Using a QI framework to improve care

1. Using a QI framework to improve care • Set the vision for improvement • Understand the problem • Identify Areas for Improvement • Devise a Measurement Strategy • Prioritize small tests of change • Measure change • Sustain the change 11:05

2. Why measure change? • Allows you to understand the impact of your changes • Allows you to feedback performance to those doing well & those struggling to improve performance • Allows group to see progress to goal

3. Case Example: Run Chart Audit & Feedback Tee time implemented Baseline Case Manager on leave

4. Improvement in Pain Scores • Pitfall of averages: • Aggregate data dilutes measurements • Does not allow evaluation over time

5. Improvement in pain scores Day 1 to Day 2 100 80 60 40 20 0 Did We Improve?

6. Goal = 57% 44%

7. Try the next test of change

8. Using a QI framework to improve care • Understand the problem • Convince others there is a problem • Identify areas for improvement • Prioritize small tests of change • Devise a measurement strategy • Measure change • Sustain the change 11:15

9. Coaching & Celebrating Success • Identify early wins • Recognition does not have to be big • Recognize this is a marathon – small wins to a big goal

10. How do we engage others in the problem? • Appeal to both sides of our doctor brain:

11. Finding your story

12. Data visualization

13. Inspiring data

14. Your data should tell your story 1854 in London. Cholera strikes. In just 10 days, over 500 people have been killed in one neughborhood. No one understands the source. Except John Snow, an epidemiologist who realized the pump at the corner of Cambridge & Broad street must be the source.

15. Take home Lessons

16. Fishbone Diagram The Cause The effect Equipment Process People The Problem primary cause secondary cause Materials Management Environment

17. Identify Areas for Improvement Offer to write orders for the team if they are busy? Informal ✔ in w/ primary teams PCS Rounds Call the primary team after each patient is seen with clear to-do now recs Call the bedside nurse to let him/her know of new orders? One team member does PM check in Write notes with “official recs” Write note with updated PM recs Page team with updated recs Nurse updates the card for patient Gives patient information card on their pain regimen

18. Remember the three measurements Four - Sepsis Mortality - Cost - LOS Balancing Measures (potential harm) Outcomes (patient level results) - Allergic Reactions - Antibiotic Resistance - C. Difficile Process: (actions) Structure (adherence to the program) - Antibiotics Stocked - EMR alert created - Changes to ED staffing - Lactate drawn - Blood cultures prior to antibiotics - Time to sepsis bundle delivery - Time to MD evaluation

19. High Effort One team member does PM check in Write note with updated PM recs Gives patient information card on their pain regimen Thankless tasks Low Impact High Impact Call the primary team after each patient is seen with clear to-do now recs Easy Wins Low Effort

20. Improvement in pain scores Day 1 to Day 2 100 80 60 40 20 0 Did We Improve?

21. Coaching & Celebrating Success • Identify early wins • Recognition does not have to be big • Highlight how these short term wins are contributing to the bigger vision

22. Questions / Comments ? Michelle Mourad: michelle.mourad@ucsf.edu