Plan-Do-Study-Act Cycle and QI Tool Refresher

1. Plan-Do-Study-Act Cycle and QI Tool Refresher March 27, 2014

2. WELCOME BACK!

3. Today’s Agenda • PDSA Refresher • Quality Improvement Fundamentals • Plan-Do-Study-Act Cycle • Quality Improvement Application • Wrap-up – Questions and Training Post-assessment

4. QI Fundamentals • Definition • Quality Assurance vs. Quality Improvement • Benefits • Four Basic Principles • 3 Key Questions

5. QI in Our Terms “QI is the use of a deliberate and defined improvement process, such asPlan-Do-Study-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.” Bialek, R., Beitsch, L. M., Cofsky, A., Corso, L., Moran, J., Riley, W., & Russo, P. (2009). Proceedings from Accreditation Coalition Workgroup: Quality Improvement in Public Health.

6. QA and QI are Not the Same

7. QI Can… • Reduce cost and redundancy • Eliminate waste • Streamline processes • Enhance ability to meet service demand • Increase customer satisfaction • Improve outcomes!

8. QI - Four Basic Principles • Develop a strong customer (client) focus • Continually improve all processes • Involve employees • Mobilize both data and team knowledge to improve decision-making

9. QI – Three Key Questions • 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 improvement?

10. Where do we begin?The Plan-Do-Study-Act (PDSA) Cycle • PDSA (also known as Plan-Do-Check-Act (PDCA), was made popular by Dr. W. Edwards Deming • Is widely used by quality professionals, process improvement engineers, & health care professionals • Science based, data driven, iterative process improvement methodology • Turns ideas into action and connects that action to learning

11. PDSA – An Overview • Four Stages • Nine Steps • Repeatable Steps • Can be used by one person, a team, or an agency • Used to improve existing processes

12. Stage One - PLAN

13. Stage Two - DO

14. Stage Three - STUDY

15. Stage Four - ACT

16. QI Toolbox for the PLAN Stage • Team Charter - A Tool to Keep You Organized • Aim Statement - A Tool to Define the Goal • Process Mapping - A Tool to Examine Current Process Flow • Fishbone Diagram - A Tool for Identifying Root Causes • Affinity Diagram - A Tool to Identify Potential Solutions

17. A Tool to Keep you Organized: Team Charter

18. QI Team Charter What is it? One to two page document that describes the team’s purpose and targeted improvement. • Serves as your team’s roadmap • Helps reduce the “now what?” feeling • Helps the team come to agreement regarding: • Communication • Accountability • Delivery of products • Evolves over the course of the project

19. What to Include: • Team sponsor • Team members and roles • Problem, issue, or opportunity statement • Description of the process improvement • Aim statement • Customers and their needs • Timeline for completing each stage of the PDSA cycle • Timeline and frequency of team meetings • Internal and external stakeholders • Improvement theories (If…Then)

20. A Tool to Define the Goal: Aim Statement A concise, specific, written statement that defines precisely what the team hopes to accomplish with its QI efforts. Remember the three fundamental questions when writing your aim: 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 improvement?

21. Aim Statements • Include a numerical measure for the target • Are time specificand measurable • Define the specific populationthat will be affected

22. A Tool to Examine Process Flow: Process Mapping • Analyze and improve processes • Identify areas of complexity and re-work • Generate ideas for improvement • Illustrate process improvements

23. Preparing to Process Map

24. Symbols used to Process Map • Start & End: An ovalis used to show the materials, information or action (inputs) to start the process or to show the results at the end (output) of the process. • Activity: Abox or rectangleis used to show a task or activity performed in the process. Although multiple arrows may come into each box, usually only one arrow leaves each box. • Decision: A diamondshows those points in the process where a yes/no question is being asked or a decision is required. • Flow: An arrowshows the direction or flow of a process.

26. A Few Hints and Tips • Map the currentprocess! • It’s okay if team members have different ideas about how the process works. • Keep steps simple; begin each step with an action verb. • Process mapping is dynamic! • Post-it notes, dry-erase markers, & pencils are your friend!

27. A Tool for Root Cause Analysis:Fishbone Diagrams

28. Fishbone Diagrams - Purpose • To identify and examine underlying or root causes of a problem • To identify a target for your improvement that is likely to lead to change • To explore possible causes of a problem

29. Fishbone Diagrams: Construction

30. A Tool to Identify Potential Solutions: Affinity Diagrams Group 1 Group 2 Group 3 Group 4 Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea

31. Affinity Diagram: Purpose • Creatively generate a large number of ideas and organize them into natural groupings among them to understand possible solutions to a problem.

32. Affinity Diagrams: When to Use • To generate consensus • When you need your team to think creatively • To breakdown communication barriers • To allow breakthroughs to emerge naturally • To overcome “team paralysis”

33. Affinity Diagrams: Step by Step

34. Questions?

35. Break

36. PDSA Application

37. Lunch

38. PDSA Application, con’t

39. Next Steps

40. Questions?

41. Evaluation and AdjournThank you!