Quality Improvement

1. Quality Improvement Introduction to Reliability This material (Comp 12 Unit 3) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000013. This material was updated in 2016 by Johns Hopkins University under Award Number 90WT0005. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/

2. Introduction to ReliabilityLearning Objectives • Discuss the basic concepts of reliability. • Understand what makes organizations highly reliable.

3. What Is Reliability? • “The extent to which an experiment, test, or measuring procedure yields the same results on repeated trials.” (Webster’s Dictionary) • “Reliability principles, used to design systems that compensate for the limits of human ability, can improve safety and the rate at which a system consistently produces desired outcomes.” (Nolan, T., Resar, R., Haraden, C., Griffin, F.A.)

4. Which Clinic Would You Prefer? 3.01 Chart. Courtesy of Dr. Anna Maria Izquierdo-Porrera.

5. How Do We Measure Reliability? Reliability = # of actions that achieve the intended result ÷ total # of actions taken Reliability is expressed as an order of magnitude. • Unstable process: more than 1–2 defects per 10 attempts. • 10-1: 1–2 defects per 10 attempts. • 10-2: 1–2 defects per 100 attempts. • 10-3: 1–2 defects per 1000. • 10-4: 1–2 defects per 10,000. • 10-5: 1–2 defects per 100,000. • 10-6: 1–2 defects per 1,000,000. • And so on.

6. Examples of Reliability in Health Care 3.02 Table.

7. Strategies to Improve Reliability

8. Example: Improvement of Diabetes Care • Guideline recommendation: >3 Hemoglobin A1c every 2 years. • You are tasked with improving the rate of patients being tested appropriately. • Because you are in the HIT department, you will use HIT tools to improve the reliability of the process.

9. Prevention of Failure • Strategies: • Using intent and standardization. • Segmentation. • Tools: • Basic standardization. • Best practice guidelines, tools, and techniques. • Memory aids, such as checklists. • Feedback mechanisms regarding compliance with standards. • Awareness campaigns.

10. Identification and Mitigation • Strategies • Human factor changes. • Redundancy • Independent double checks. • Tools • Reduce fatigue and distraction. • Schedule key tasks. • Take advantage of habits and patterns. • Decision aids and reminders built into the system. • Differentiation. • Constraints. • Affordances.

11. Redesign for Success • Understand where the failure is occurring. • Determine the remedy. • Failure modes: • What could go wrong? • Failure causes: • Why would the failure happen? • Failure effects: • What would be the consequences of each failure?

12. Bundles • A “bundle” is a group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually. • Providing each element of care within a bundle leads to more reliable care for patients.

13. Example: Diabetes Care Bundles • What would you include in a diabetic bundle? • The example of a good diabetic bundle is that used to enhance reliability at CareSouthCarolina. • It includes: BMI, education, 2 HgbA1c tests, LDL test, use of statin.

14. Introduction to ReliabilitySummary • Designing a reliable system is a stepwise process that requires the incorporation of prevention of failure, identification and mitigation of failure, and system redesign from failure. • Different processes require different levels of reliability.

15. Introduction to ReliabilityReferences — 1 References Elgert, S. Reliability Science: Reducing the Error Rate in Your Practice. These seven principles can help ensure that your patients receive the right care at the right time every time. Fam PractManag. 2005 Oct;12(9):59-63. Merriam-Webster’s Dictionary. Available from: http://www.merriam-webster.com/dictionary/reliability Nolan, T., Resar, R., Haraden, C., Griffin, F.A. Improving the Reliability of Health Care. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2004. Available from: www.IHI.org Reliability: Sepsis Management Bundle. Available from: http://www.ihi.org/knowledge/Pages/Measures/ReliabilitySepsisManagementBundle.aspx When Good Enough Isn’t … Good Enough: The Case for Reliability. Institute for Healthcare Improvement. Available from:http://www.ihi.org/resources/Pages/ImprovementStories/WhenGoodEnoughIsntGoodEnoughTheCaseforReliability.aspx

16. Introduction to ReliabilityReferences — 2 Charts, Tables, Figures 3.01 Chart: Which Clinic Would You Prefer? Courtesy Dr. Anna Maria Izquierdo-Porrera. 3.02 Table: Examples of Reliability in Health Care. Courtesy Dr. Anna Maria Izquierdo-Porrera. Images Slide 7: Strategies to Improve Reliability. Adapted from Nolan, T., Resar, R., Haraden, C., Griffin, F.A. Improving the Reliability of Health Care. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2004. Available from: www.IHI.org

17. Quality ImprovementIntroduction to Reliability This material (Comp 12 Unit 3) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000013. This material was updated in 2016 by Johns Hopkins University under Award Number 90WT0005.