1. Healthcare Quality Improvement Dr. Nishan Sharma nishan.sharma@ucalgary.ca University of Calgary, Canada March 2015 1

2. What is Quality Improvement? your ideas? 2

3. What is Quality Improvement? making things better everyone in healthcare making changes that will lead to better patient health and better system performance 3

4. Why do Quality Improvement? your ideas? 4

5. Why do Quality Improvement? make care safer, less harm to patients give patients and families better experience make care faster, less money, less waste 5

6. 6 1. Think about the change you want to make 2. Small cycles of change before you make a big change

7. 7 Most people start here - wrong Should start here

8. Goals for Workshop 1.Finding a good problem to solve 2.Making a good plan for change 8

9. Before You Start Making a Plan 1.Make sure your hospital or group wants to make a change 2.Make sure you have help (you cannot always do it yourself) 9

10. Step 1 – Writing your Problem Find a problem you want to solve There are lots of places to look for a problem: – What is a problem you see everyday? – What is a complaint your patient has, or you have? – Where do things take too long to happen? – What is an issue in your community? – What seems to work in other hospitals, but not your hospital? – Do you have any communication problems with your team, or your patients? – How are supplies being used, or where can waste be reduced? 10

11. Activity 1 – Write your Problem Divide into groups On the top of Worksheet 1, write down a problem you want to improve (My Example: “I want to lower infection rates”) – don’t make the problem too big – don’t try and make your idea perfect right now Pick one from your team, then we will talk about ideas (5 minutes) 11

12. Step 2 – Focusing your Problem the problem you wrote will be like the a mountain you want to climb for a big problem or a big mountain, you cannot climb all at once, or without a plan we will focus your problem so we can make a good plan 12

13. Your Ideas If you were going to go up a mountain, what are some things you need to think about? 13

14. Things to Think About If I was planning a trip up a mountain, I would think: – Who is going? – When am I going? – How long will it take? – What things will I need? – What path will I take? – What jobs will people have? 14

15. Focus Your Problem the Same Way Look at your problem from Activity 1, and add some details like that: – What do you want to improve? – Who do you want to improve it for? – Where do you want the change to happen? – By when do you want to see the change? – What change do you want to see? – Who is going to be helping? 15

16. My Example First, I had “I want to lower infection rates” Now – What do I want to improve: Infection rates – Who do I want to improve it for: Patients who stay overnight – Where do I want to see the change: In the maternity clinic – By when do I want the change to happen: In one month – What change do I want to see: I want to lower infection rates by half – Who is going to be helping: All staff in the ward 16

17. My Example First, I had “I want to lower infection rates” Now: “Staff in our clinic want to lower infection rates for patients admitted to our maternity ward by 50% by next month” This is called an Aim Statement 17

18. Activity 2: Write your Aim Statement Worksheet 1, Activity 2, create your Aim Statement, talk with your team (5 minutes) We will then talk about your Aim Statements 18

19. How PDSA Works Plan (P) – Do (D) – Study (S) – Act (A) cycles 1.look at your system, understand how it is working right now 2.making a small change 3.measure if change worked 4.planning the next change – then 1, 2, 3, 4 again, and again 19

20. Why make small changes? more confidence that change will be improvement find out which small change might make big difference don’t waste time or energy or money on big change and not know how it failed 20

21. Small changes lead to bigger changes 21 Try one small change, with one patient Same change, more patients More changes, all patients Make standard practice

22. Activity 3 – PDSA Game in your group, set up a system where you: – roll the ball off the table – have ball bounce one time, and – have ball land in the cup – we will see who can get most in a row you have 10 minutes we will then test and talk about it 22

23. Activity 3 – PDSA Game this game was PDSA cycles – big plan was to have ball go in many times – you planned your system – you saw how system worked (try one time) – you made one small change for each test (you did not try, then make a bunch of changes, then try again) – measured if it works – make another small change – tested until it worked 23

24. Plan now we are thinking of the small step, the first stage up that mountain pick one quick change you might make to get you to your goal – In my example infection rates can be reduced by better hand washing, or different way to clean room, or training the cleaners, or different cleaning products - pick one – you want to test each change on its own, so you know what actually made a difference 24

25. Plan in your plan for a small change, you need to know what success would look like, so you need to have research data – in my example, we would have to know the current infection rates to know if our change made a difference 25

26. Plan – My Example – What small change are you going to make? we are going clean the maternity clinic before and after each delivery – When are you going to do it we will change to this procedure next Tuesday – Who will do it? cleaning staff – How long are you going to do it for? We will do this for one month 26

27. Plan – My Example – Where will you do it? in our clinic – Who needs to know about it? All cleaning staff – Who is going to collect the research data? Nurses – How will the data be collected and shared? Track number of infections, post on staff or share in weekly meeting 27

28. Activity 4 – Detail Plan Fill out Worksheet 2 with details for your plan (10 minutes) – Discuss at your table if you like 28

29. Do we will talk about rest of PDSA cycle quickly Do – make your changes small! try with 1 patient, or 1 location, 1 day or 1 hour – it can take many tries to think that something might work, but it only takes one failure to know that it won’t – remember, small scale does not mean small change – do it by Tuesday – write down problems you have – look at your research data as you get it 29

30. Study what happened? what effects did your change have on your outcome? did outcome match plan? find out if change worked – did clinical outcome change? – observe the effect on the system – ask the people (provider, patients) questions 30

31. Act What permanent (small) change do you want to make? What other parts of the system will be affected by the change? Help people make the change, communicate – the change that was made – how to make the change – when to make the change 31

32. Your Feedback Please 1.What did you learn? What will you take away? 2.How can workshop be improved? 3.Any other comments 32