Introduction to Quality Improvement Essentials

This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.

1. Introduction to Quality Improvement

2. Learning Objectives Develop Develop a problem statement

3. Outline Problem Statement

4. Defining Quality (AHCRQ) 4

5. The gap between what we can do and what we actually do The “Know – Do Gap”

6. What We Know vs. What We Do Know–Do Gap What We Know

7. Where we are Vs. Where we should be Quality Gap Where we should be

8. Defining Quality Improvement QI is a systems approach that applies the scientific method to the analysis of performance and systematic efforts to improve it

9. Defining Quality Improvement CONT….. It requires a systematic, ongoing process that uses performance data to measure quality changes.

10. “The Science of Improvement” 10 - Adapted from Perla et al., 2013

11. Client Focus Team Approach Leadership Commitment Focus on Processes Systems Thinking Data Driven Continual Improvement Common Principles of QI

12. Establish a QI team Define the problem Set overall improvement priority Define measures and collect data Develop and test changes Measure change Continuous cycles Common QI Project Steps

13. Quality Improvement Tools Under- Standing the problem Prioritizing solutions Testing change ideas

14. Measure Change: Family of Indicators QI TOOL BOX APPROACH Understand Complexity of Quality Challenge: Rich Picture Develop Change Ideas: Driver Diagram Prioritize Problems and Solutions: Focusing Matrix Pareto Charts Find Root Causes: RCA Fishbone Diagram Process Map Translate Data into Information: Run Charts

15. The Model for Improvement AIM What are we trying to accomplish? MEASUREMENT How will we know if a change is an improvement? CHANGE What changes can we make to result in improvement? - Langley G, Nolan T, Norman C, Provost L (1996) The Improvement Guide

16. Performance Improvement Framework vs Plan-Do-Study-Act Cycle Plan Do Study & Act

17. Repeated Use of PDSA Cycle Changes that lead to improvement Wider-scale tests of change Small-scale tests of change Implementation at scale Data

18. End Goal National, Regional or International Accreditation Body The Stepwise Approach Score on On-Site Audit 55-64% 65-74% 75-84% 85-94% ≥95% Zero Stars One Star Two Stars Three Stars Four Stars Five Stars

19. Problem Statement Definition A clear and concise statement that describes the symptoms of a problem to be addressed Describes the scope and impact of a problem Generally, in c ludes a brie f des c ripti o n o f the problem as well as supporting data on: Where the problem is occurring Time frame Size of the problem T opic

20. The Problem Statement 20

21. Problem Statement Purpose Creates a sense of ownership for teams Serves as both an internal and external communication tool for QI teams Describes the “symptoms” in measurable terms Drives the Root Cause Analysis (RCA) process

22. Key Questions in Developing Problem Statement: Problem, Scope, and Impact Size/scope of the problem? Where is it happening? What is the time frame? What is the impact? 22

23. Problem Statement Does NOT include the causes Does NOT include the actions or corrections required Does NOT assign blame Does NOT address more than one problem

24. Do these include the key elements of a strong problem statement? Partner X does not meet their targets Waiting times are too long There are many errors in our data Partner Y’s reports are always late and incomplete because there is a lot of turn over in their staff 24

25. Example 1: High School Dropout “The high school dropout rate in our community has risen by 20% over the past two years, negatively impacting our future workforce”. Does this include the key elements of a strong problem statement?

26. Example 2: Low CTX Coverage “Over the past 2 years, only 50% of HIV- exposed infants at the 22 health facilities supported by implementing partner X were prescribed CTX by the time they were 6 weeks - old, leading to avoidable morbidity and mortality.” Does this include the key elements of a strong problem statement?

27. Questions?