5-quality-improvement for patient safety.ppt

quality improvement for patient safety

1. PATIENT
SAFETY
Dr. Haitham El HadidyDr. Haitham El Hadidy
General ManagerGeneral Manager
School of Medicine – BUCSchool of Medicine – BUC
Doctorate degree in Hospital AdministrationDoctorate degree in Hospital Administration
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2. Using quality-improvement
methods to improve care

3. Introduction Introduction

4. To recognize that adverse events occur is not enough, we also have
to understand their causes and make the changes necessary to prevent
further harm.
■Most practitioners will be familiar with the term:
evidence-based practice,

5. ■Quality-improvement uses methodologies that are designed to:
 measure the features associated with an adverse event
 The components or the process of care that may result in an
adverse event, and
 The development and testing of appropriate solutions
It is more than counting the frequency of an adverse events

6. ■Patient safety requires deep
understanding of the processes of patient care,
as well as the ability to measure patient
outcomes and test whether the interventions
used to fix a problem were effective

7. To understand the role
of quality improvement

8. Asking and learning about tools that can be used to
improve patient safety;
Recognizing that good ideas can come from anyone;
Being aware that the local environment is a key factor in
the improvement process;
Being aware that the ways that people in the system think
and react are as important as the structures and
processes in place;

9. Edwards Deming, the father of improvement theory, described
the following four components of knowledge that underpin
improvement :
Appreciation of a system;
Understanding of variation;
The theory of knowledge; and
Psychology.

10. Appreciation of a system
We need to remember that most patient-care outcomes or services
involve complex systems of interactions between health-care
professionals, procedures and equipment, organizational
culture, and patients.
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11. Understanding variation
■Variation is the difference between two or more similar things,
(as different rates of success for appendectomies performed in two different
regions of a country) .
There is an extensive variation in health care, (and patient outcomes can
differ from one ward to another, from one hospital to another, from one region to another and from
one country to another).
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12. Common causes of variation

Shortages of personnel, equipment, drugs or beds

13. Theory of knowledge
■To predict that changes we make will lead to better results.
Experience in having written plans predicting what information they
will need to know.
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14. Psychology
It is importance to understand the psychology of how people interact
with each other and the system.
For example A medical ward in a hospital includes a number of people who will vary in their
reactions to a similar event, such as the introduction of an incident-monitoring system to track
adverse events.
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15. Improvement principles

16. The basic principles of quality improvement:
Patient focus,
Strong leadership,
Involvement of all team members,
The use of a process approach,
The use of a system approach,
Continual improvement,
A factual approach to decision making and
Relationships.

18. 1- What are we trying to accomplish?
■Asking this question helps focus the health-care team on the
areas they are concerned about improving or fixing.
■It is important that everyone on the team agrees that a problem
exists and that it is worthwhile to try and fix it.

19. ■Some examples are:
1- Do we all agree that the infection rate in patients who have had an
operations is too high? (do we have the figures indicating the high infection rate?)
2- Do we all agree that we need a better appointment system for the people
using the clinic? (are there complaints about the appointment system used at the clinic? )
3- Do we all agree that the way the drugs are stored to leads risks damage to
the drugs? (have any drugs stored been damaged in the last month?)

20. ■Health professionals will need to measure the outcomes in
question before and after the change to see whether the actions
the team took made a difference. The improvement can be
confirmed when the collected data show that the situation has
improved over time.
■This involves the team testing the different interventions they
have designed and implemented.
2- How will we know that a change has resulted in
an improvement?

21. When beginning
an improvement project

22. A team needs to be established
Set out the aims and objectives of the improvement process
Establish how it will measure the changes
Select the changes to be made
Test the changes
Implement the changes
Spread the changes

23. The role of measurement in
improvement

24. There are three main types of measures used in improvement:
Outcome measures;
Process measures; and
Balancing measures.

25. Outcome measures
Some specific examples include:
adverse events Frequency ,
Access: waiting time for appointments and examinations;
Critical care: (number of deaths in the emergency department or the number of deaths due to
postpartum haemorrhage or);
Medication systems: the number of medication dosing or administration errors
that occurred.

26. Process measures
Some specific examples:
■Surgical care: number of times swab count completed;
■Drug administration: delays in administration of drugs, taking into account
factors affecting the prescribing, dispensing and administration of the drug;
■Delays in transfer.
■Access: number of days the ICU is full and has no spare beds.
Process measures refer to measurements of the workings of a system.

27. Balancing measures
■These measures are used to ensure that any change does not create
additional problems. They are used to examine the service or organization
from a different perspective.
An example of a balancing
•Making sure that efforts to reduce the length of stay in hospital for a
particular group of patients do not lead to increased readmission rates for
those patients caused by patients not knowing how to appropriately care for
themselves.

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