Activity Code SM698 - The American Conference for the ... · PDF filemy healthcare...
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Activity Code SM698
Transcript of Activity Code SM698 - The American Conference for the ... · PDF filemy healthcare...
Activity Code SM698
(Quality) Improvement: A (Very) Brief Introduction (Teaser)
Bruce D. Agins, MD MPH Medical Director, NYS Dept of Health AIDS
Institute National Quality Center; HEALTHQUAL
International
Learning Objectives Upon completion of this presentation, learners should be better able to:
• Describe the principles of quality improvement.
• Review the concept of system performance variation.
• Identify strategies for involving consumers in quality management activities.
• Identify components that lead to sustainability of quality management programs.
Your QI Experience A. I have never directly
participated in a QI team in my healthcare organization.
B. I have been a member of a QI team in my healthcare organization focusing on HIV care.
C. I have been a member of a QI team in my organization focusing on something other than HIV care.
D. Both 2 and 3.
E. What is QI? A. B. C. D. E.
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Your Experience with QI and MOC (Performance in Practice)
A. MOC doesn’t apply to me.
B. I have not ever fulfilled my QI (Part IV) requirements.
C. I have fulfilled my QI requirements through the ABMS program module.
D. I have fulfilled my QI requirements through an alternative pathway (portfolio program).
E. What is MOC?
A. B. C. D. E.
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In which discipline did QI start?
A. Laboratory science
B. Automobile manufacturing
C. Health care
D. Statistics
E. Communication
A. B. C. D. E.
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• “… Between the health care we have and the care we can have lies not only a gap, but a chasm…”
• “… The problems come from poor systems – not bad people…”
What is the Problem? SALZBURG GLOBAL SEMINAR 2012
• “Health care interventions that are known to work and save lives are not being implemented for every patient every time.
• We must address this gap between knowing and doing.”
Definitions of Quality
“Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired [health] outcomes and are consistent with current professional knowledge.” Institute of Medicine. Medicare: A Strategy for Quality Assurance. Vol. 1. (1990)
“Quality care” has many definitions, but at VA it means: • The right type of care for your health condition • Care that results in the best possible outcome for you • Care delivered with attention to your concerns, needs, and life goals • Care that keeps you safe from hazards and harm
Quality Improvement: Simply Put
• Understanding variation
• Systems thinking
Which of the following is not a fundamental principle of improvement science?
A. Working in teams
B. Focusing on the customer
C. External audit
D. Systems-based thinking
E. Testing changes
A. B. C. D. E.
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QI Principles
Fundamental Concept of Improvement: “Every system is perfectly designed to achieve exactly the results it achieves”
Principles of Improvement:
– Understanding work in terms of processes and systems
– Developing solutions by teams of providers and patients
– Focusing on patient needs
– Testing and measuring effects of changes
– Peer learning
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What is a System? (IOM)
System: a set of interdependent elements working to achieve a common aim. The elements may be both human and nonhuman (eg, equipment, technologies).
Appreciation of a System
16 API- 2014
Systems Thinking
Source: Donabedian, A. Explorations in Quality Assessment and Monitoring Vol. 1. The Definition of Quality and Approaches to Its Assessment . Ann Arbor, MI: Health Administration Press, 1980. Adapted by USDHHS, HRSA.
QI Principles
Fundamental Concept of Improvement: “Every system is perfectly designed to
achieve exactly the results it achieves”
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Decision Point Should our findings be submitted for a poster or
prepared for publication?
A. Yes
B. No
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Shewhart Charts
The Shewhart chart is a statistical tool used to distinguish between variation in a measure due to common causes and variation due to special causes
(Note: A stable process does not say anything about the quality of the process)
HC Data Guide, p. 113 27
Using Shewhart Chart to Focus AIM
28 HC Data Improvement Guide
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UCL = 12.60
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New Needles Test
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HC Data Guide p. 117 30
QI Principles
Fundamental Concept of Improvement: “Every system is perfectly designed to achieve exactly the results it achieves”
Principles of Improvement:
– Developing solutions by teams of providers and patients
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Why Teamwork?
What does the process really look like?
QI Principles
Fundamental Concept of Improvement: “Every system is perfectly designed to achieve exactly the results it achieves”
Principles of Improvement:
– Focusing on patient needs
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Dimensions of Quality
Technical Quality
Provider
Perception of
Quality of HIV
Care
Experience Quality
Consumer
Perception of Quality
of HIV Care
Leonard Berry
• Consumer advisory board
• Focus groups
• Exit interviews
• Participation on quality teams
• Reviewing data
• Setting priorities for improvement
• Patients serving on QM Committee
How to involve consumers?
QI Principles
Fundamental Concept of Improvement: “Every system is perfectly designed to achieve exactly the results it achieves”
Principles of Improvement:
– Testing and measuring effects of changes
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TESTING CHANGES
QI Principles
Fundamental Concept of Improvement: “Every system is perfectly designed to achieve exactly the results it achieves”
Principles of Improvement:
– Peer learning
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Regional QI Groups? (learning networks; learning communities)
• Regional groups promote sharing of
improvements and strategies
• Local issues drive priorities
• Coordination of care enhanced
• Facilitates involvement of other stakeholders:
– State….city….county….
WHY IS THERE CONFUSION ABOUT QI?
Which of the following is not a model of QI?
A. Honda Manufacturing System
B. Kaizen
C. Six sigma
D. Lean thinking
E. Lean-Sigma
F. Toyota Production System
A. B. C. D. E. F.
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Improvement Models
• Model for Improvement (PDSA)
• Six Sigma
• Lean
• 5S
• Kaizen
• Total quality management
Which of the following is a component of robust process improvement?
A. Identifying root causes of a problem
B. Measuring the importance of each cause
C. Proving the effectiveness of the solutions
D. Deploying programs to ensure sustainability of the improvements
E. All of the above
A. B. C. D. E.
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8 Chassin and Loeb. Health Affairs, 30, no.4 (2011):559-568 The Ongoing Quality Improvement Journey: Next Stop, High Reliability
Leatherman, Ferris, Berwick, Omaswa and Crisp. The Role of Quality Improvement in Strengthening Health Systems in Developing Countries. Int J Qual
Healthcare 2010; 22: 23-43.
DEFINITION: Rather than attempt to re-define the meaning of quality in a global context, the group developed a shared understanding of the term ‘quality improvement’ as both a philosophy and a family of discrete technical and managerial methods.
Methods: Process investigation and analysis Operations research Teamwork Assessment and improvement Optimal use of measurement and statistics in daily work Benchmarking Participative management techniques
Methods are focused on patients and their families and enable providers and organizations to continuously learn and to change the systems in which they work to achieve improved health outcomes for those they serve.
Key Elements: Data Use
• Guideline supported measures
• Measurement platform
• Alignment with national systems
• Embedded data quality assurance
• Data reporting strategies
• Apply process improvement methods to data systems
• Process for review of performance data and decision-making based
on results
Use the Data to Guide your
Improvement Work
• Doing well, or not?
• Performance stable, or a trend?
• Compared to other grantees?
Look at the data
• Which areas need improvement?
• What are our priorities for improvement?
Decide how to act on the data
• Identify project team
• Define improvement goal Begin
improvement work
What We Want to Avoid……..
Quality Management Program
SOME CLOSING THOUGHTS
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WHAT DO WE HAVE TO DO TO GET HERE?
Laying the Foundation for Sustainability
• Leadership -- the will
• Planning
• Organizational structures for improvement
• Patient & community involvement
• Data systems
• Linking process measures to outcomes
• Knowledge management/communication
• Staff capacity-building
• Peer learning through regional groups and national QI conferences
Within Our Reach • Biomedical interventions are now available to achieve
both health outcomes and zero transmission.
• Improvement methods are known and have spread to provider communities.
• Implementation of guidelines is possible throughout the healthcare sector.
• Strong leadership is demonstrable.
• The journey to improve has already begun…
The Challenges That Lie Ahead
• The “deep reach” to the most marginalized, vulnerable and remote populations.
• The use of real-time data to inform strategies for change at the local level.
• The engagement of the providers and consumers to work together to achieve improvement goals in their community health.
• Undeveloped communication/knowledge management strategies.
• Integration of HIV improvement work into national health sector quality management programs.
• Sustainability of improvement once initial gains are achieved.
RESOURCES
• National Quality Center – www.nationalqualitycenter.org
• HRSA – http://www.hrsa.gov/quality/
• VA – http://www.va.gov/qualityofcare/
• AHRQ – www.ahrq.gov
• Institute for Healthcare Improvement – www.ihi.org
• University Research Corporation – www.urc-chs.com
• HEALTHQUAL International – www.healthqual.org
ADDITIONAL RESOURCES
Specific Acknowledgements
• Margaret Palumbo
• Michelle Geis
• Joshua Bardfield
• Rashad Massoud
• Sherry Martin
• The NQC team
• HRSA/HAB
Activity Code SM698
