July 20, 2016 These presenters have nothing to disclose Leading Quality Improvement Essentials for Managers Lesson 5: Practice Improvement Essentials Janet Porter, PhD Kathy Duncan, RN
Rhonda Dickman, RN, MSN, CPHQ Rhonda Dickman is a Quality Improvement Specialist with the Tennessee Hospital Association’s Tennessee Center for Patient Safety, supporting hospitals in their quality improvement work, particularly in the area of readmissions. She is also the clinical manager of the Tennessee Center for Patient Safety’s PSO (patient safety organization). Rhonda has worked in the field of hospital quality management since 2006 and has a clinical background in trauma, critical care, oncology, and organ donation. rdickman@tha.com 615-401-7404
3 Attendance Chat name and organization into the chat box Email Rhonda Dickman that you attended – rdickman@tha.com Log in to the webinar using your username and password: – User name: email address used to register – Password: the password you set up when you registered
4 Lead Faculty Kathy D. Duncan, RN , faculty, Institute for Healthcare Improvement (IHI), directs IHI Expeditions and manages IHI's work in rural settings. Previously, she provided spread expertise to Project JOINTS, co-led the 5 Million Lives Campaign National Field Team, and was faculty for the Improving Outcomes for High Risk and Critically Ill Patients Innovation Community. She also served as the content lead for the Campaign's Prevention of Pressure Ulcers and Deployment of Rapid Response Teams areas. She is a member of the Scientific Advisory Board for the AHA NRCPR, NQF's Coordination of Care Advisory Panel, and NDNQI's Pressure Ulcer Advisory Committee. Prior to joining IHI, Ms. Duncan led initiatives to decrease ICU mortality and morbidity as the director of critical care for a large community hospital.
5 Supporting Faculty Janet Porter, MBA, PhD , serves as consultant to hospitals and physician practices for Stroudwater Associates. She has 35 years of experience as a hospital administrator, teacher, consultant, and public health leader. Dr. Porter served as the Chief Operating Officer of Dana- Farber Cancer Institute; the Associate Dean of Executive Education at the University of North Carolina’s School of Public Health; the Interim CEO of the Association of University Programs in Health Administration (AUPHA); and the Vice President, and then COO, of Nationwide Children’s Hospital in Columbus, Ohio. Currently teaching strategic management in the Healthcare Executive MBA program at the University of Miami, she is also an active adjunct professor at the University of North Carolina at Chapel Hill and Ohio State University. Dr. Porter received her BS and MHA from Ohio State University, and her MBA and PhD in health care strategy from the University of Minnesota.
Tennessee Leading Quality Improvement: Management Essentials Course Leading Change/Influencing Others - Session 2 June 8 JP Manage the Work Time Management – Session 3 June 22 JP Build the Project Management – Session 4 July 6 JP skills and capabilities Patient and Family Engagement – Session 1 May 25 JP needed to lead quality improvement Practice Improvement Essentials – Session 5 July 20 KD Manage Improvement efforts at the middle Identify and Spread Improvement - Session 6 August 3 KD manager level of an Incorporating Finance in Improvement– Session 7 August 17 organization Building and Creating Joy in Teams – Session 8 August 31 KD Develop Teams Leveraging Teams with Partners – Session 9 Sept 14 JP
7 Practice Assignment For a current project or past project, ask yourself? – What has gone well? What could have gone better? What have you learned? – What would you do differently next time? Volunteers: – Paige Barnes, Marshall Medical Center
8 Today’s Objectives Apply the Model for Improvement to at least one improvement opportunity. Use a PDSA cycle to test at least one change Identify which team members you need to engage in a specific test of change Demonstrate how to analyze data over time using a run chart and run chart rules
9 Reflection Video: Model For Improvement Part 1 (2:55) and Part 2 (3:00) Video: PDSA Cycles Part 1 (4:45) and PDSA Cycles Part 2 (3:48) IHI Open School: The human side of Quality Improvement
Model for Improvement Aim of I mprovement What are we trying to accomplish? Measurement How will we know that a of change is an improvement? I mprovement What change can we make that will result in improvement? Developing a Change Act Plan Testing a Change Study Do Adapted from Langley, G. J., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, CA: Jossey-Bass, 1996.
4 Components of an Aim Statement State the aims clearly (What do you want to accomplish? How good, by when?) Define location or population Set stretch goals Include numerical goals/targets 11
Model for Improvement Aim of I mprovement What are we trying to accomplish? Measurement How will we know that a of change is an improvement? I mprovement What change can we make that will result in improvement? Developing a Change Act Plan Testing a Change Study Do Adapted from Langley, G. J., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, CA: Jossey-Bass, 1996.
Three Types of Measurement Outcome Measures – Voice of the customer or patient. How is the system performing? What are the results? Process Measures – Voice of the performance of the process or system. Are the parts/steps in the system or process performing as planned? Balancing Measures – Looking at a system from different directions or dimensions. What happened to the system as we improved the outcome and process measures? (e.g. unanticipated consequences, other factors influencing outcome). Don’t “rob Peter to pay Paul”
Key Points of Measurement The purpose of measurement in Improvement is for learning not judgment! All measures have limitations, but the limitations do not negate their value for learning. Measures tell a story; goals or targets provide a reference point to evaluate performance. These measures should operationalize the Aim Measures should be integrated into the team’s daily routine Data should be plotted over time on annotate graphs Focus on the Vital Few
Model for Improvement Aim of I mprovement What are we trying to accomplish? Measurement How will we know that a of change is an improvement? I mprovement What change can we make that will result in improvement? Developing a Change Act Plan Testing a Change Study Do Adapted from Langley, G. J., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, CA: Jossey-Bass, 1996.
Where might you find changes? 16
What Changes Can We Make? Understanding the System Primary Secondary Process Outcome Drivers Drivers Changes Change 1 S. Driver 1 P. Driver Change 2 S. Driver 2 Aim: An Change 3 improved system S. Driver 3 P. Driver S. Driver 1 S. Driver 2
What can a driver Diagram do for you? 18
19 Driver Diagram A Driver Diagram is an improvement tool used to organize theories and ideas in an improvement effort. It displays visually, our theory about potential areas we can leverage to change the status quo. The driver diagram is often used to scope or size a project and to clarify the plan for reaching the aim. Primary Drivers: major processes, operating rules, or structures that will contribute to moving towards the aim Secondary Drivers: elements or portions of the primary drivers. The secondary drivers are system components necessary in order to impact primary drivers, and thus reach project aim. Specific Ideas to Test or Primary Drivers Secondary Drivers Change Concepts Specific changes /Change concepts: D1 Specific changes are concrete actionable AIM ideas to take to testing. Change concepts D2 are broad concepts (e.g. move steps in the process closer together) that are not D3 yet specific enough to be actionable but which will be used to generate specific ideas for change. D4 D5
Driver Diagram Basics Specific Ideas to Test or Primary Drivers Secondary Drivers Change Concepts D1 AIM D2 D3 D4 D5 20
Driver Diagram Basics Specific Ideas to Test or Primary Drivers Secondary Drivers Change Concepts D1 AIM A good aim: 1) D2 Identifies the system to be improved (scope, D3 patient population, drivers selected) 2) Has specific D4 numerical goals and 3) Includes D5 timeframe 21
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Driver Diagram Basics Specific Ideas to Test or Change Concepts Primary Drivers Secondary Drivers Primary Drivers: D1 AIM Major processes, operating rules, or D2 structures that will contribute to D3 moving towards the aim D4 D5 23
Robin Zudell Queen of the Valley MC 24
Driver Diagram Basics Specific Ideas to Test or Change Concepts Primary Drivers Secondary Drivers D1 AIM Secondary Drivers: Elements D2 or portions of the primary drivers. The secondary D3 drivers are system components necessary in order to impact primary D4 drivers, and thus reach project aim. D5 25
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