Quality Improvement Processes

A Rose By Any Other Name… A Rose By Any Other Name…

Basic Concept

• Quality Improvement Processes Quality Improvement Processes

• come in many shapes and sizescome in many shapes and sizes

• go by many different namesgo by many different names

• are marketed by many different sourcesare marketed by many different sources

• With a common goal…With a common goal…

• To improve and assure the safety, quality, and To improve and assure the safety, quality, and cost efficiency of health carecost efficiency of health care

Today’s Goal

• Our goal today is to lay the groundwork for Our goal today is to lay the groundwork for future training sessions regarding quality future training sessions regarding quality improvementimprovement

• We will get a taste of numerous methodologies We will get a taste of numerous methodologies and approached to quality improvementand approached to quality improvement

• One size does not fit allOne size does not fit all

• Quality improvement is a journey taken in Quality improvement is a journey taken in baby steps – not giant leapsbaby steps – not giant leaps

Common Quality Improvement Processes

• Model for ImprovementModel for Improvement• Rapid Cycle Quality ImprovementRapid Cycle Quality Improvement

• PDSAPDSA

• Human FactorsHuman Factors• Lean MethodologyLean Methodology

• 5S5S• Failure Modes and Effects AnalysisFailure Modes and Effects Analysis• Root Cause AnalysisRoot Cause Analysis

Exercise

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

Learning

• Do we all define the process in the same way?Do we all define the process in the same way?

• Did we assume steps without spelling them Did we assume steps without spelling them out?out?

• Did we all address the problem in the same Did we all address the problem in the same way, or were there variations in our processes? way, or were there variations in our processes?

Rapid Cycle Process Improvement

• A process improvement approach to evaluate A process improvement approach to evaluate change change

• This model allows for integration of new and This model allows for integration of new and existing systems.existing systems.

• This model promotes small scale rapid cycle This model promotes small scale rapid cycle change over short periods of time.change over short periods of time.

WHAT is the PDSA Cycle?

• A process improvement approach to evaluate A process improvement approach to evaluate change change

• This model allows for integration of new and This model allows for integration of new and existing systems.existing systems.

• This model promotes small scale rapid cycle This model promotes small scale rapid cycle change over short periods of time.change over short periods of time.

The PDSA Cycle for Learning and Improvement

PlanAct

DoStudy

- Objective- Questions and predictions (Why?)- Plan to carry out the cycle(who, what, where, when)

- Carry out the plan- Document problems and unexpected observations- Begin analysis of the data

- Complete the analysis of the data - Compare data to predictions - Summarize what was learned

- What changes are to be made?

- Next cycle?

What Do We Mean by Rapid Cycle Improvement?

• Let’s Let’s PLANPLAN The Perfect Peanut Butter and Jelly The Perfect Peanut Butter and Jelly Sandwich!!!!Sandwich!!!!

• What do we want to improve?What do we want to improve?

• What change should we test?What change should we test?

• What is our anticipated outcome?What is our anticipated outcome?

• TheorizeTheorize

What Do We Mean by Rapid Cycle Improvement? • Let’s Let’s DODO The Perfect PB & J Sandwich!!! The Perfect PB & J Sandwich!!!

• Put the theory into practicePut the theory into practice

• Map the new planMap the new plan

• Carry out the change on a small scale or pilot Carry out the change on a small scale or pilot basisbasis

• Evaluate change with qualitative and Evaluate change with qualitative and quantitative dataquantitative data

What Do We Mean by Rapid Cycle Improvement?

• Let’s Let’s STUDYSTUDY The Perfect PB & J Sandwich!!! The Perfect PB & J Sandwich!!!

• Evaluate and determine the degree of success.Evaluate and determine the degree of success.

• Determine what, if any, modifications are Determine what, if any, modifications are required.required.

What Do We Mean by Rapid Cycle Improvement?

Let’s Let’s ACT ONACT ON The Perfect PB & J Sandwich!!! The Perfect PB & J Sandwich!!!AdoptAdopt

by testing on a larger scale in a new cycleby testing on a larger scale in a new cycleAdaptAdapt

based on lessons learned from the testbased on lessons learned from the testAbandonAbandon

By trying something differentBy trying something different

The PDSA Cycle for Learning and Improvement

PlanAct

DoStudy

- Objective- Questions and predictions (Why?)- Plan to carry out the cycle(who, what, where, when)

- Carry out the plan- Document problems and unexpected observations- Begin analysis of the data

- Complete the analysis of the data - Compare data to predictions - Summarize what was learned

- What changes are to be made?

- Next cycle?

Repeated Use of the Cycle

Hunches Theories Ideas

Changes That Result in Improvement

A P

S D

APS

D

A P

S DD S

P ADATA

PDSA

• Allows you to test your theory on a few Allows you to test your theory on a few patients patients

• It may take several PDSA cycles and several It may take several PDSA cycles and several months to get your process manageable. months to get your process manageable.

• That’s OK! That’s OK!

Use the PDSA Cycle for:

1.1. Testing or adapting a changeTesting or adapting a change

2.2. Implementing an improvementImplementing an improvement

3. Spreading the improvements to the rest of 3. Spreading the improvements to the rest of your organizationyour organization

PDSA Cycles Must Be:

• ActiveActive

• Quickly plan and make process changesQuickly plan and make process changes

• IterativeIterative

• Cycle after cycleCycle after cycle

• LearningLearning

• Take time to study effects of your actionsTake time to study effects of your actions

Human Factors

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

In Other Words…

• Human Factors is about how the Human Factors is about how the designdesign of of things impacts how well we do any task.things impacts how well we do any task.• Design of our workplaceDesign of our workplace• Design of the tools we useDesign of the tools we use• Design of processes (how we do things Design of processes (how we do things

around here)around here)

Is This the Same Old Thing?

• No!No!

• Human Factors is Human Factors is complementarycomplementary to what you are to what you are already doing to improve health carealready doing to improve health care

• Human Factors will make your improvement efforts Human Factors will make your improvement efforts more efficient and effectivemore efficient and effective

• There is a Human Factors concept behind every There is a Human Factors concept behind every successful improvement effortsuccessful improvement effort

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

Talk About Human Factors!!!

Human Factors and the Model for Improvement

Plan

Study Do

Act

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!

Lean Methodology• It’s all about:It’s all about:

• Waste and ValueWaste and Value

• Always challenging processes toAlways challenging processes to

• Produce better outcomes for customersProduce better outcomes for customers

• Create more value with less wasted time, Create more value with less wasted time, effort, and resourceseffort, and resources

• Speed delivery while reducing costSpeed delivery while reducing cost

• Lay less burden on the people doing the Lay less burden on the people doing the work.work.

5S

• 5S is a philosophy and a way of organizing and 5S is a philosophy and a way of organizing and managing the workspace. managing the workspace.

• The key impacts of 5S is upon workplace morale and The key impacts of 5S is upon workplace morale and efficiency. efficiency. • By ensuring everything has a place and everything is By ensuring everything has a place and everything is

in its place then time is not wasted looking for things in its place then time is not wasted looking for things and it can be made immediately obvious when and it can be made immediately obvious when something is missing. something is missing.

• The real power of this methodology is in deciding what The real power of this methodology is in deciding what should be kept and where and how it should be storedshould be kept and where and how it should be stored

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 efficiencyand safety.

Failure Mode Analysis

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

Failure Mode Analysis

FMEA includes review of the following:FMEA includes review of the following:

Steps in the processSteps in the process• Failure modes (What could go wrong?)Failure modes (What could go wrong?)• Failure causes (Why would the failure happen?)Failure causes (Why would the failure happen?)• Failure effects (What would be the consequences of Failure effects (What would be the consequences of

each failure?)each failure?)

Continued

Root Cause Analysis

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

RCA Tools

• The 5 Whys?The 5 Whys?

• AppreciationAppreciation

• Drill DownsDrill Downs

• Cause and Effect Diagrams (Fishbone Cause and Effect Diagrams (Fishbone Diagrams)Diagrams)

Success““There are no secrets to success. It is the There are no secrets to success. It is the

result of preparation, hard work, and result of preparation, hard work, and learning from failure.”learning from failure.”

General Colin L. PowellGeneral Colin L. Powell

Quality Improvement Quality Improvement is a is a Process, Process, not an not an EventEvent

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