Session for Introduction to Quality Improvement By Lisa

Session for Introduction to Quality Improvement, credit to Lisa

1. Fundamentals of
Quality
Improvement
Lisa Price, MD

2. Agenda
Why does quality matter?
Brief detour into history of quality
management
Principles of quality management and how
does it apply to the world of medicine

3. Why does quality matter?
Institute of Medicine 2000
CO + UT and NY studies–adverse events 2.9 and 3.7% of
hospitalizations
‘97 there were 33.6 mil admissions
Observed adverse events resulted in death 6.6 –13.6% of time.
Extrapolated 44,000 to 98,000 deaths every year due to medical
error
8
th
leading cause of death
Ahead of AIDS, breast cancer and MVA’s

4. Why does quality matter?
Population Health
Per capita costExperience of care
The Triple Aim=Survival

5. What is Quality?
qual-i-ty
An inherent or distinguishing
characteristic
A degree or grade of excellence

6. A Brief History of Quality
Management

Shewhart Deming Ohno

7. What are the principles of Quality
Management and how do they apply to the
world of medicine?

8. 1. Work is a series of processes.
supplier processor customer
Who is your customer?

9. 2. Strong supplier-customer relationships are
critical for good quality management

10. 3. The majority of quality failure is
due to a problem in the process.

11. Why Do Errors Occur?
Questions to Ask
Has this happened before?
Would another person have done the same thing?
Could this have been anticipated?
If “yes” to any of these = System Error
94% of errors belong to the system
Responsible people are necessary but not sufficient to
ensure quality in complex systems

12. 4. Poor quality is expensive.
2 types of quality improvement -improve features
and reduce defects
Defects/errors result in costs
Discarding defective product
Costly surveillance programs
Rework
Workarounds add complexity and not value
Dissatisfied customers result in loss of market share
Litigation

13. 5. Understanding process
variability is key.
True understanding of a process
Ability to separate out change in outcome due to
process change from “noise”
Unpredictable processes are inherently flawed

14. 6. Quality control should focus on
the most vital processes.
Creation of “robust” processes at critical steps
can dramatically improve quality.
Resources are finite. How do you identify
where to get the most “bang for your buck?”
Value stream mapping -documents steps in
a process, how long each takes, and
identifies waste

15. 7. Fundamentals of quality improvement
are basic scientific thinking.
Do
StudyAct
Plan

16. 8. Universal employee
involvement is critical.
Quality Committee Culture of Quality
Train all employees on basic quality methods and
empowering them to identify waste and create
solutions.
Steering committees
Project teams
Work done across departments and levels

17. Summary
Errors most often come not from workers but
systems. A culture of blame, shame and exhortations
to be “more careful” will not improve the system.
QI is a managerial science guided by theory, statistics
and psychology
It is the continuous search for small opportunities to
reduce waste, rework and unnecessary complexity
The greatest asset of any system is its human
thinkers, who with proper leadership can identify
these opportunities and act

18. Next Steps-QI In Action
1. Understand the problem
2. Identify areas of improvement
3. State the goal
4. Implement the change
5. Measure
6. Hold the gain and extend the improvement.

20. Health Care Problem Addressed
Names of Team Members

21. 1.Understanding the Problem
What do you already know about the problem?
What is the BUSINESS DRIVER behind the problem?
Are you aware of any data available about your problem?
What has been your experience with the problem?
Who are the stakeholders in this process?
Use a Cause-and-Effect Diagram to describe your problem in more detail

22. Cause-and-Effect diagram
Materials and Equipment People and management
Environment Process
Effect

23. 2.Identify Areas for Improvement
Looking back at your cause and effect diagram, what are
areas for improvement?
Which areas could result in the most change if improved?
What would the ideal process look like?

24. 3. Measuring progress
What are the metrics that can help you assess
improvement for your process?

25. 4. Explicitly State Your Goals
Remember: they should result in meaningful
improvement, they should be something that you really
could influence, and should be non-controversial.
State your goals in SMART format.
Specific
Measurable
Attainable
Relevant
Time-bound

26. 5. Effective Solutions
What are the solutions that can effect the
changes/improvement you are hoping to achieve?
Remember, usually more than one change is needed and
try to prioritize stronger intervention.

27. 6.Building on Success
How could improvement be sustained long term?