Rapid Cycle Quality
Improvement
Course Outline
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The Quality Journey
Rapid Cycle Improvement Model
Change Concepts
Teams
Tools
Barrier Busters
1
Group’s Prior Experience with
Quality Improvement
Participant Survey Results
Very Little
1-2 yrs
3-5 yrs
5-10 yrs
10+yrs
2
What is Quality?
Quality is a never-ending
cycle of continuous
improvement.
-Deming
3
Quality Alphabet Soup
C
P
A
C
D
Q
PI
I
PD
SA
M
Q
T
QI R
CQ
I
QA
IO
P
4
Group’s Tools for Quality
Improvement
Participant Survey Results
5
Quality Improvement Program
Vision, Goals, Objectives
Quality Indicators – Monitoring
Quality Project
Continuous Improvements
Solve Problems
Change Systems
Sentinel Events
6
The Quality Journey
Quality Assurance
Quality Improvement
Rapid Cycle Quality Improvement
7
QA vs. QI
Quality Assurance
 Conform to
standards
 Relies on
inspection
 Focus on items
 Quality is separate
function
 Departmental
function
Quality Improvement
 Improved
performance
 Monitor over time
 System orientation
 Quality integrated
in organization
 Interdisciplinary
function
8
Malcolm Baldrige
National Quality Award
P a tie n t / C u s to m e r a n d H e a lth C a re
M a rk e t F o c u s e d S tra te g y a n d A c tio n P la n s
2
5
S trategic
P lanning
S taff
Foc us
7
1
O rganiz ational
P erform anc e
R es ults
Leadership
3
6
Foc us on P atients ,
O ther C us tom ers ,
and Markets
P roc ess
Management
4
Information and A naly sis
9
PDSA Cycle
10
AIM Statement
What are we trying to accomplish?
 The Aim
Statement articulates the
goals, guides the improvement effort,
and keeps the team focused.
Specific
Measurable
Challenging
11
Measurement
How will we know that a change is an
improvement?
 What
to measure - what will be
different?
 What are the guidelines
12
Cycles of Improvement
What changes can we make that will
result in an improvement?
 It’s your opportunity to brainstorm:
Possible changes
People that are needed
Required resources
Potential for collaboration
Necessary leadership support
13
Cycles of Improvement
Continuous improvements of
multiple changes.
PD
PD
PD
PD
SA
SA
Change 1
SA
SA
PD
PD
PD
PD
SA
SA
Change 2
SA
SA
PD
PD
PD
PD
SA
SA
SA
SA
Change 3
14
Rapid Cycle Improvement
Model
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in an improvement?
Cycle 1
Cycle 2
Cycle 3
15
Potential EMSC Monitors:

Timely management
 Wait time to see an MD in the ER
 Time to initiate antibiotics in fever management
 Use of an intraosseous line when needed
 Transfer within 2 hours when appropriate

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
Use of the Broselow, or similar, system
Pain management in the non verbal child
Asthma management
 Obtaining a patient height
 Peak flow measurement
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Abuse recognition
Provision of injury prevention education
16
What Quality Improvement
activities are you working on at
your hospital?
Participant Survey Results
17
An Example of Rapid Cycle
Planning
Where do we begin?
18
Change Concepts
 Change
concepts are generic ideas that
can be applied to your situation to spark
an idea for a specific change in your
situation
 Not all change concepts apply to all aims
 Brainstorm ways to apply these concepts
to the problem at hand
19
Change Concepts
 Enhance
the Producer /Customer
relationship
 Listen to patients
 Coach customers to use product/service
 Reach agreement on expectations
 Mass
customize services to patient
20
Change Concepts
 Change
the work environment
 Reduce demotivating aspects
 Implement cross training
 Clarify roles & expectations
 Improve
work flow
 Synchronize
 Find and remove bottlenecks
 Do tasks in parallel
 Adjust to peak demand
21
Change Concepts
 Manage
Time
 Reduce the setup or startup time
 Optimize maintenance
 Reduce wait time
 Manage
Variation
 Eliminate waste
 Reduce or eliminate overkill
 Recycle or reuse
22
Change Concepts
 Optimize
inventory
 Match inventory to demand
 Use pull systems - proactive
 Reduce multiple brands

Design systems to avoid mistakes
 Use reminders
 Use differentiation
 Use constraints
 Minimize handoffs
23
Team

Composition
 Sponsor
 Leader
 Team member(s)
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Helpful hints
 Be Multidisciplinary
 Assure available
leadership
 Include hands-on
expertise & variety of
skills, e.g. computer skills
 Recognize progress
 Clarify roles &
responsibilities
 Handle conflict
constructively
 Maintain core group for
consistency
24
Essential Tools

Meeting Agenda (every meeting)
 Meeting Summary (every meeting)
 Project Work plan (create 1, post & update)
 Project Report Form (Internal - External)
25
Other Helpful Tools
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Brainstorming
Run Charts
Flow Charts
Cause & Effect Diagram
Pareto Diagram
Nominal Group Technique
Force Field Analysis
 Refer to Section 12 - Tab “QI Tools & Techniques”
26
Example – Run Chart
Self Administered Med Project
DRG 372 & 373
Percent of Pts Receiving Medication
50.0%
46%
45.0%
40.0%
44%
42%
41%
38%
Percent of Pts
35.0%
37%
35%
34%
33%
34%
32%
30.0%
30%
29%
26%
25.0%
23%
22%
20.0%
22%
22%
21%
21%
24%
25%
19%
16% 17%
15.0%
15%
15%
15%
13%
13%
12%
10.0%
11% 11%
10%
8%
8%
5.0%
24%
23%
6%
5%
7% 7% 7%
6% 5% 5% 5%
3%
2%
7%
5%
6%
6%
3%
0.0%
Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun99
99
99
99
99
99
00
00
00
00
00
00
Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun00
00
00
00
00
00
01
01
01
01
01
01
Jul- Aug- Sep01
01
01
Month
% Pts Rec'd Darvocet
% Pts Rec'd Tylenol 3
27
Example – Control Chart
Self Administered Med Project
DRG 372 & 373
Percent of Pts Receiving Darvocet
Pre Project
Project Implemented
60%
Percent of Pts
Mean: 39.4%
40%
Mean: 23.8%
20%
0%
28
Barrier Busters
 Barrier
- Problems with Setting an Aim
Is there sponsorship for the project?
Does project fit with organizational
mission?
Does project conflict with our values?
Is Aim Statement clear and precise?
29
Barrier Busters
 Barrier
- Problems with Teams
Is your leader available and empowered?
Are you meeting weekly?
Does everyone know their responsibilities?
If you have conflicts, who can you request
to facilitate your team?
30
Barrier Busters
 Barrier
- Problems with Resources
Suggestions:
Keep your team small at first
Use volunteers and champions
Collect just enough data
Set a dedicated meeting time
Huddle if needed (15 minutes is all you need!)
Involve senior leadership if resources are a
problem
31
Barrier Busters
Barrier - Resistance :
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“No one thinks there is a problem”
 Take the high ground...
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“We are different”
 Share information and challenge assumptions...
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“It’s too difficult”
 Look at others (internally & externally) that have successfully
made a change
 Break ideas for change into small components
 Present changes as a “test” - that can be accepted, refined, or
abandoned
 Use just enough data
 Post results of the small test from the outset as proof that it can
happen
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Engage senior leadership - it is a must
32
Resistance – How people
respond to change…
– 2.5%
 Early Adopters – 13.5%
 Early Majority – 34%
 Late Majority – 34%
 Laggards – 15%
 Innovators
33
Barrier Busters
 Barrier
- Problems with Ownership
Be sure to include all impacted areas
Collaborate with staff at all levels
Involve the people that DO the work
Find champions in several disciplines
Keep sponsors informed and involved
34
Next Steps: Action List
 What
is one problem in your work
setting where you think Rapid Cycle
Quality Improvement would help you?
 What is one thing that you can do by
next Tuesday?
35
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Rapid Cycle Quality Improvement