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Quality Improvement Series Session 4- shaping the AIM Windy Stevenson lammersw@ohsu.edu

Quality Improvement Series Session 4- shaping the AIM Windy Stevenson lammersw@ohsu.edu. Today’s Agenda. Where are we, and how did we get here? What are the pros and cons of our project? Where do we want to be, and what does that mean? . Take Home Points (review).

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Quality Improvement Series Session 4- shaping the AIM Windy Stevenson lammersw@ohsu.edu

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  1. Quality Improvement Series Session 4- shaping the AIM Windy Stevenson lammersw@ohsu.edu

  2. Today’s Agenda • Where are we, and how did we get here? • What are the pros and cons of our project? • Where do we want to be, and what does that mean?

  3. Take Home Points (review) • Real (sustainable) change comes from changing systems, not changing within systems • education alone doesn’t work • don’t push the current system to work harder • It’s your job to spot the system that isn’t working • Be specific about what you want to accomplish, and why; be intentional • Focus on patients • Start before you think you are ready; don’t get paralyzed • Don’t be the donkey

  4. Don’t be the donkey!

  5. Problem statement The DCH ambulatory clinic problem lists are incomplete and inaccurate Advantages • WE picked it, and therefore it has meaning to us • We know there is plenty of opportunity for improvement • Capacity to improve both patient safety and provider satisfaction • Important to OHSU

  6. Systems… A system is a set of interdependent parts sharing a common purpose. • The parts • The interaction of the parts • The people • Every system is perfectly designed to achieve • the results it achieves.

  7. The Problem List “System” • What results is our current system designed to produce? • WHY? What is the definition of CHAOS?

  8. Challenges (ie barriers) • Time • Culture • Ownership • Definition of accuracy • Lack of natural error identification • Lack of natural rewards • Need for manual audits

  9. Where do you start? Problem statement: The DCH ambulatory clinic problem lists are incomplete and inaccurate. BUT WHAT DOES THAT MEAN???

  10. Well child care • 2yo WCC • No documented medical or surgical conditions

  11. Well child care

  12. Well child care- complex kid • 4 mo WCC- former premie

  13. Acute care visit- healthy kid • 5yo in clinic for cough • No medical or surgical conditions • Has had 3 acute visits and one ED visit but no WCC with us

  14. Acute care visit- complex kid • 3yo with complex hx in clinic for “dropped something on foot”

  15. What about if they DON’T show? • 5 yo with asthma; no show for scheduled clinic appt

  16. Start SOMEWHERE! • Institutional or leadership priorities • Clinical • Fiscal • Safety risk • Most annoying (therefore most motivation to fix?) • Most easily solved • Most easily measured • Most meaningful to customers

  17. How do you create a SMART aim? • Specificwe are intentional and focused • Measurablewe can prove we’ve had an impact • Actionablethere are no known insurmountable barriers • Realisticit’s within our scope • Timelywe’ll do it within a time frame

  18. Where to go from here • What do we want to do first? • Success begets success • What can we ACTUALLY accomplish? • What patient population(s) or problem type(s)? • To impact what time point (before the visit?) • What is our AIM?

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