8 Key Steps of Implementing Quality Improvement Projects

1. 8 Key Steps of Implementing Quality Improvement Projects Amelia Broussard, PhD, RN, MPH

2. Step 1Make Commitment; Start Work: • Promise time/resources to do this right. • Budget time for improvement activities. • Use quality tools and resources creatively, • Alter strategies as needed for staff and culture to support “ownership” of improvement work. • Don't do this alone. Process requires a “core team” • Include at a minimum of division leadership and key owners of the processes under improvement.

3. Step 2: Form a Team • What is a team? • A group of individuals working together for a common purpose. • Team shares mutual accountability for successful outcome. • Teams create environments in which participants can keep up with needed changes, learn more about core processes, and gain skills in collaboration

4. Teams are more Effective If • Task is complex • Creativity is needed • Path forward is unclear • More efficient use of resources is required • Fast learning is necessary • High commitment is desired • Implementation of plan requires cooperation of others • Task or process is cross-functional

5. Teams Require • Clearly defined purposes and goals that serve organization • Defined parameters within which to work • Communication within the organization • People with necessary knowledge and skills to accomplish task • Knowledge about how they are going to accomplish tasks

6. Teams and Change • Most teamwork involves change • Change is seldom easy. • “Laws” of organizational change: • People don’t resist change, they resist being changed; • Things are the way they are simply because they got that way; • Unless things change, they are likely to remain the same; and • Change would be easy if it weren’t for all the people!

7. Forming a Successful Team • Three to six members are typical size • Include people from work areas that will be impacted by changes • Representation of all affected areas ensures understanding of projected improvement • It also promotes buy-in for changes.

8. Team Selection • Composition is the most critical success factor in any improvement project • Division Leadership is responsible and accountable for team composition. • Smaller the team, the faster and better the results. • Five or six team members are ideal. In a small setting, four member teams are norm. • . • Team members should be prepared to meet at least twice a month; weekly is ideal

9. Selection Process • Selection process consists of three steps: • Identifying good candidates for the project • Determining the optimal team mix, • Recruiting the team

10. Who Makes A Good Team Member? • Potential team member, want to ask following questions: • Is this person respected for their judgment by a range of staff? • Does s/he enjoy a reputation as a team player? • Technically, what is person’s area of mastery

11. Good Team Member Cont’d • Is s/he an excellent listener? • Is this person a good verbal communicator? • Is person a proven problem solver? • Is s/he frustrated by current systems and processes? • Is person demonstrably open to change?

12. Identifying Team Leaders • Members in three leadership roles will guide team activities • Senior Leader • Process Champion • Quality Lead. • All three leadership roles function as team liaisons and representatives across programs and divisions.

13. Senior Leader • Has authority to allocate time and resources needed to achieve team’s aim (goal) • Has authority over areas affected by change • Will support spread of successful changes throughout organization

14. Process Champion • Is an opinion leader and is well respected by peers • Understands processes of work involved in change effort • Has a good working relationship with colleagues and day-to-day leader • Wants to drive improvements in system

15. Quality Lead • Drives project, ensuring that cycles of change are tested and implemented • Coordinates communication between team and leadership • Oversees data collection • Works effectively with champion and other team members

16. Teamwork Principles • Members need to work at active listening and respecting one another’s point of view. • Ground rules for group should be established, documented and reviewed periodically • Ground rule examples include: start on time, make no judgments, and keep confidentiality among group members, ensure that all voices are equal, use humor

17. Meetings Work Best When Members of Team: • Commit to meeting time and process • • Clarify roles and responsibilities each time • • Begin and end meetings on time • • Listen to and respect perspectives • • Do assigned “homework” • • Give honest feedback • • Evaluate and mark success • • Make time enjoyable

18. Stages of Team Growth • Stage 1: Forming – members cautiously explore boundaries of acceptable group behavior • Stage 2: Storming – teams begin to realize task is different and more difficult than they imagined, and become testy, anxious, or overzealous • Stage 3: Norming – team members reconcile team loyalties and responsibilities • Stage 4: Performing – team settles it’s relationships and expectations and starts performing

19. Step 3: Select and Define an Improvement Project • Guidelines for selecting project • Is important to organization and its clients or grantees? • Is it an area where senior leaders, division directors, and staff will cooperate in improvement effort • Is not already undergoing major changes or being studied by another group • Is relatively simple, with clearly defined starting and ending points. • May break complex issue into simpler task

20. Define the Process • Goal is to develop useful description of your process as it currently works. • May lead to discoveries of obvious improvements. • Allows everyone on team to come to agreement on key tasks involved

21. Key Methods Of Describing A Process • Set boundaries on the process • Flowchart process • Diagram physical workflow • May use Fishbone diagram to determine areas for possible improvement

22. Step 4: Define an Improvement Aim (Goal) • Where Are You Now? • Where Do You Want to Be? • Make Baseline Performance Assessments • Validate level of performance on selected improvement project

23. Write an AIM Statement: • An AIM (goal) statement articulates in 1 or 2 sentences what the team is trying to improve • Based on assessment of current performance already completed • Agreement with group on suitable stretch goal for improvement. • Important to do process well first time to keep team on track • It will keep team focused, re-orient members when they get off track • Facilitate development of simple measurements to determine if a change is indeed an improvement.

24. Develop measurements to evaluate your improvements • What is it you are trying to improve and for whom? • It is important to identify simple way to evaluate improvement progress over length of your project • Learn from consumers of your process and use these lessons to inform team’s improvements

25. How To Know Change Is An Improvement? • Remember to look at small microsystems (small replicable units) of process • Is there already data collection process in place that measure impact? • Can real time data collection be easily inserted into current flow of work?

26. Step 5: Cause Analysis • It’s critical to identify causes of problem under study before jumping to conclusions on best solutions. • Best to localize occurrence of problem before attempting to identify specific or root causes. • Important to be sure everyone agrees on definition of problem. • Explore “causes of causes” to make sure your addressing “upstream” issues affecting actual problem under study. their effects.

27. Root Cause Analysis • Systematic analysis of an issue to identify the root causes rather than the symptoms. • Cause and effect charting is another way to clearly sort causes from their effects.

28. “Brainstorm” As A Group • Brainstorming is process of offering creative ideas that comes to mind (without any judgment attached to it). • Use flip chart to write down ideas that members of team feel might be addressed • All team members should be encouraged to participate in this process – perhaps go around the table and take turns providing one suggestion at a time. • Write down all ideas, some ideas may address the same • Combine similar themes. • Avoid jumping to solutions at this point.

29. Prioritize Ideas • Prioritize objectives. • Team should vote on which objective needs to be worked on first, second, and third • Plan to focus on 2 or 3 objectives at first then revise if necessary • Important that all team members participate in anticipated improvement within specified timeframe. • Each team member should be working toward this goal.

30. Step 6: Plan and Test Changes • Develop appropriate solutions • Test changes that lead to improvement • PLAN, DO, STUDY, & ACT Cycle (PDSA): • Simply defined: • Plan simple improvement project according to goals and objectives • Do project activities • Study whether project is making an improvement (or not) • Act accordingly, incorporating any changes or course corrections

31. Step 7: Implement and Sustain Successful Changes • Key to sustaining improvement is institutionalizing successful changes • Steps to be taken to secure permanent changes to make it part of the larger system: • Document e new process or changes to system • Educate and communicate changes to ALL staff involved • Add new process to any orientation or staff training procedures • Develop mechanisms to continually assess changes

32. Step 8: Ending Improvement Teams/Projects • Results checked against original goals and needs of division, staff and improvement target • Identified any remaining tasks to be done, • Established responsibility for monitoring change over time • Documented and trained people, when necessary, in new process. • Communicated changes to everyone affected by them. • Reviewed team’s accomplishments for areas of improvement. • Celebrated efforts of team with a lunch, formal announcement of team results, special presentation to the division, Quality Council, or other expression of celebration.