1. How to Design a Quality Improvement Project
Kendiss Olafson MD FRCPC MPH
Assistant Professor
Section of Critical Care
University of Manitoba

2. What is Quality Improvement?
Quality improvement is a formal approach to the analysis of performance and systematic approach to improving it.

3. Institute of Medicine To Err is Human (1999)
Brought issue of patient safety and medical errors to for front
2% of all deaths are due to preventable medical errors
Crossing the Quality Chasm (2001)
Urgently calls for changes to health care processes to improve quality of care
Sets up framework for healthcare quality improvement
Brings importance of patient and family centered healthcare to frontline

4. Quality Improvement versus Research
Traditional Research
Quality Improvement
Goal is to attain new generalizable knowledge
Trial new methods
Data for publishing
Goal to improve care
Based in established knowledge and applying this to local site
Data internal use (usually but not always)

5. How to Design a Quality Improvement Project
Identify Gap in Care

6. Quality of Care Indicators (STEEPS)
SAFE
Hospital Acquired Infections (VAP, C. Dificle, CLI, Post-op Infection)
Medication Errors
TIMELY
Waiting times (See specialist, start chemo)
EFFECTIVE
Patient Mortality
Organ Donation rates
ASA use post MI
EFFICIENT
Hospital LOS
Health care Costs
PATIENT-CENTERED (FAMILY CENTERED)
Patient/Family Satisfaction
STAFF WORKLOAD
Staff turnover and burn out

8. How to Design a Quality Improvement Project
Identify Gap in Care
Review Literature – Identify Evidence based practices

9. Use Pre-existing Bundles and Toolboxes

10. How to Design a Quality Improvement Project
Identify Gap in Care
Review Literature – Identify Evidence based practices
Quality Improvement Tools

11. Quality Improvement Strategies
Continuous Improvement (PDSA)
Total Quality Management
Six Sigma
Lean
Quality Improvement Tools
Process map
Cause-Effect Diagram
Pareto Chart
Control Charts
Scatter Diagram
Fishbone Diagram
Decision Matrix
Strategies and tools to help organize, analyze and impact change within a process

12. Develop protocols and Bundles of Care

13. Educate and Engage

14. Reminders and Forced Function
Antibiotic Auto-stop
Automatic orders
Surgical Checklists

15. Address Infrastructure
Workplace Design
Equipment
Human Resources
Audit
and
Feedback

16. How to Design a Quality Improvement Project
Identify Gap in Care
Review Literature – Identify Evidence based practices
Quality Improvement Tools
Measuring Impact

17. Quality Improvement Studies Challenges to Measuring Impact
Involves Healthcare Systems and Health Care Delivery Not just single intervention
Randomized Controlled trials of Health care systems
Multiple interventions are tested over time
Empiric Research with repeated measurements over time

18. Traditional Medical Research
Time Consuming
Expensive
Only One intervention tested
Measure
Outcome
Measure
Outcome
Measure
Differences in
Outcomes
Intervention
Data collection
Data collection
Time

19. Quality Improvement Model
HOW ?
Measure
Difference
Measure
Difference
Measure
Difference
Intervention
Intervention
Intervention
Data collection and Measuring Outcomes
Time

20. Statistical Process Control
Manufacturing
Process required to make a nut and bolt
Healthcare
Process required to make a sick person well
Statistical Process Control measures the variation associated with the outcome of a process

21. Statistical Process Control
Type of Illness
Severity of Illness
Co-morbidities
Demographics
Health Care Workers
Resources
Treatment given
Complications occurring
Variation in Outcomes
Process required to make a sick person well
Differentiate common cause variation from extraordinary variation
Goal is to optimize outcomes:
Identify extraordinary variation early and act on it
Limiting variation associated with a process

23. Creating a Quality Improvement Project
Identify Gap in Care
Review Literature – Identify Evidence based practices
Quality Improvement Tools
Measuring Impact