Quality Improvement Session 1

1. Quality ImprovementSession 1 PDSA “Join the Quality Circle” Larissa Verda, MD PhD Division of Hospital Medicine Cook County Hospital 2013-2014

2. Quality of care • “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Institute of Medicine, 2001) • “That portion of a patient’s outcome over which health care providers whether individuals or organizations, have control” (Chin M et al. 2003)

3. Quality Improvement • Incorporated in the ACGME General Competence “Practice Based Learning & Improvement” • “Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.”

4. Quality Improvement • Quality Assessment • Quality Assurance • Quality Improvement A set of techniques/methods for continuous study and improvement of the processes of delivering healthcare services and products to meet the need and expectations of the customers…

5. Quality Improvement Institute of Medicine Six dimensions of Quality • Safety • Effectiveness • Patient centeredness • Timeliness • Efficiency • Equity

6. QI components • Self-reflection • Quality or Practice Improvement • Lectures/Seminars/Conferences • Quality Improvement Project • Evidence Based Medicine • Teaching Skills

7. QI components • Self-reflection • Quality or Practice Improvement • Lectures/Seminars/Conferences • Quality Improvement Project • Evidence Based Medicine • Teaching Skills

8. Self-reflection and QI • What is self-assessment? • What is reflective practice? • Why they are important?

9. Self-reflection and QI • What is self-assessment? • What is reflective practice? • Why they are important? Active process of using data and prior feedback to analyze one’s practice in order to identify learning needs for the purpose of improving care; “Guided self-audit” Caverzagie KJ and Holmes ES. SGIM 2012

10. Self-reflection and QI • What is reflective practice? • What is self-assessment? • Why they are important? Systematic approach to review one’s clinical practice, including errors, seek answers to problems, and make changes in practice habits, styles, and approaches, based on self-reflection and review Incorporates self-assessment into a change in behavior Caverzagie KJ and Holmes ES. SGIM 2012

11. Self-reflection and QI • Incorporate data and feedback • Reflect upon strength and weaknesses • Identify learning objectives • Develop action plans to accomplish!!!

12. Self-reflection and QI “Everyone thinks of changing the world, but no one thinks of changing himself.” Leo Tolstoy

13. QI components • Self-reflection • Quality or Practice Improvement • Lectures/Seminars/Conferences • Quality Improvement Project • Evidence Based Medicine • Teaching Skills

14. EBM and QI Glasziou P et al. BMJ QualSaf2011

15. EBM and one model for QI Glasziou P et al. BMJ QualSaf2011

16. QI components • Self-reflection • Quality or Practice Improvement • Lectures/Seminars/Conferences • Quality Improvement Project • Evidence Based Medicine • Teaching Skills

17. Teaching skills and QI

18. QI components • Self-reflection • Quality or Practice Improvement • Lectures/Seminars/Conferences • Quality Improvement Project • Evidence Based Medicine • Teaching Skills

19. Quality Improvement - Strategy 1966 - Donabedian proposed measuring the quality of care by observing its • Structure (accessibility, availability and quality of resources) • Processes (delivery of care services by clinicians and providers) • Outcomes (final result of health care – mortality, patient satisfaction and improved health status)

20. Quality Improvement - Strategy W. Edwards Deming • American statistician, professor, author, lecturer, and consultant • Improved production in the U.S. during World War II and in Japan after the war • Pioneer – use of statistical analysis to achieve better industrial quality control – ‘quality movement’

22. Quality Improvement - Strategy • Total Quality Management = Continuous Quality Improvement • Organizational approach involving organizational management, teamwork, defined processes, system thinking, and change to create an environment for improvement. There is an opportunity for improvement in every process and on every occasion.

23. Quality Improvement - Strategy • CPI clinical practice improvement • International Organization ISO 9000 • Zero defects • Six Sigma

26. Quality Improvement

27. Quality Improvement Project • Identify an issue • Build a team to address it • Define the problem • Choose a target • Test the change • Reconsider or extend the improvement efforts

28. Quality Improvement Project • Identify an issue • Build a team to address it • Define the problem • Choose a target • Test the change • Reconsider or extend the improvement efforts A process that is causing concern or a possible opportunity for a positive change.

29. Quality Improvement Project • Identify an issue • Build a team to address it • Define the problem • Choose a target • Test the change • Reconsider or extend the improvement efforts Representation from groups involved – this step is critical

30. Quality Improvement Project • Identify an issue • Build a team to address it • Define the problem • Choose a target • Test the change • Reconsider or extend the improvement efforts Identify and carefully describe what it is you really want to improve; the source of the problem you are confronting

31. Quality Improvement Project • Identify an issue • Build a team to address it • Define the problem • Choose a target • Test the change • Reconsider or extend the improvement efforts Introduce and evaluate interventions, using quality improvement tools and skills

32. Quality Improvement Project • Identify an issue • Build a team to address it • Define the problem • Choose a target • Test the change • Reconsider or extend the improvement efforts Data measures to determine when a process change over time is likely to be due to chance and when it is not

33. Quality Improvement Project • Identify an issue • Build a team to address it • Define the problem • Choose a target • Test the change • Reconsider or extend the improvement efforts Reconsider, sustain, and/or extend process improvements

34. QI project • Project should be with potential to improve the quality of practice and enhance the quality of care • Project should be • Relevant • Achievable • Measurable results

35. QI project To be continued Next session is on QI strategies and tools Please attend brainstorming session