Presentation on theme: "Performance Improvement Team Handbook"— Presentation transcript:
1 Performance Improvement Team Handbook Developed by Southeast Georgia Health SystemQuality Management Department
2 IntroductionCongratulations! You all have been selected as members in a new PI team. The most critical task for any new team is to establish its purpose, process and measures of team progress. Once these are established, they should be posted at each team meeting for reference.Many teams enjoy terrific starts and then soon fizzle. The real challenge is to keep a team focused on its purpose.We use the PDCA model for PI teams and we are introducing the Rapid Performance Improvement (RPI) Methodology.Teams make improvements related to the six aims: safe, effective, patient centered, timely, efficient and equitable. As a result clinicians experience greater satisfaction at being able to better do their jobs and bring improved health to those who receive their care.
3 Teams Utilize the PDCA Methodology P: Plan the improvementD: Do the data collection needed, implement the modified or new processC: Check the data for improvementA: Act to sustain the improvementTeams follow certain methodology: PDCAP: Plan the improvementD: Do the data collection needed, implement the modified or new processC: Check the data for improvementA: Act to sustain the improvement
4 The PDCA cycle for learning and improvement ActPlanObjectiveQuestions andpredictions (why)Plan to carry out the cycle(who, what, where, when)What changesare to be made?Next cycle?CheckDoComplete theanalysis of the dataCompare data topredictionsSummarize whatwas learnedCarry out the planDocument problemsand unexpectedobservationsBegin analysis ofthe data
5 Principles of PDCA Cycles Use shorter cycles of changes to accelerate rate of improvementsmall scale tests (“What can you test by next Tuesday”)just collect enough informationCreate flow of ideas, then emphasize implementationincrease the frequency of testsincrease the belief that the change will result in improvement and minimize resistance upon implementationAdoption of existing knowledge (‘not more research but more application of existing knowledge’)‘Steal shamelessly, Share senselessly’Promote peer learningToyota: 80 improvements per employee; US hospital: 0.5 improvement per employeeelectronic interchange of improvement learning (IHI-Extranet; Kaiser Permanente-Learning Link; VHA Improvement Exchange)
6 Tips for PDCA Cycles - formulate question and predict results - test first in ‘safe zones’ (with team members, volunteers)- ‘Just-do-it’ mentalitycollect useful just enough data, not perfect datathink a couple of cycles aheadscale down size of test (# of patients, clinics)be innovative to make test feasibleExample: Improve decision support by using a standard based flowsheet- adapt flowsheet with one pt- revise flowsheet and test with Dr. 1 pts on Monday- present flowsheet to all MDs- revise and test for one week- implement and monitor standards
7 Smaller Scale Tests: Scale Down Timeframe YearsQuartersMonthsWeeksDaysHoursMinutesReduce your timeframe to plan Test Cycle!When you’re in your meeting, listen for a time frame. Move down two levels to do a test. This formula helps people rethink the time frame.If you hear quarters…Ask what test can we do by the end of next week?If you hear weeks, what can do in the next hours. You won’t get the change all tested but gets people moving.
8 New Teams may utilize the Rapid Performance Improvement (RPI) Methodology Rapid Performance Improvement (RPI) Methodology, a practical performance-based process improvement approach. The sequence of steps involved is:Document the goals and problems to be addressedCurrent performance is documentedPractices are compared to best practice and “gaps” are identifiedGaps are prioritized and a revised process is developed to achieve these objectivesThe revised processes are deployed to the target groups and results are monitoredPerformance and process adherence are assessed to determine the level of success. The resulting new practices become the target groups’ current performance and the cycle is repeated.We are introducing a new methodology:Rapid Performance Improvement (RPI) Methodology, which is a practical performance-based process improvement approach. The sequence of steps involved is:Document the goals and problems to be addressedDocument Current performanceCompare practices to best practice and identify“gaps”Prioritize Gaps and develop a revised process to achieve these objectivesThe revised processes are disseminated to the target groups and results are monitoredAssess performance and process adherence to determine the level of success. The resulting new practices become the target groups’ current performance and the cycle is repeated.
9 Rapid Performance Improvement (RPI) Methodology Tools Gap Analysis:Current PerformanceBest PracticeGaps IdentifiedGap Prioritization:Gap Identified DescriptionSeverity RatingProbability RatingDetectability RatingHazard Scorepriority numberSeverity: = No Harm; 2 = Temporary Harm; 3 =Permanent Harm; 4 Death/major loss of functionProbability: = Remote; 2 = Uncommon; 3 = Occasional; 4 = FrequentDetectability: 1 = Very Likely; 2 = Likely; 3 = Unlikely; 4 = Very UnlikelyHazard Score: Risk Priority Number (RPN = Severity x Probability x Detectability)
10 Team RolesAll members except the facilitator are active team members even though they may have additional roles.
11 Team Roles Team Member Team Leader Recorder Timekeeper Facilitator Members are chosen because they work in, have knowledge of that is the focus of the team. or receive benefit of the process that is the focus of the team. They share responsibility for the effectiveness of the team.Contribute ideasMake decisionsPlan future workSupport collaborationCollect and analyze dataTeam LeaderThe leader is generally the person who is recognized as the owner of the process that is the focus of the team.Works with the facilitator to develop a plan for the teamCoordinates and directs the work of the teamManages the meeting processRecorderRecorder can be assigned or rotated to help the team maintain a record of its work.Records on flipchart when neededTakes minutesTimekeeperTimekeeper can be assigned or rotated to help the team manage time.Helps the team determine how it wants to be informed about the timeCalls out the time remaining on agenda items or at designated intervals decided by the team.FacilitatorFacilitator is a team advisor who monitors and helps team members keep their interactions positive and productive.Works with the team in developing plansProvides feedback to the team to keep them on trackAssists in interpretation of dataAssists in maintaining efficiency
12 Team Rules Keep an open mind Listen and understand what is said Avoid side conversationsRespect other’s opinionsAvoid personal agendasCome prepared to do what’s good for the health systemComplete assignmentsFollow up on action itemsNo idea is a bad ideaBe creativeTake risksNo criticism allowedStart on timeEnd on timeParticipate!Have fun!
13 Brainstorming Activity Generate ideasUse games and exercises to “warm up” your creative thinkingWhen ideas slow down, try another exercise to generate fresh ideasBreaking into smaller groups may be helpfulUse a computer or flip chart to capture every comment/idea
14 Set SMART Goals Goals are SpecificMeasurableAchievableRealisticTime-phasedSet goals: realistic, reasonable, challenging, attainable goalsLong-termIntermediate-termShort-term
15 Using Data Identify why we are collecting the data JCAHO PI.1.1, DHR, CMSWhat are we going to do with it?Always define dataAsk yourself if the data is complete or do we need additional informationWhen using data, define targets and benchmarks. Identify those benchmarks on the graphic displays.Remember: Data is not information until it has been interpreted!
16 Statistical TermsMean-sum of quantities/number of quantities (the average)Median-middle value when all data points are arranged numerically; used a lot of times as the middle line in run charts because it requires no calculationMode-the most frequently occurring valueStandard deviation-measure of the spread of a distributionControl limit-an expected limit of common-cause variation referred to as either an upper or lower limit. Limits are calculated from process dataVariation-the inevitable difference among individual outputs of a process. The sources of variation can be grouped into two major classes: Common Causes and Special Causes.
17 Performance Improvement Tools Flowcharts are available in Powerpoint and QI Macros in Excel.Oval represents the beginning or ending of a processRectangle represents an action step in the process.Diamond represents a decision step.Arrows represent the direction of the process flow.
18 Performance Improvement Tools Tree DiagramRun ChartHistogramPareto ChartTools are available in QI Macros in Excel
19 Performance Improvement Tools Failure Modes and Effects AnalysisScatter Diagram and Probability PlotComparison MatrixRelationship DiagramTools are available in QI Macros in Excel
20 Plans of Action Develop programs/methods/plans of action: The requirements for achieving set goals.Who will do which part.How the different parts tie together.Determine the phases of the action planIdentify a representative that will be responsible for each phase.Determine the beginning, middle, and end of each phase.Determine benchmarks to measure strengths and areas of improvement
22 ReferencesMoen, Ronald, Thomas Nolan; “Process Improvement” Quality Progress, 1987, p62Langley, Gerald, Kevin Nolan and Thomas Nolan; “The Foundation of Improvement,” Quality Progress, June 1994, p. 81Langley, Gerald, Kevin Nolan, Thomas Nolan, Cliff Norman, and Lloyd Provost; “The Improvement Guide” San Francisco, CA; Jossey-Bass, 1996Nolan, Kevin; “ASQs Accelerating Change Collaborative Series: A Challenge for Industry,” Quality Progress, Jan 1999, p552006 Hospital Accreditation Standards. Joint Comission on Accreditation of Healthcare OrganizationsQI Macros Training Manual. Lifestar