Chapter 3 Quality Improvment Models _Basic final.pptx

Chapter 3 Quality Improvment Models _Basic final.pptxChapter 3 Quality Improvment Models _Basic final.pptx

1. Quality Improvement Models Chapter 3 QI Training 1 12 January 2024

2. Enabling Objectives By the end of this session, participants will be able to: Discuss the rational for using quality improvement models Identify some commonly used quality improvement models in Health care setting. Describe quality improvement models adopted in Ethiopia Explain application of the adopted models. 12 January 2024 QI Training 2

3. Outline Introduction Why are QI models used? Commonly used QI models in Health care setting Quality improvement models in Ethiopia and their application Summary 12 January 2024 QI Training 3

4. Larger group discussions Reflection questions Why are quality improvement (QI) models used? What are some commonly used QI models in healthcare? List the QI models approved in Ethiopia? Time: 10 minutes 12 January 2024 QI Training 4

5. Why are QI Models used? A re frameworks or roadmaps used to organize the work of improvement initiatives or activities They encourage planning based on theory They empower people in the organization/facility to take action They facilitate use of team work emphasize and encourage interactive learning 12 January 2024 QI Training 5

6. Commonly used QI Models in HC Kaizen Model for Improvement 12 January 2024 QI Training 6

7. Six Sigma Challenge Lean Lean Six Sigma SBM-R Commonly used QI Models in HC (Cont’d) 12 January 2024 QI Training 7

8. Small Group Exercise In a group made up of 4 to 6 participants Discuss among yourselves the QI models you have used Have you applied QI models to develop and execute Improvement project? What was the aim of the project? What lessons did you learn? Time: 5 minutes discussion 12 January 2024 QI Training 8

9. Commonly Used QI Models (… Cont’d) Several overlapping and complementary QI models exist All stem from Science of Improvement Starts with an aim Develops innovative ideas and tests towards improvement Some provide framework to improve patient care Care Model Lean Model Some focus on processes that monitor the results of measures Six Sigma Model FADE (Focus, Analyze, Develop, Execute) MFI (Model for Improvement) 12 January 2024 QI Training 9

10. KAIZEN’S 5S Methodology MODEL FOR IMPROVEMENT None is superior over the other “They all have an essentially similar set of QI ideas and methods under different names and terminology with a different approach of implementation.” Ethiopian NHQSS-II QI Models – Ethiopian Context 12 January 2024 QI Training 10

11. Reflection Question Why Ethiopia Selected the two models? 12 January 2024 QI Training 11

12. KAIZEN’S 5S Methodology 12 January 2024 QI Training 12

13. KAIZEN’S 5S Methodology Japanese English Definition Muri Irrational burden or overburden Any activities imposing irrational, unreasonable and unnecessary stress of efforts from personnel, material or equipment. Muri leads to huge mental or physical burden. Muda Waste of time and other resources “Seven wastes”: overproduction, inventory (overstock or redundancy), transportation (unnecessary movement), motion (Unnecessary time to look for staff and goods, rework (due to avoidable errors), over-processing (due to misallocation of resources) and waiting (for items and tools to produce and deliver goods and services) Mura Irregularities or inconsistency Any variations leading to unbalanced situation. When workflow is out of balance and workload is inconsistent and does not comply with the standards, Mura emerges. 12 January 2024 QI Training 13

14. KAIZEN Contd.. Guiding principles Good processes bring good results. Go see for yourself to grasp the current situation. Speak with data, manage by facts. Take action to contain and correct root causes of problems. Work as a team. It is everybody’s business. 12 January 2024 QI Training 14

15. Kaizen’s 5S Framework Way of organizing and managing the workspace and work flow with the intent to improve efficiency of work by eliminating waste improve the work environment and efficiency Preventing Errors 12 January 2024 QI Training 15

16. Individual Exercise Instruction Instruction: You have 60 seconds to circle or strike out the numbers 1 to 49 in sequential order (e.g.: 1, 2, 3, …) The facilitator will tell you when to start and when the 60 seconds is over s/he will ask you to stop. Each sheet/page is to be faced down until you are told to turn/flip to a particular page. Each person should be prepared to call out his/her score at the end of each exercise. Annex: Module 3: KAIZEN 5S Exercise Time: 5 minutes (1 minute per page) + 15 minutes discussion 12 January 2024 QI Training 16

17. Sample of Sheet/Page 1 12 January 2024 QI Training 17

18. Sample of Sheet/Page 2 12 January 2024 QI Training 18

19. Sample of Sheet/Page 3 12 January 2024 QI Training 19

20. Sample of Sheet/Page 4 12 January 2024 QI Training 20

21. Sample of Sheet/Page 5 12 January 2024 QI Training 21

22. Reflection Questions What difference did you notice between sheets/pages 1 and 2? What difference did you notice between sheets/pages 2 and 3? What difference did you notice between sheets/pages 3 and 4? What difference did you notice between sheets/pages 4 and 5? 12 January 2024 QI Training 22

23. SORT (SEIRI )- remove unused stuff (unnecessary / may or may not be necessary / necessary) SET (SEITON )- proper orderliness SHINE (SEISO) – cleanliness STANDARDIZE (SEIKETSU) - set up norms & equalization SUSTAIN (SHITSUKE) – consistent practice of 5S KAIZEN: 5S as an entry point for all QI 12 January 2024 QI Training 23

24. 5S….. Sort (seri): Remove unused stuff from working place by: Categorizing and color code the items. Have criteria for discarding. Developing inventory list for all categorized items. Storing (keep) “may be needed” items. Regularly sorting of unused items. Developing culture of returning items to where they belong. 12 January 2024 QI Training 24

25. 5S…. Set in order (seiton): organize all necessary items in proper order for easy services provision (proper orderliness) by: Have a consensus where items should be kept Consider work flow while arranging items Organizing cabinets with labeling/numbering. Keeping items at their respective areas and label them accordingly. Directional arrows leading to services areas. Labeling of service rooms. Updating stock/equipment inventories. 12 January 2024 QI Training 25

26. 5S…….Shine (seiso): Maintain high standards of cleanness. Everyone should participate Routine cleaning campaign - Daily, weekly, monthly and quarterly “Shine” time schedule. Clean not only the place that comes into your view but also behind, under furniture or equipment. Clean and attractive environment will be appreciated by internal and external clients. Cleaning tools, cleaning tool renewal, tool storage, space arrangement and provision better uniform for cleaning staff are also important particularly for the cleaners. 12 January 2024 QI Training 26

27. 5S……Standardize (seiketsu): The first three components set the stage for the facility to develop and implement standard operating procedure to maintain good working environment. Set up the sort, set and shine as a norm in every section of the health facility. Work instruction. Standard operating procedures (SOPs). Standard and regulation for both administrative and technical staff. 12 January 2024 QI Training 27

28. 5S ….. Sustain (shitsuke): Train and maintain discipline of the health care workers engaged (consistent practice of 5S). To train and maintain discipline of the health workers engaged. Apply regular self-assessment. 12 January 2024 QI Training 28

29. Importance of 5S The workplace gets cleaned and better organized. Facility system become easier and safer Mistakes and risks will be reduced Results are visible to everyone Visible results enhance the generation of more and new ideas. People will be proud about their clean and organized workplace Create a positive attitude for improvement of quality among frontline workforces. 12 January 2024 QI Training 29

30. Example of 5S activities in Medical Records Room Before 5S After 5S Source: Dialah Clinic, Nimba County, Liberia 12 January 2024 QI Training 30

31. Before 5 S Application After 5 S application Health Center 12 January 2024 QI Training 31

32. MCH Mini Store BEFORE After 12 January 2024 QI Training 32

33. Recognition and encouragement Practice 5S at selected unit conduct facility assessment and selection target area(s) for 5S Regular monitoring & evaluation Staff training on 5S Train QIT on 5S Advocacy with health facility managers Refresher trainings Share progress of 5S activities to other areas Prepare INTRODUCE IMPLEMENT SUSTAIN How Can You Implement 5S in Your Facility Share progress of 5S activities to other areas IMPLEMENT Standardize activities and regularly monitoring Share progress of 5S activities to other areas IMPLEMENT Standardize activities and regularly monitoring 12 January 2024 QI Training 33

34. 5S Tools These are tools needed to apply the 5S practice Red tag Useful for “S1” when you cannot decide whether an item is “necessary” or “not necessary” Alignment Useful for S2 “SET” activities. It is useful for organizing files, and equipment in order to improve orderliness and beautification 12 January 2024 QI Training 34

35. 5S Tools Contd.. Labeling Useful for S2 “SET” activity. It is useful to reduce time wasted looking for necessary items Color coding Useful for S2 “SET” activities. It is for clear identification of items. It is useful to increase productivity and mistake proofing . 12 January 2024 QI Training 35

36. 5S Tools Contd.. Numbering/alphabetical coding Useful for S2 “SET” activities. This is to organize files and other items numerically or alphabetically. It helps users to find necessary items quickly and for practicing the “Can See-Can Take Out – Can Return” principle. Zone Useful for S2 “SET” and S4 “STANDARDIZE” activities. It is dedicate a specific area for specific item. It shortens the time lapsed looking for necessary items thereby increasing productivity. 12 January 2024 QI Training 36

37. 5S Tools Contd.. Safety signs Useful for S2 “SET” and S4 “STANDARDISE” activities. It is notify the presence of hazardous item or material. It is useful to assure safety of staff, clients and family. Sign board Useful for S2 “SET”” activity. Putting clear and informative signs to direct to easily find the clients and staff to service area or places they want to go. It increases productivity by creating a modality for an easy communication. 12 January 2024 QI Training 37

38. 5S Tools Contd.. Symbol Useful for S2 “SET” activities. Putting marks or symbols to communicate visually. XY axis on notice board Useful for S2 “SET” and S4 “STANDARDIZE” activities. Useful to keep orderliness and arrangement of posters and papers on notice board. 12 January 2024 QI Training 38

39. 5S Tools Contd.. Symbol Useful for S2 “SET” activities. Putting marks or symbols to communicate visually. XY axis on notice board Useful for S2 “SET” and S4 “STANDARDIZE” activities. Useful to keep orderliness and arrangement of posters and papers on notice board. 12 January 2024 QI Training 39

40. Group Exercise GROUP EXERCISE Discuss the finding from your assessment of department/unit’s work area using 5S audit checklist Time: 15 minutes discussion 12 January 2024 QI Training 40

41. Model For Improvement The model comprises three basic questions and a fourth element that describes a PDSA cycle for testing innovations The four simple steps are: Set aims Find promising ideas for change Define measurements and Test those ideas/changes on a small scale in real work settings 12 January 2024 QI Training 41

42. MFI-Driving all QI initiatives Components of Model for Improvement 1. Three Fundamental Questions What are we trying to accomplish? What changes can we make that will result in an improvement? How will we know that a change is an improvement? 2. PDSA cycle Framework for an efficient trial-and-learning methodology Used for Learning Developing a change Testing a change Implementing a change 12 January 2024 QI Training 42

43. Summary Different QI models exist but all with the same concepts. Ethiopia had adopted two of the QI models: Kaizen’s 5S methodology: an entry point for all QI activities. Model for Improvement: key tool providing structure for QI initiatives. Small scale, multiple and rapid tests of changes are at the heart of Model for Improvement that leads to process improvement 12 January 2024 QI Training 43

44. Thank you! 12 January 2024 QI Training 44