11/14/2012 Public Health Quality Improvement 101 Public Health - PDF document

11/14/2012 Public Health Quality Improvement 101 Public Health Quality Improvement 101 Learning, Experiencing, & Doing Quality Improvement Learning, Experiencing, & Doing Quality Improvement Workshop 2 Workshop 2 November 14th, 2012 Welcome! 2 Congratulations…you’re paving the way for improvement in NC Public Health! 1

11/14/2012 Objectives of Workshop 2 • Reflect on experience, celebrate successes, and share lessons learned • Gain a deeper understanding of how to use QI tools and methods • Equip teams to calculate ROI E i t t l l t ROI • Discuss strategies to overcome barriers/challenges • Develop a plan to sustain QI project and spread QI 4 Workshop 2: Agenda • Today’s Focus: Celebrate and Re ‐ Connect – Putting the Pieces Together – QI Tool Time – Share Your Improvement Stories • Tomorrow’s Focus: Sustaining – Share Your Improvement Stories – Holding What You Gained: Sustaining Improvements – Return on Investment (ROI) Calculation – Problem Solving to Resolve your QI Issues 5 Workshop 2: Agenda • Friday’s Focus: Preparing to Return Home – Spreading Improvements to Others – Team Planning Time – Wrap ‐ up 6 2

11/14/2012 Workshop Overview Workshop Overview Guiding Principles/Ground Rules – Participation is essential – Agenda as a guide – “Share seamlessly and steal shamelessly” – Silence your cell or blackberry 7 Housekeeping Items Housekeeping Items • Meeting Space Layout • Take Breaks as Needed • CEU Credits • Feedback – “Bright Ideas” Cups • Questions – Green Index Cards • Course Handouts 8 Introductions Introductions 9 3

11/14/2012 Hopes and Hesitations Hopes and Hesitations Write on an index card : • One Hope you have for the Workshop • One Hesitation you have about the Workshop HOPE HESITATION 10 Assignment: Newspaper Headline Assignment: Newspaper Headline Each team is paired with a partner team (Look on inside of your tent card) Instructions: Instructions: – Listen to your partner team’s report out – Create a headline to summarize their experience – Think of a picture to accompany the headline 11 CH Nurse Consultants CH Nurse Consultants Created by Scotland County Created by Scotland County “Dreaming for Rainbows, the NC Child Health ‘Bright Futures’ Program is Following the Yellow Brick Road” 12 4

11/14/2012 Public Health Quality Improvement 101 Public Health Quality Improvement 101 Putting the Pieces Together Presenter: Claire See& Kerri Ward 13 Where You’ve Been Where You’ve Been GETTING STARTED Select a QI Project Assemble a QI Team THE MODEL FOR IMROVEMENT (The QI Roadmap) What are we trying to accomplish? AIM How will we know that our changes H ill k th t h are an improvement? MEASURES What changes can we make that will result in an improvement? TEST ideas with IDEAS P lan ‐ D o ‐ S tudy ‐ A ct cycles for learning & improvement SPREAD and SUSTAIN change ideas that are successful CONTINUOUS QI (Big QI) Creating a Culture of QI  Create the urgency for improvement  Remove obstacles, train and empower staff  Form a quality council  Prioritize and create early wins  Create a vision for improvement  Build on successful projects  Communicate the vision  Hardwire quality into your culture and strategic plan QI Projects (Small qi) What are we trying to accomplish?  Aim Statement  Charter (AIM) Collect Data  Measurement Plan  Gemba Walk How will we know that a change is an improvement?  Customer/Staff Surveys (MEASURES) Display Data K  Run Chart nt A Model for Improvemen I Understand Current Condition Z  Gemba Walk  Pareto Chart E  Value Stream Map  5 Whys N QI Tools  Spaghetti Diagram  Fishbone Diagram  Swim Lanes E What changes can we make that Identify Change Ideas V will result in an improvement?  8 Wastes (DOWNTIME) E (IDEAS)  Evidence Based Guidelines N  General Change Concepts T  Feedback from Clients/Staff Prioritize Change Ideas  Impact Matrix (PACE Chart) TEST IDEAS  PDSA Cycles IMPLEMENT/SUSTAIN/SPREAD  Sustainability and Spread Checklists  PDSA Cycles 5

11/14/2012 QI Style QI Style QI Style QI Style 16 Team Song Title Team Song Title ‐ Wake Wake • Share Your: – Health Department Name – Team Aim – Team Song Title (or song) • Why did you choose this song title? 17 Team Song Title Team Song Title ‐ Albemarle Albemarle • Share Your: – Health Department Name – Team Aim – Team Song Title (or song) • Why did you choose this song title? 18 6

11/14/2012 Team Song Title Team Song Title ‐ Columbus Columbus • Share Your: – Health Department Name – Team Aim – Team Song Title (or song) • Why did you choose this song title? 19 Break Time... Break Time... 20 Public Health Quality Improvement 101 Public Health Quality Improvement 101 QI Tool Time Presenter: Gene Smith & Amanda Cornett 21 7

11/14/2012 Session Objectives Session Objectives • Briefly review previously introduced tools and concepts thru question and answer • Introduce and use new tools and concepts • Discuss how to apply new tools to current QI project Industrial Extension Service 22 www.ies.ncsu.edu New Tools New Tools • Spaghetti Diagrams • Layout Design • Functional Flowchart/Swim Lanes Chart • Kanbans Spaghetti Diagram Spaghetti Diagram A layout showing equipment and personnel and their movement through the area RN Flow Patient Flow Scale Drug g Supplies Supplies Samples Room Central Nurses Station Dr. Office Dr. Procedure Room Flow Exam Exam Exam Room Room Room 8

11/14/2012 Spaghetti Diagram ‐ Travel Distances Before = 662 steps and 16 stops After = 252 steps and 13 stops p Waiting Room Trips went from 5 down to 3. Functional Flowchart (AKA Swim Lanes) Functional Flowchart (AKA Swim Lanes) Mail Room Process Courier Bring cages Start into mailroom Unload bins from cages Slice thin & small Put envelopes in Sorter envelopes on trays & pull out Sort the thicks machine labels from the thins & the smalls S Count thick C t thi k Put envelopes on P t l envelopes, labels the shelf and stack Extractor Thick opened manually, sorted by type Pick up tray Put claims in from shelf, go trays by type Thin envelopes have to desk claims extracted & sorted Lead Pick up trays & QC each take trays to End place on cart tray input prep Value Add Non-Value Add Industrial Extension Service 26 www.ies.ncsu.edu The Pizza Place: Current State Scenario 27 9

11/14/2012 Spaghetti Diagram Scenario Spaghetti Diagram Scenario • Draw a Spaghetti Diagram for the work flow at our Pizza Place • Draw a Swim Lane Chart for the work flow at our Pizza Place The Pizza Place Current State Layout Functional Flowchart AKA Swim Lane Chart Functional Flowchart AKA Swim Lane Chart 10

11/14/2012 Tips for Layout Design Tips for Layout Design Basics to improve flow: • Keep continuous flow concept as a focus when designing a new layout. • Physical location of work stations and/or equipment should correspond to work sequence. equipment should correspond to work sequence. • Identify facility constraints (electrical outlets, etc.) • Determine which staff need access to which equipment. Tips for Layout Design – cont’d Tips for Layout Design cont’d Basics to improve flow: • U ‐ Shaped or C ‐ Shaped (aka cellular) designs are often most efficient in Lean. • Test layout designs to make sure they’re working. • Establish pre and post measurements to p p document flow improvements. • Do not create a layout that cannot be changed. Flow & Layout Flow & Layout Before After 11

11/14/2012 Layout Layout – Future State Exercise Future State Exercise Instructions • Review the current state of The Pizza Place’s layout • Apply layout design principles and design the future state layout • Create the future state using a flip chart and post ‐ its Create the future state using a flip chart and post its • List measures that would show if improvements were made to the layout • Create a future state swim lane chart for your new layout The Pizza Place Future State Layout Before After 12

11/14/2012 Functional Flowchart AKA Swim Lane Chart Functional Flowchart AKA Swim Lane Chart Kanban System Kanban System • Visual signal • Creates a “pull” of material • Can be a card, tag, folder, empty slot, vacant location designated and located on the floor, email, line on a container, th fl il li t i a container, etc. • Must be accompanied by standard work Kanban for Supplies Kanban for Supplies 13

11/14/2012 Example of a 2 bin system and layout changes in healthcare ‐ Play video Industrial Extension Service 40 www.ies.ncsu.edu One Point Lesson One Point Lesson Team Report Team Report ‐ Outs Outs 42 14