1. Chapter 1 Introducing Quality Improvement

2. Chapter 1: Introducing Quality Improvement
S.A.F.E uses quality improvement (QI) as a core methodology. This chapter will focus on understand QI methods.

3. Resources Plan Do Study Act Checklist and Log Driver Diagram
Measurement Plan
Stakeholder Map

4. Domains of Quality CROSSING THE QUALITY CHASM: A New Health System for the 21st Century INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS
Person centred
What matters to me
Safe
Do we harm patients?
Effective
Do we give the right treatment every time all the time?
Equitable
Are the services and outcomes equal for all
Timely
Is there good access?
Efficient
Do we get value?

5. What is Quality Improvement?
Quality Improvement can be defined as the:
“combined and unceasing efforts of everyone – healthcare professionals, patients and their families, researchers, payers, planners and educators – to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development”
Batalden and Davidoff

6. Deming’s Profound Knowledge
System where you work
Variation in the system
Psychology - the people
Theory of knowledge
One needs to understand the system in which one works – usually called the clinical micro system.
Variation within processes is the major problem and one needs to study what is good variation and what is unneeded variation
People make up systems and one should look at the beliefs and attitudes which drives behaviours
Finally the theory of knowledge is the change methodology one uses.
Deming

7. Microsystems Staff Patients Performance Leadership Strong Leadership
Great Organizational Support
Focus on Staff (Professionals)
Education and Training of Staff
Interdependence of Care Team
Performance Result Focused
Process Improvement Focused
Patient-Centered (Patient Focus)
Community and Market Focus
Information & Information Technology Orientation
Reference Nelson et al 2008
The Clinical Micro-system is where improvement occurs – the doctor, nurse and patient or the ward or the clinical team.
One needs clinical leadership to drive improvement, staff engagement and ownership of the problem to be solved
One also needs to measure one’s performance so one can continually improve.
Reference Dartmouth

8. Theory to method to measurement
Systems
Variation
Psychology
Theory of knowledge
Theory
Method
Measure
The interaction between theory method and measurement

9. The Model for Improvement
What are we trying to accomplish?
How will we know if the change is improvement?
What changes can we make that will result in improvement?
Plan Do
Study
Act

10. Change in the Microsystem
The individual
Clinical skills
Self management
Personal development
Clinical Micro system
Individual team and patient
Where improvement takes place
Meso system
Supports micro system
Macro organisation
Connects meso systems and micro systems
Network district regional
Whole patient journey
Across organisations

11. 5 Ps to Assess Improvement in a Microsystem
Purpose - Our aim and mission.
Patients - Our reason for doing our work.
People - Our staff who take care of patients.
Processes - Our interrelated process that make up the micro system.
Patterns – The way we work and measure what we do (Measurements, Data, Run Charts)
The 5 Ps allows for the assessment of how a microsystem is functioning
Reference Dartmouth

12. What change can we make that will result in an improvement ?
Model for Improvement
What change can we make that will result in an improvement ?
The PDSA Cycle
The PDSA cycle allows for the testing of ideas one patient at a time
Langley Nolan et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2nd Edition April 2009, Jossey-Bass
P 89

13. Where to start? Implement changes Test changes Establish measures
Define area for change
Set aims
Establish measures
Test changes
Implement changes

14. S.A.F.E Driver Diagram

15. PDSA Paper Aeroplane Activity
Quality Improvement in Action
Aim: Design a paper plan that will fly the furthest distance
Think of the areas you need to consider:
Design
Construction
Measurement
Run your tests a few times:
What are you learning?
How will you factor your learning into the next test?
Did your change result in improvement ?

16. Spreading Change through Collaboration
The success of S.A.F.E has been in establishing, encouraging, and supporting networks to share learning, experiences, and ultimately, change. What networks can you engage with to help spread your improvements?