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QI requirement and Application Methodology-I

QI requirement and Application Methodology-I. Venkata Giri Andukuri , MD, MPH Assistant Professor Department of Medicine Creighton University. Why QI?. “If you can't describe what you are doing as a process, you don't know what you're doing” - Edward Deming

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QI requirement and Application Methodology-I

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  1. QI requirement and ApplicationMethodology-I VenkataGiriAndukuri, MD, MPH Assistant Professor Department of Medicine Creighton University

  2. Why QI? “If you can't describe what you are doing as a process, you don't know what you're doing” - Edward Deming • US Healthcare economics • Patient Safety • Systems improvement • You • ACGME/CLER

  3. IM QI Project Requirements • Every resident has to participate “meaningfully” in at least one QI project each year of their residency • All projects are to be submitted to the QI champion of the department • Every project needs to have a mentor from the IM department, can have more than one mentor • Meaningful- AIM, Baseline measurement, PDSA, repeat measurement • You can have the same project for all 3 years with 3 separate iterations of improvement • Present the full cycle of improvement in April of each year • If Teams are working together then the roles are defined and all the meetings are attended and can work on a PDSA together and needs approval of the QI champion

  4. Inter-dept Future Interest and novel ideas Incident reports and M&Ms Based on system needs QI champion in the department Core faculty Mentor QI Chief resident/fellow Will include interested residents and students Rotation and curriculum Residents, Fellows and Students Department dashboard GME/ QI lead Resource Assessment by QI champions committee, GME and CMO Submit on the online CHI QI portal- common dashboard Shark Tank committee- Leaders Structure of QI

  5. My 11 year old, 5th grader working on a project!

  6. The overall QI approach • Find something you want to improve • Problem Statement • Team Selection • Set your Aim • Determine potential changes – Project Metrics • Test your changes • Track your data • Summarize and share

  7. Is the process perfect? “Every process is perfectly designed to get the results it gets” -Paul Batalden

  8. Finding something to improve? • Incident reports • M&M conference • Core measures and guidelines • Interdisciplinary management • Patient access • Customer satisfaction • System needs

  9. Problem Statement • A well-written problem/opportunity statement will: • Be no more than 2 sentences long • Specify a measureable aspect of the problem and give actual values • Use objective measures of the problem, not suspicions/assumptions • Address: • What is happening such that it is considered to be a problem • Where the problem is appearing • How long the problem has been occurring • The magnitude of the problem • The impact or potential impact of the problem on the business • The level of performance needed to avoid the potential impact

  10. Team Selection • Team selection is critical • Team members’ skills and knowledge should align with the project needs • Team members must have a working knowledge of the process being improved • Team member are considered to be subject matter experts and are the people closest to the process • Team members need to be available for the duration of the project • This builds commitment and buy in to the project outcomes by virtue of being involved from the beginning • Skill Diversity is important • Technical, practical, analytical, interpersonal • Team size (none of us is as smart as all of us) • You’ll fail alone or with an army; 4-6 team members is appropriate • Consider support or Adhoc members • IS/IT • HR • Facilities • Finance • Providers

  11. Team Roles • QI Champion • Resident Team Lead • Mentor • Process Owner • Performance Excellence Resource • Team Members

  12. AIM Statement “Some is Not a Number, Soon is Not a Time” Donald M. Berwick

  13. Set your AIM (SMART-ly) • Aim needs to have the following characteristics - “SMART” • S- Specific • Is the statement precise about what the team hopes to achieve? • M- Measurable • Are the objectives measureable? Will you know if the changes resulted in improvement? • A- Attainable/Actionable/Achievable • Is this doable in the time you have? Are you attempting too much? Could you do more? • R- Relevant/Reliable/Realistic • Do you have the resources needed (people, time, support?) • T- Timely/Time bound/Time frame • Do you identify the timeline for the project - when will you accomplish each part? • Example- We aim to improve (reduce) hospital-acquired infections (or more specific) in ICU patients by 25% from our baseline as defined by CABSIs/1000 catheter days (or other measure) by December 31, 2017.

  14. Determine potential changes? • Understand the process • Process mapping/value stream mapping • Pareto diagram

  15. Project Metrics How will you know if you were successful? • You need to measure key metrics before & after you pilot • Make sure the key metrics are well defined and can be measured • Key metrics should be directly linked to what you are improving • Stating what you are going to measure can be challenging but leads directly to project success • This creates clear objectives

  16. Project Metrics Examples of processes that can be measured: • Work in Progress (WIP) • How many EKGs are waiting to be read? • Throughput • How many patients are seen in an eight hour period? • Distance Traveled • Total route traveled when putting together a surgery case cart • Time • Time to transport patients to & from rehab • Time waiting for results • Time to be seen by a doctor

  17. Project Metrics Choose 2 Primary Metrics along with a Secondary Metric • Primary Metrics: • Are tied to the problem statement and objective • Are measurable • Are aligned with business objectives • Need to be tracked at the proper frequency (e.g. daily, weekly, etc.) • Can be expressed graphically over time • Secondary Metric • Represents something that cannot be sacrificed to achieve the primary metric • i.e. if the primary metric focuses on efficiency, the secondary metric may focus on quality or process robustness

  18. Process: Inpatient Stay Process: Cleaning a patient room Project Metrics Examples of Primary & Secondary Metrics • Primary metrics • LOS • Secondary Metric • Readmission rate • Primary metric • Cycle time • Secondary metric • Hospital acquired infection rate • Patient satisfaction scores

  19. Project Metrics Examples of good project metrics: • Decrease patient wait time by 10 minutes • Decrease documentation errors by 50% • Decrease no-shows by 40% • Decrease turn around time for patients getting test results by 5 business days • Increase patient volume by adding 1 walk-in appointment per day

  20. Project Metrics Goal vs. Project Metrics • The goal is the overall objective of what you want to accomplish • i.e. Increase patient satisfaction by creating a process that allows them to make same day appointments • The project metrics are what you will measure to make sure you obtain your overall goal • Add 1 additional add-on appointment to the schedule • Decrease check-in time by 5 minutes • Decrease time searching for supplies by 8 minutes

  21. QI Work as Systems and Processes (Donabedian, 1988) What is done (what care is provided) How it is done (when, where, and by whom care is delivered)

  22. Common Quality Improvement Processes • Rapid Cycle Quality Improvement (RPIW) • PDSA • Human Factors Engineering - EBD • Lean Methodology – Value stream, waste • 5S- Sort, Store, Shine, Standardize and Sustain

  23. PDSA/PDCA – Edward Deming

  24. PDSA • Allows you to test your theory on a few patients • It may take several PDSA cycles and several months to get your process manageable

  25. Use the PDSA Cycle for: • Testing or adapting a change • Implementing an improvement • Spreading the improvements to the rest of your organization

  26. PDSA Cycles Must Be • Active • Quickly plan and make process changes • Iterative • Cycle after cycle • Learning • Take time to study effects of your actions

  27. “Success is the ability to go from one failure to another with no loss of enthusiasm” Sir Winston Churchill

  28. A P S D D S P A A P S D A P S D Repeated Use of the Cycle Changes That Result in Improvement DATA Hunches Theories Ideas

  29. “I didn't fail the test, I just found 100 ways to do it wrong” Benjamin Franklin

  30. Understanding Measurement • Descriptive statistics • Pareto charts ----------- • Run charts- Median------------------- • Control charts- Mean----- • Scatter diagrams • Errors - Type I & II-------------

  31. QI & Research • https://medschool.creighton.edu/research/clinical-research-pathway/qi-or-clinical-research • If all the answers to these questions are “True” then it is QI • If any of the answers are “False” then contact Dr. Andukuri

  32. Questions? Thank You!

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