IGNITE! Introduction to QI Methods
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Introduction to QI methods
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Transcript of IGNITE! Introduction to QI Methods
Introduction to QI methods
Mobile Phones
Fire Alarms
Toilets
Fire Exits
2
Your facilitator today is:-
Liz Twelves
Academy Programme Lead
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What is AQuA?
Advancing Quality Alliance • North West quality improvement organisation
• Established 2010
• Membership: 70 organisations - Acute, Primary care, Community, Mental health and Ambulance trusts across North West England
• Core team of around 30 staff plus Associates and Affiliates
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Expectations?
Learning Objectives for the Session
By the end of the session you should be able to:
Understand aspects of the philosophy of QI
Be able to apply a model for improvement
Improve your ability to frame your project
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Getting to Know You
Activity - In groups, discuss some of the following to find
out what you may have in common:
- Where you were born
- Where you work
- What you do
- Where you studied
- What can people do to help you to learn
something new?
The aim of this chapter is to provide an outside view – a lens – that I call a system of profound Knowledge. It provides a map of theory by which to understand the organizations that we work in.” (Deming 1993 p. 92)
Appreciation
of a System
Understanding Variation
Theory of Knowledge
Psychology
Subject Matter Knowledge
Knowledge
for
Improvement
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Deming’s System of Profound Knowledge
Activity
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© 2010 AQuA
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The Model for Improvement
A P
DS
Plan
DoStudy
Act
AIM: What are we trying to accomplish?
MEASURES: How will we know if a
change is an improvement?
CHANGE: What changes can we make
that will result in improvement?
© Associates for Process Improvement
PDSA Testing - simulation exercise
The Skittle Challenge
The Skittle Challenge
• Aim – to be left with one Skittle
• Execution
– Put a Skittle on each circle
– Remove one to start
– Jump over one at a time and remove it
– Keep going until you can’t jump over any more
– How many are left?
The Skittle Challenge
• Aim – to be left with one Skittle • Measure – number of Skittles left • Changes – which one to remove first? – what order to remove them in? – how you work as a team? • Execution
– Put a Skittle on each circle – Remove one to start – Jump over one at a time and remove it – Keep going until you can’t jump over any more – How many are left? (Plot your data and annotations) – Think about how it went and what you could improve next round.
(Theory and prediction based on learning)
– DO NOT EAT the Skittles – yet…
PDSA #
Theory Prediction
1 Start with No. 5 empty
Will have 3 skittles left
2
3
4
5
6
Number of Skittles Left
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Nu
mb
er le
ft
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5
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2
1
1 2 3 4 5 6
PDSA
Why Test Changes?
• To increase the belief that the change will result in
improvements in your setting
• To learn how to adapt the change to conditions in your
setting
• To evaluate the costs and “side-effects” of changes
Overall to minimise the resistance when spreading the
change throughout the organisation.
“What will happen if we try something different?”
“Let’s try it!” “Did it work?”
“What’s next? ”
Cycles of Tests Build Confidence
AP D
S
A
P
D
S
AP
D S
A
P
D
S
APD
S
A
P
D
S
A P
DSProposals,
theories,
hunches,
intuition
Changes that
will result in
improvement
Learning
from data
Run Chart to Measure Performance
Test 1
ABCXYZ
Test 2 -
XYZABC
Test 2 123456
Tests 3-6
987654
0
1
2
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5
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10
1 2 3 4 5 6 7 8 9 10 11 12 13
skittles left
skittles left
A solution….
6-1, 4-6, 1-4, 7-2, 13-4, 2-7, 11-4, 14-5, 10-3, 3-8, 4-13, 12-14, 15-13.
The Skittle Challenge
• Consistency of purpose
• Prediction
• Planning
• Documentation
• Sharing and stealing!
• Learning from failure
Measurement and Data Collection during PDSA Cycles
• Collect useful data, not perfect data –
data for learning, not evaluation
• Use a pencil and paper until the information system is ready
• Record what went well and what didn’t work so well during the test of change
All improvement comes from designing, testing and implementing changes
Seven Propositions of the Science of Improvement. Perla et al , 2013
The aim of this chapter is to provide an outside view – a lens – that I call a system of profound Knowledge. It provides a map of theory by which to understand the organizations that we work in.” (Deming 1993 p. 92)
Appreciation
of a System
Understanding Variation
Theory of Knowledge
Psychology
Subject Matter Knowledge
Knowledge
for
Improvement
24
Deming’s System of Profound Knowledge
Getting to the root of the problem
My trip to work
Mean
Upper process limit
Lower process limit
0
20
40
60
80
100
120
Consecutive trips
Min.
Monthly data shows improvement Average length of pre-ward stay on Barnsley
Stroke Ward
from 01/2007 to 07/2007
0
0.5
1
1.5
2
2.5
3
3.5
1 2 3 4 5 6 7
Months
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The chart shows
the average
monthly length of
time before
patients got to the
Stroke ward
6/17/2016 © AQuA Academy 2013
Weekly data tells a slightly different story
Average length of pre-ward stay on Barnsley
Stroke Ward
from 01/2007 to 07/2007
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
1 3 5 7 9
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Weeks
28 6/17/2016 © AQuA Academy 2013
Patient level data adds another level of understanding
29 6/17/2016 © AQuA Academy 2013
Types of Variation Common Cause Variation
• Inherent in the design of the process
• Is due to regular, natural or ordinary causes
• Affects all outcomes of the process
• Results in a ‘stable’ process that is predictable
• Also known as random or unassignable variation
Special Cause Variation
• Is due to irregular or unnatural causes that are not inherent in the design of the process
• Affect some, but not necessarily all aspects of the process
• Results in an ‘unstable’ process that is not predictable
• Also known as non-random or assignable data
© 2014 AQuA
Group
Work
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Issues with lunch
Patient complaints
• My lunch was late
• I have nowhere to eat except my bed
• I got the wrong food
• My food was cold/lukewarm
• I didn’t like the quality of the food
• I didn’t like the selection
• I couldn’t eat the lunch I was given because it was the wrong kind of food for me
• I wasn’t on the ward when lunch arrived and the food had gone when I got back
Complaints from the catering department
• No one was available on the ward to give out the lunches when they arrived
• Kitchen – didn’t get the order early enough
• The patient was away for tests when the food arrived and I ended up taking it
back
• There was nowhere to put food that couldn’t be distributed at the time
• No one let me on to the ward for ages when I arrived
• Staff didn’t know who was meant to be helping distribute the lunch
• Some of the orders were wrong when we arrived
Fishbone diagram
A systematic and structured method for identifying potential root causes of failures
– Classifies potential causes for a failure into
five basic separate categories (but you can also adapt these to suit your areas)
– Very logical and analytical method of
determining potential causes for failures
© AQuA Academy 36
Understanding the root cause 5 Whys
• To get to the solution you need to understand the root cause for the most significant direct causes
• This could take any number of “whys”
• Do not stop until you reach what you believe is a ‘cause’ and not a ‘symptom’
• If you reach a cause that cannot be controlled, such as weather, go back one level and see if eliminating that cause will help
© AQuA Academy 37
Complaints about
lunches
Methods Environment
People Equipment
Choices not collected
accurately
Menu cards not used
Dietary requirements
not fully understood
Patients not available
to receive not lunch
Not correctly positioned
Patients off-ward for
treatment / appointment
Staff not available
to dispense
lunches
Not all staff trained
Not lunch duty rota
Busy ward
Insufficient staff
Lunch not arriving
on time
Orders not sent early enough
Issues accessing
the ward Delivery time not
agreed
No social space to
eat lunch
Miscommunication
between ward and
catering
Food not a correct
temperature
No where to store
hot/cold food on ward
Food quality and
selection not good
Fixed supplier
Small ward – limited
facilities
© 2010 AQuA
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The Model for Improvement
A P
DS
Plan
DoStudy
Act
AIM: What are we trying to accomplish?
MEASURES: How will we know if a
change is an improvement?
CHANGE: What changes can we make
that will result in improvement?
© Associates for Process Improvement
Aim Statement
Good
Bad
Ugly
We aim to reduce harm and improve patient safety for all of our
internal and external customers.
By June of 2012 we will reduce the incidence of pressure ulcers in the
critical care unit by 50%.
Our outpatient testing and therapy patient satisfaction scores are in the
bottom 10% of the national comparative database we use. As directed
by senior management, we need to get the score above the 50th
percentile by the end of the 1st Quarter of 2012.
We will reduce all types of hospital acquired infections.
According to the consultant we hired to evaluate our home health
services, we need to improve the effectiveness and reliability of home
visit assessments and reduce rehospitalisation rates. The board agrees,
so we will work on these issues this year.
Our most recent data reveal that on the average we only reconcile the
medications of 35% of our discharged inpatients. We intend to increase
this average to 50% by 1/4/12 and to 75% by 31/8/12.
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Aim Statement Team name: ……………………….
• What are you trying to achieve? – ………………………..
• By how much? – ………………………
• By when? – …………………………..
• For whom? – …………………………………….
Aim statement
…………………………………………………………………………….
Adapted from
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Aim Statement • Team name: Lunch time – on time
• What are you trying to achieve? – Get the patients their lunch of choice on time everyday
• By how much? – 95% of lunches
• By when? – December 2015
• For whom? – Patient in Bay 1
• Aim statement
95% of patients in Bay 1 receive their lunch of choice every day by December 2015
Adapted from
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What changes can we make that will lead to an improvement?
• Knowledge
• Ideas
• Creativity
De Bono’s 6 Thinking Hats
Managing the thinking process: Could you summarise finding so far?
Information / data needs: What are the facts
Ideas: Is there a different way of looking at this?
Benefits / positives: Can we list them?
Negatives / risk: What can go wrong?
Emotion / gut feeling: What is your gut feeling?
Repeated use of the PDSA cycle
Testing and
refining ideas
Implementing new procedures & systems - sustaining change
Bright
idea!
Scottish Primary Care Collaborative
Borders GP Practice
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% o
f P
eo
ple
wit
h D
iab
ete
s
% of Diabetes Patients with a BP<140/80
Diabetes (blood pressure) Improvements with PDSAs
PDSAs to improve
shared diabetes
information with
Secondary Care
PDSA to contact all
Patients who have not
had a BP check in the
last year
PDSAs
PDSAs PDSAs
PDSAs to improve
current patient
recall system
PDSAs to
Validate
Diabetes
Register
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Analysis:
• 8 runs – can apply rules
• Shift aligned to new menu card process
New menu card process
Staff briefing
Create Multiple PDSA Ramps
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receptionist porters Nurses
Summary & Close
Contact AQuA Via
• The website at: www.advancingqualityalliance.nhs.uk
• Email at: [email protected]
• Phone AQuA on: 0161 206 8938
• @AQuA_NHS
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Thank you and ….
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