1. How to choose a qualityimprovement project 101 Judi Grimes Metropolitan Nashville Health Department

2. Goals1. Explain the need to prioritizeprojects2. Be able to use a decision matrixand flow chart3. Convert case studies into models for practice change 3. READY 4. Organize a team to begin the process Identify leader/facilitator Identify staff Set a meeting time And..................... 5. Ask yourself, Self, am I ready to take action? Is there management support?Are the right people at the table?Do I have the time to invest in making changes atthis point in time? 6. Identify and prioritize 3 topics for improvement FIRST: List any data findings thathave been collected from a work planor other activities.This could be a survey, monitoring results, audit findings, or whatever. 7. What if data is not available? Ask your staff some questions: Is there anything we could stand to do faster? Does staff have to do anything that createsroadblocks to service? Can we change something to better serve theneeds of our clients? 8. SECOND: Use a decision matrix to prioritize Dont know how? Check outhttp://asq.org/learn-about-quality/decision-makin 9. THIRD: Develop aproblem statement forthe selected topic 10. A good problem should: State the effect of the problem State the gap Be specific and use facts Be measurable State the problem but not the solution Example: Clinic X in neighborhood Y has identified 56cases of tuberculosis from a population of 10,000people as evidenced by electronic chart review 11. AIM 12. Identify the desired goal/result for your agency 13. Define where you want to be Targets should be challenging but not the completegoal If a process, complete a flow chart Do a root cause analysis to identify possiblefactors influencing the #1 topic Talk about the chosen topic for improvement andbrainstorm about influencing factors (Fishboneanalysis) Select the factor the group thinks has the mostsignificant impact and is possible to achieve 14. FIRE 15. Develop a QI Action Plan for theselected factors and implement A detailed outline of how to correct the rootcause of the problem and specify the exactaction to be taken Ask: What, by whom, by when? Consider testing the plan and revising if needed 16. Evaluate Look at the results over time and standardizeimprovements See if the proposed action yields the expectedimprovement Allow time for change to occur The results determine the next steps... Keep your successes moving forward!!! 17. Case Study 18. Improving syphilis testing Background: Agencies that receive Ryan WhiteHIV funding grants are required to provide andtrack primary care services to individuals withHIV. One reported measure is the rate ofsyphilis testing Prior to this project, syphilis testing rate amongHIV positive individuals in metro Nashville was46% way below the national average 19. Improving syphilis testing In preparation for the annual QI plan, syphilistesting was identified as something to improve After using a decision matrix, it was decidedthat this should be of primary importancebecause of the abysmally low testing rate A fishbone diagram was used to identify rootcauses... 20. Improving syphilis testing The problem turned out to be simple therewas no good tracking system for determiningwhen to do the annual syphilis test A decision was made to just do it on eachpatients first visit of the calendar year Management buy-in occurred easily becausethere was no cost involved Annual syphilis testing rate improved to 78% bythe end of the year 21. Thank you!Please direct questions to:Judi.grimes@nashville.gov