how to design a quality improvement project kendiss olafson md frcpc mph assistant professor section...
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How to Design a Quality Improvement Project
Kendiss Olafson MD FRCPC MPHAssistant ProfessorSection of Critical CareUniversity of Manitoba
What is Quality Improvement?
• Quality improvement is a formal approach to the analysis of performance and systematic approach to improving it.
Institute of MedicineTo Err is Human (1999)• Brought issue of patient safety and medical
errors to for front• 2% of all deaths are due to preventable
medical errorsCrossing the Quality Chasm (2001)• Urgently calls for changes to health care
processes to improve quality of care• Sets up framework for healthcare quality
improvement• Brings importance of patient and family
centered healthcare to frontline
Quality Improvement versus Research
Traditional Research• Goal is to attain new
generalizable knowledge
• Trial new methods• Data for publishing
Quality Improvement• Goal to improve care• Based in established
knowledge and applying this to local site
• Data internal use (usually but not always)
How to Design a Quality Improvement Project
1) Identify Gap in Care
Quality of Care Indicators (STEEPS)SAFE • Hospital Acquired Infections (VAP,
C. Dificle, CLI, Post-op Infection)• Medication Errors
TIMELY • Waiting times (See specialist, start chemo)
EFFECTIVE • Patient Mortality• Organ Donation rates• ASA use post MI
EFFICIENT • Hospital LOS• Health care Costs
PATIENT-CENTERED (FAMILY CENTERED)
• Patient/Family Satisfaction
STAFF WORKLOAD • Staff turnover and burn out
How to Design a Quality Improvement Project
1) Identify Gap in Care2) Review Literature – Identify
Evidence based practices
Use Pre-existing Bundles and Toolboxes
How to Design a Quality Improvement Project
1) Identify Gap in Care2) Review Literature – Identify
Evidence based practices3) Quality Improvement Tools
Quality Improvement Strategies• Continuous Improvement (PDSA)• Total Quality Management• Six Sigma• Lean
Quality Improvement Tools• Process map• Cause-Effect Diagram• Pareto Chart• Control Charts
• Scatter Diagram• Fishbone Diagram• Decision Matrix
Strategies and tools to help organize, analyze and impact change within a process
Develop protocols and Bundles of Care
Educate and Engage
Reminders and Forced
Function
• Antibiotic Auto-stop• Automatic orders• Surgical Checklists
Address Infrastructure
• Workplace Design• Equipment• Human Resources
Audit and
Feedback
How to Design a Quality Improvement Project
1) Identify Gap in Care2) Review Literature – Identify
Evidence based practices3) Quality Improvement Tools4) Measuring Impact
Quality Improvement StudiesChallenges to Measuring Impact
• Involves Healthcare Systems and Health Care Delivery Not just single intervention– Randomized Controlled trials of Health care
systems• Multiple interventions are tested over time
– Empiric Research with repeated measurements over time
Traditional Medical Research
Data collection Data collection
Time
Measure Outcome
Measure Outcome
Inte
rven
tion
MeasureDifferences
in Outcomes
Time Consuming
Expensive
Only One intervention tested
Quality Improvement Model
Data collection and Measuring Outcomes
Time
Measure Difference
Inte
rven
tion
Measure Difference
Inte
rven
tion
Measure Difference
Inte
rven
tion
HOW ?
Statistical Process Control
• Statistical Process Control measures the variation associated with the outcome of a process
Process required to make a nut and bolt
Process required to make a sick person well
Manufacturing
Healthcare
Statistical Process Control
• Differentiate common cause variation from extraordinary variationGoal is to optimize outcomes:• Identify extraordinary variation early and act on it• Limiting variation associated with a process
Process required to make a sick person well
Type of Illness
Severity of Illness
Co-morbidities
Demographics
Health Care Workers
Resources
Treatment given
Complications occurringVariation in Outcomes
Creating a Quality Improvement Project
1) Identify Gap in Care2) Review Literature –
Identify Evidence based practices
3) Quality Improvement Tools
4) Measuring Impact