quality imporvement

Quality Improvement

Mohamed Hany Kamel, MRCGP, MHPE MD, TQMD, DHHM

The best comment!!!

3 HCS-Mohamed Edrees

What is Quality?

Satisfying customer needs, product features

Freedom from deficiency, lowest possible cost

What is Quality improvement?

It is the use of captured metrics, and lessons

learnt to continually improve quality

Juran trilogy diagram

Why has it happened?

The changing

business

conditions urges

the need for

adopting new

trends of quality

The Dual nature of medical quality

(perceptions!)

Content quality

clinical expertise and technical aspects of

healthcare (diagnosis, carrying out procedures)

Most patients assume that providers possess and deliver technical

quality

Delivery/service quality

interpersonal components of care (e.g., empathy and

communication) and to how well the patients’

requirements and expectations are being

met (e.g., access, timely billing)

Where to start to improve

quality?

A global role

Failure to provide quality

%15

due to faults related to

individuals

%85

faults in the management-

controlled systems and processes

Self-control

1- focus on health outcomes: Measurable

improvements, focusing on real challenges

2- practice leadership at all levels

3- you can learn to lead: facing challenges, receiving

support and feedback

4- Leadership is learned overtime

5- Sustain progress through management systems:

integrate into the routine system

Principles of developing MWL

Think of something that you have

accomplished in your life that you are

proud of, something that was a

challenge for you and for which you had

to overcome big obstacles.

Do you notice how in each case there was a shift from seeing something as a problem (for someone else to solve), to taking it up as a personal challenge?

A problem is “out there” and often blamed on

external forces.

A challenge is something you own and take on.

1- With your team review mission & strategic objectives

2- Create a shared vision that inspire team to face a new challenge

3- Agree on one measurable result that will move you closer to one aspect of vision

4- Assess current situation (scanning)

5- Identify obstacles & Select priority actions

7- Develop an action plan and implement

From vision to action

Mission and Vision

Personal mission

Each of us brings a contribution.

We know that when we are present, something

unique is brought to the situation.

For example, some people bring humor, others bring

order, and some bring clarity.

Think for a minute about a time when you felt you

were really contributing. What did you bring to the

situation?

Take a minute and write that down. Next, use what

you wrote to figure out a mission for yourself in the

workplace

Personal mission

Why is it important to have a mission?

Does it give you clarity about what to do and where

to spend your energy?

Being clear about your purpose helps you to focus.

Why does an organization need a

mission?

Only when health workers are aware of the

organizational mission, or ultimate purpose, will they

fully understand the meaning and the value of their

efforts.

Most organizations already have a mission

statement, but these statements are often neglected

or taken for granted by the staff

Constructing the mission statement

1. What do we do?

define the needs of the populations to be served and

specify which of those needs the organization intends to

address.

2. Whom do we serve?

define the target population.

Constructing the mission statement

3. How do we do it?

the means, resources, or strategies by which the

organization intends to reach its goals.

4. Why do we do it?

the basic reasons behind the organization’s decision to do

what it does.

A well-framed mission will guide your organization’s

work over the long term and inspire your staff.

The team will want to take the time to refine the

language, asking for the opinions of staff who know

the organization well.

Then you can finalize and disseminate the mission

statement to staff and board members, those who

are served by the organization, and the general

public.

Mission statements

Does it clearly state what you do? (What business you

are in )

Does it clearly state who you serve?

Does it describe your setting?

Is it broad enough so that all staff in the organization

can see how they contribute?

Will it make sense to average citizen if they see it on

the wall?

Will you be impressed if you see it on the front page of

the newspaper?

Mission Vs. vision

•A mission states why something exists.

•A vision is a picture of a desired future. It describes where

the group or the organization wants to be in the future. It

includes an image that you can see in your mind

PERSONAL VISION

Humans have a wonderful ability to create things in

our minds, to dream, and to imagine the future.

Unfortunately, people can misuse this capacity by

imagining the worst possible outcomes.

Most good outcomes in the world were first imagined

by someone.

In order to play a role in creating the future, you must

first imagine what you want to happen.

A vision is a picture we create in our

mind of a desirable future toward

which we can begin to act.

Exercise

Relax and think about yourself two years from now.

Imagine what you most want. Nothing will get in your

way or stop you. If anything were possible, what

would you really want to see?

You can close your eyes if it helps you to visualize.

Reflection

Organizational Vision

Where are we going? It is the moment to dream, to decide what your

organization wants to be in the future and how it

wants to be viewed by the outside world.

Vision

It is a powerful picture of a desired state that

provides a broad perspective and inspiration to keep

working, overcome obstacles, and struggle to

achieve results.

What experts say about vision

■ Burt Nanus (1986) says, “the vision is a realistic,

believable, and attractive future for your

organization…. such a motivating idea that it

promotes the necessary skills, talents, and

resources to make it happen and points out the way

we intend to follow.”

■ For Jay Conger (2000), the vision is a mental image

that represents a desirable future state, ideal, or

dream with a vast scope.

It should be

Tangible and descriptive

an image of the future that people can easily visualize.

Compelling and inspiring

a powerful call to action.

Challenging enough to demand the best efforts of

everyone in the organization

Achievable so that people will work toward it.

Constructing the statement

Step 1. Keep the big picture in mind.

Refer to your organization’s mission and the population you are supposed to serve so that the vision aligns with the mission.

Step 2. Answer the following questions:

What will our organization look like in three to five years?

What aspects of the mission will we have achieved and in what areas will we excel?

What will make us most proud? (e.g., the health status of our beneficiaries, the quality of our services, the commitment and creativity of our staff, the financial stability of our organization).

What values do we uphold, and how will they be reflected in our services and the way we run our organization?

Write down the answers to each of these questions and come to a consensus within your team.

Constructing the statement

Step 3. Look at your organization through the eyes of your target population, beneficiaries, donors, partners, collaborators, competitors, and society in general. For each of these groups, ask: How do we want these groups to see our organization in three

to five years?

What will they say about our services?

What will they say about our staff?

What will they say about our reputation in their communities?

Write down the answers to these questions and come to a consensus within your team.

Step 4. Translate these ideas into a few sentences that describe the desired future in a concrete manner,

Visions are often stated in the present tense

Review the shared vision and pick one

aspect it to put into action.

What would be a compelling, measurable result that

would indicate you are moving in the direction of the

shared vision?

Lets try to make it SMARTer

Is it an absolute challenge? ◦ we will totally solve the problem - such as immunizing all children

in our area

or is it a relative challenge? ◦ we will make some improvement towards solving the problem -

such as holding special immunization days through which we can

reach 60% of all children in our area

The desired result needs to be specific enough so that it

can be measured by a frequency, a percent or a number.

SMART

Specific — clearly written and understood

What are the indicators to monitor progress and

evaluate results?

What are the data sources needed to measure your

indicators?

The desired performance must be framed in terms that

are measurable

Measurable — we can monitor progress

towards results

Can your team affect the results given your level in the

organization?

Are there actions your team can take to meet your

selected challenge?

Do these actions contribute to the health outcomes you

want to impact?

Are there any conflicting needs or interests in your

organization that may affect your results?

The desired result must be appropriate to the goals of

your team and to the mission of your organization

Appropriate — to the scope of your program

or work activities

Ask your manager and other key stakeholders if this

challenge is something that your team can and

should be working on.

Can the action plan be carried out with the resource

available to the project?

You can realistically achieve the desired results in the

time you have planned.

Realistic — achievable and within your

control

Can you achieve the results in the time you have

planned?

If the result will take more time than you have

planned, you may consider selecting another

challenge.

There is a specific time period for achieving the

desired results.

Time bound — with a specific time period for

completion

What do you have to scan in order to better

understand the current situation as it relates to the

result you want to achieve?

People’s health care needs

Service statistics

Goals of your organization

National priorities

Resource usage and needs

Your team members’ strengths, needs, and concerns

Select one of the desired measurable

results that a team formulated

Why aren’t you already there?

What is blocking the way to this result?

Select obstacles for this exercise that are in your

control, not outside your control

Write them down to your challenge model

Priority matrix

Now that you have identified your mission, vision,

measurable result, current situation, and obstacles

together with their root causes, you can define your

challenge and add it to your Challenge Model.

Then you can define actions to address your

challenge.

write a challenge statement.

Begin each challenge statement with

“How will we achieve X result…in the face of Y

obstacles…?”

- In your teams brainstorm actions for each of the root

causes that you identified.

- We cannot possibly do everything.

- What are the criteria that we are going to use to

prioritize our decisions?

Example Criteria

(Rate from 1 to 3)

Priority actions

Train counselors

Conduct

community

education

seminars

Renovate clinics

Time to implement

(1 = the most time)

(3 = the least time) 2 2 1

Cost to implement

(1 = the most cost)

(3 = the least cost) 2 3 1

Potential for improving

quality in the long term

(1 = the least potential)

(3 = the most potential) 3 2 2

Capacity to implement

(1 = the least available)

(3 = the most available) 1 3 1

Totals 8 10 5

With your team use the priority matrix to choose the

best actions

Finish your challenge model now and share the

selected actions with the group

quality imporvement

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