Relevant:
Tie project to a UNM goal
Timely:
Realistic time limit
Like other projects think of potential submission deadlines as a goal for project completion

30. AIM/S.M.A.R.T. Goal statement
The better your aim statement the more likely it is the project will be successful

31. Examples of S.M.A.R.T. goals
Dr. Charlie Pizanis will transfer every patient from the ED to an inpatient bed within one hour of the decision to admit
Dr. Patrick Rendon will increase resident creation of S.M.A.R.T. goals by 99% in 6 months
Dr. Sergio Huerta will decrease the amount of MEMEs by 25% by the end of the lecture (NOT TRUE)

33. Practice writing a S.M.A.R.T. goal for your project (INTERACTIVE)
Think, Pair, Share!

34. Moving forward with the Pilot Stage of Engineering Change and using a PDSA cycle

37. QI Concepts are easy… PILOT STAGE
Research Question
Conclusion
Hypothesis
SMART GOAL +
SCIENTIFIC METHOD
Analysis
Experiment

39. PDSA… ALL DAY

40. Planning Stage Literature review
What has and has not been done
Could something that's already being done be implemented here
Could we do it better?
Assemble a team with clear roles for each participant
Mentor
Staff – Nursing, Pharmacy, Medical Assistants, Students, Team Champion, Division leaders?
Determine what you want to measure

41. Planning Stage Evaluate current process Consider the ideal system
Know the process in detail
Current protocols
Consider the ideal system
Best practice
Guidelines
Identify gaps between current and ideal state (target)
Discuss potential barriers
Why is the system the way it is?
Determine areas that would be most amendable to change

42. Using the 72 IHI Change Concepts for Improvement

44. QI Concepts are easy…Core areas for change

45. 5 W’s of what you plan to test
And what your prediction(s) will be

46. 5 W’s of your data collection

48. Moving from the AIM statement to PDSA (INTERACTIVE)
Fill out PLAN portion of your PDSA cycle

49. PDSA… ALL DAY

50. Recording what happened

51. PDSA… ALL DAY

52. Analyzing data

53. PDSA… ALL DAY

54. How do I proceed to the next step in my PDSA cycle

60. Plenty of success stories in our department!
Dr. Rogers – Glycemic control
Dr. Fleming – AMA discharges
Dr. Jens (I can never spell last name) – Several projects
Up an coming successes
Dr. Pizanis – ED – IM process improvement
Drs. Roesch and Lacey – IPASS
Dr. Davis - Sepsis

61. QI Concepts are easy… Boxes are Fluid

67. QI timeline for projects at UNM
Complete IHI AIM - Begin “Plan” portion of you PDSA cycle
You did this already – HURRAY!
Set up a meeting with your mentor – Continuing “Plan”
Goal of meeting with your mentor in next few weeks
Present at “Shark Tank” at next HTT meeting - Continue “Plan”
Show and tell of your projects
Complete “Q2/Quality Squared Form” - Start “Do” portion of PDSA
Receive data – Start “Study” portion of PDSA cycle
Analyze data and process – Start “Act” portion of PDSA cycle