Quality ImprovementQuality ImprovementMaria Diaz, MDMaria Diaz, MD

Pediatric Ambulatory CarePediatric Ambulatory CareSt. Barnabas HospitalSt. Barnabas Hospital

10-28-200910-28-2009

OverviewOverviewDefinitionsDefinitionsAims for improvement in health careAims for improvement in health careWhy is QI important for residents ?.Why is QI important for residents ?.Benefits of QI projects.Benefits of QI projects.How to start a QI project.How to start a QI project.Model for Improvement.Model for Improvement.PDSA cycle.PDSA cycle.Examples of success using QI.Examples of success using QI.References.References.

DefinitionsDefinitions

QualityQuality: Meeting the needs and : Meeting the needs and exceeding the expectations of those exceeding the expectations of those we serve. Delivery all and only the we serve. Delivery all and only the care that the patient and family care that the patient and family needs.needs.

DefinitionsDefinitions

Improvement: Improvement: It is not,It is not,– Yelling at people to work harder, faster, Yelling at people to work harder, faster,

or safer.or safer.– Creating order sets or protocols and Creating order sets or protocols and

then failing to monitor their use or then failing to monitor their use or effect.effect.

– Traditional QA.Traditional QA.– Research (but they can co-exist nicely)Research (but they can co-exist nicely)

DefinitionsDefinitions

Healthcare Quality ImprovementHealthcare Quality Improvement: : is the body of knowledge, attitudes, is the body of knowledge, attitudes, and skills necessary to efficiently and skills necessary to efficiently influence and continuously improve influence and continuously improve the multiple elements of care the multiple elements of care delivery within a medical practice.delivery within a medical practice.

Six specific aims for improvement.Six specific aims for improvement.Health care should be:Health care should be:

SafeSafe:: Avoid injuries to patients from the Avoid injuries to patients from the care that is intended to help them. care that is intended to help them.

Effective:Effective: Avoid overuse of ineffective Avoid overuse of ineffective care and underuse of effective care. care and underuse of effective care.

Patient-Centered:Patient-Centered: Providing respectful, Providing respectful, responsive, individualized care.responsive, individualized care.

Six specific aims for improvement.Six specific aims for improvement.Health care should be:Health care should be:

Timely:Timely: Reducing waits and harmful Reducing waits and harmful delays in care.delays in care.

Efficient:Efficient: Avoiding waste of equipment, Avoiding waste of equipment, supplies, ideas and energy. supplies, ideas and energy.

Equitable:Equitable: Providing equal care Providing equal care regardless of personal characteristics, regardless of personal characteristics, gender, ethnicity, geographic location, and gender, ethnicity, geographic location, and socio-economic status. socio-economic status.

The Goal for Quality improvement The Goal for Quality improvement in health care is TO PROVIDE THE in health care is TO PROVIDE THE RIGHT CARE FOR EVERY PATIENT, RIGHT CARE FOR EVERY PATIENT, EVERY TIME!!EVERY TIME!!

Why is Quality Improvement Why is Quality Improvement important for YOU???important for YOU???

Why should you care? Why Why should you care? Why WE care?WE care?

One of the Competencies: Practice One of the Competencies: Practice Based Learning and ImprovementBased Learning and Improvement

Residents must be able to Residents must be able to investigate and evaluate their investigate and evaluate their patient care practices, appraise and patient care practices, appraise and assimilate scientific evidence, and assimilate scientific evidence, and improve their patient care practices.improve their patient care practices.

Benefits of resident involvement in Benefits of resident involvement in Quality Improvement.Quality Improvement.

Patient care outcomesPatient care outcomes

Resident learning and professional Resident learning and professional developmentdevelopment

Resident engagement and Resident engagement and satisfactionsatisfaction

Faculty and other team member Faculty and other team member engagement and satisfaction.engagement and satisfaction.

How do I start a QI project?How do I start a QI project?

Model for ImprovementModel for ImprovementThe model has two parts:The model has two parts:

1.1. Three fundamental questions, which Three fundamental questions, which can be addressed in any order. can be addressed in any order.

2.2. The Plan-Do-Study-Act (PDSA) cycle The Plan-Do-Study-Act (PDSA) cycle to test and implement changes in to test and implement changes in real work settings.real work settings.

What are we trying to accomplish?What are we trying to accomplish?

Setting Aims

The aim should be time-specific and The aim should be time-specific and measurable; it should also define the measurable; it should also define the specific population of patients that specific population of patients that will be affected. will be affected.

How will we know that a change is How will we know that a change is an improvement?an improvement?

Establishing MeasuresUse quantitative measures to Use quantitative measures to determine if a specific change determine if a specific change actually leads to an improvementactually leads to an improvement

What changes can we make that What changes can we make that will result in improvement?will result in improvement?

Selecting ChangesAll improvement requires making All improvement requires making changes, but not all changes result in changes, but not all changes result in improvement. Therefore we must improvement. Therefore we must identify the changes that are most identify the changes that are most likely to result in improvement. likely to result in improvement.

The Model for ImprovementThe Model for Improvement

Setting Aims Setting Aims Improvement requires setting Improvement requires setting aims. The aim should be time-aims. The aim should be time-specific and measurable; it should specific and measurable; it should also define the specific population also define the specific population of patients that will be affected. of patients that will be affected. Establishing MeasuresEstablishing MeasuresTeams use quantitative measures Teams use quantitative measures to determine if a specific change to determine if a specific change actually leads to an improvement. actually leads to an improvement. Selecting ChangesSelecting ChangesAll improvement requires making All improvement requires making changes, but not all changes result changes, but not all changes result in improvement. Organizations in improvement. Organizations therefore must identify the therefore must identify the changes that are most likely to changes that are most likely to result in improvement. result in improvement. Testing ChangesTesting ChangesThe Plan-Do-Study-Act (PDSA) The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a cycle is shorthand for testing a change in the real work setting — change in the real work setting — by planning it, trying it, observing by planning it, trying it, observing the results, and acting on what is the results, and acting on what is learned. This is the scientific learned. This is the scientific method used for action-oriented method used for action-oriented learning.  learning.  

Testing changes:Testing changes:

The Plan-Do-Study-Act (PDSA) cycle The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in is shorthand for testing a change in the real work setting — by planning the real work setting — by planning it, trying it, observing the results, it, trying it, observing the results, and acting on what is learned. This is and acting on what is learned. This is the scientific method used for action-the scientific method used for action-oriented learning. oriented learning.

Wheels in Motion: Continuous Wheels in Motion: Continuous Quality improvementQuality improvement

Implementing ChangesImplementing ChangesAfter testing a change on a small After testing a change on a small scale, learning from each test, and scale, learning from each test, and refining the change through several refining the change through several PDSA cycles, the team can PDSA cycles, the team can implement the change on a broader implement the change on a broader scale — for example, for an entire scale — for example, for an entire pilot population or on an entire unit. pilot population or on an entire unit.

Spreading ChangesSpreading ChangesAfter successful implementation of a After successful implementation of a change or package of changes for a change or package of changes for a pilot population or an entire unit, the pilot population or an entire unit, the team can spread the changes to team can spread the changes to other parts of the organization or in other parts of the organization or in other organizations. other organizations.

Quality ImprovementQuality Improvement

QualityImprovement

ReducesComplications

Reduce Cost

ImprovePatient

Satisfaction

How hospitals and clinics have How hospitals and clinics have shown success using QIshown success using QI..

Mortality has declined.Mortality has declined.Rates of adverse events have Rates of adverse events have decreased.decreased.The cost of care in ICU has seen a The cost of care in ICU has seen a gradual decline.gradual decline.Critically ill patients have been Critically ill patients have been recognized early by medical recognized early by medical response teams.response teams.

ReferencesReferences

Road Map for Quality Improvement. Road Map for Quality Improvement. Manoj Jain, MD MPH.Manoj Jain, MD MPH.

Institute for Healthcare Institute for Healthcare Improvement. www.ihi.orgImprovement. www.ihi.org

American Medical Association. American Medical Association. www.ama-assn.orgwww.ama-assn.org..

Wait until you finish your Wait until you finish your residency!!residency!!

Be Happy!!Be Happy!!