Quality Improvement Processes

1. Quality Improvement Processes A Rose By Any Other Name…

2. Basic Concept • Quality Improvement Processes • come in many shapes and sizes • go by many different names • are marketed by many different sources • With a common goal… • To improve and assure the safety, quality, and cost efficiency of health care

3. Today’s Goal • Our goal today is to lay the groundwork for future training sessions regarding quality improvement • We will get a taste of numerous methodologies and approached to quality improvement • One size does not fit all • Quality improvement is a journey taken in baby steps – not giant leaps

4. Common Quality Improvement Processes • Model for Improvement • Rapid Cycle Quality Improvement • PDSA • Human Factors • Lean Methodology • 5S • Failure Modes and Effects Analysis • Root Cause Analysis

5. Exercise • Let’s make the perfect peanut butter and jelly sandwich!

6. Learning • Do we all define the process in the same way? • Did we assume steps without spelling them out? • Did we all address the problem in the same way, or were there variations in our processes?

7. Rapid Cycle Process Improvement • A process improvement approach to evaluate change • This model allows for integration of new and existing systems. • This model promotes small scale rapid cycle change over short periods of time.

8. WHAT is the PDSA Cycle? • A process improvement approach to evaluate change • This model allows for integration of new and existing systems. • This model promotes small scale rapid cycle change over short periods of time.

9. The PDSA Cycle for Learning and Improvement

10. What Do We Mean by Rapid Cycle Improvement? • Let’s PLAN The Perfect Peanut Butter and Jelly Sandwich!!!! • What do we want to improve? • What change should we test? • What is our anticipated outcome? • Theorize

11. What Do We Mean by Rapid Cycle Improvement? • Let’s DO The Perfect PB & J Sandwich!!! • Put the theory into practice • Map the new plan • Carry out the change on a small scale or pilot basis • Evaluate change with qualitative and quantitative data

12. What Do We Mean by Rapid Cycle Improvement? • Let’s STUDY The Perfect PB & J Sandwich!!! • Evaluate and determine the degree of success. • Determine what, if any, modifications are required.

13. What Do We Mean by Rapid Cycle Improvement? • Let’s ACT ON The Perfect PB & J Sandwich!!! • Adopt • by testing on a larger scale in a new cycle • Adapt • based on lessons learned from the test • Abandon • By trying something different

14. The PDSA Cycle for Learning and Improvement

15. A P S D D S P A A P S D A P S D Repeated Use of the Cycle Changes That Result in Improvement DATA Hunches Theories Ideas

16. PDSA • Allows you to test your theory on a few patients • It may take several PDSA cycles and several months to get your process manageable. • That’s OK!

17. Use the PDSA Cycle for: • Testing or adapting a change • Implementing an improvement 3. Spreading the improvements to the rest of your organization

18. PDSA Cycles Must Be: • Active • Quickly plan and make process changes • Iterative • Cycle after cycle • Learning • Take time to study effects of your actions

19. Human Factors Human Factors is about how features of our tools, tasks, and work environments continually influence what we do and how we do it.

20. In Other Words… • Human Factors is about how the design of things impacts how well we do any task. • Design of our workplace • Design of the tools we use • Design of processes (how we do things around here)

21. Is This the Same Old Thing? • No! • Human Factors is complementary to what you are already doing to improve health care • Human Factors will make your improvement efforts more efficient and effective • There is a Human Factors concept behind every successful improvement effort

22. Talk About Human Factors!!! Each line represents the RN’s movement from one location to another. For example, RN moves between patients 14A and 14B twice.

23. Human Factors and the Model for Improvement What are we trying to accomplish? How do we know that a change is an improvement? What changes can we make that result in an improvement? Human factors can help answer this question! Act Plan Study Do

24. Lean Methodology • It’s all about: • Waste and Value • Always challenging processes to • Produce better outcomes for customers • Create more value with less wasted time, effort, and resources • Speed delivery while reducing cost • Lay less burden on the people doing the work.

25. 5S • 5S is a philosophy and a way of organizing and managing the workspace. • The key impacts of 5S is upon workplace morale and efficiency. • By ensuring everything has a place and everything is in its place then time is not wasted looking for things and it can be made immediately obvious when something is missing. • The real power of this methodology is in deciding what should be kept and where and how it should be stored

26. 5S Seiri Seiton Seiso Seiketsu Shitsuke Sort Set In Order Shine Standards Sustain Based on Japanese words that begin with ‘S’, the 5S Philosophy focuses on effective work place organization and standardized work procedures. 5S simplifies your work environment, reduces waste and non-value activity while improving quality efficiency and safety.

27. Failure Mode Analysis Failure Modes and Effects Analysis (FMEA) is a systematic, proactive method for evaluating a process to identify where and how it might fail, and to assess the relative impact of different failures in order to identify the parts of the process that are most in need of change.

28. Failure Mode Analysis Continued FMEA includes review of the following: Steps in the process • Failure modes (What could go wrong?) • Failure causes (Why would the failure happen?) • Failure effects (What would be the consequences of each failure?)

29. Root Cause Analysis • A way of looking at unexpected events and outcomes to determine all of the underlying causes of the event and recommend changes that are likely to improve them.

30. RCA Tools • The 5 Whys? • Appreciation • Drill Downs • Cause and Effect Diagrams (Fishbone Diagrams)

31. Success “There are no secrets to success. It is the result of preparation, hard work, and learning from failure.” General Colin L. Powell

32. Quality Improvement is a Process, not an Event Anonymous