Quality Improvement Tools to support Your Improvement Work

CHECK POINTS IN DEVELOPING ANAIM STATEMENT

AIM Content

• Explicit over arching description

• Specific actions or focus

• Goals

AIM Characteristics

• Measurable (How good?)

• Time specific (By when?)

• Define participants and customers

The Primary Drivers of Improvement

Will

Ideas Execution

Having the Will (desire) to change the current state to one that is better

Developing Ideas that will contribute to making processes and outcome better

Having the capacity to apply CQI theories, tools and techniques that enable the Execution of the ideas

QI

Driver Diagrams, a useful tool to help us understand the system and the messiness of life.

Driver Diagrams

PURPOSE OF DRIVER DIAGRAMS

• Helps you to set priorities• Identifying the drivers that will have the biggest

impact • Help organize your theories about what it takes to

achieve improvement • Leads you to the third question in the model for

improvement – What changes can you make that will result in improvement?

• Helps you then understand your current level of performance on these drivers

• Essentially is a set of concepts – to make these concepts operational you will need to identify measures

PRIMARY DRIVERS

• Ideally should be straight forward statements, not desired end states or wishes

• These are the things that need to be done or put in place to achieve the outcome

SECONDARY DRIVERS

• Processes, cultural norms or structures that lead to improvement

• Supported by evidence

• Differ in relative impact on outcome

• Should be necessary and sufficient to achieve goal – or why bother?

Inventory national programmes and measurementsMeet with programme leader to understand programme intent, audience, historyHarmonize our metrics

Improve Safety and reliability of Hospital Healthcare Services in Scotland

Scottish Government Sets Patient Safety as Strategic Priority

Boards Accept Safety as Key Strategic

Priority for Effective Governance

Robust, evidence

based proven clinical changes

IHI/QIS Team Expert at Content, Coaching

and Programme Management

Align SPSP with national improvement

programmes and measures

Primary DriversDemonstrable results to communityClear, shared measurement setVisible on all senior leader agendaPSA represents & demonstrates cohesive, united programmeNational Policy alignment

Secondary Drivers

Ownership of agreed upon set of outcomesReview of outcomes at each meetingQuality and safety comprises 25% of agendaRecovery plans for unmet outcomesInfrastructure supports improvement and measurementInvolve patients in safety

Scottish Patient Safety Programme

Driver Diagram

International and national expert clinical facultyFaculty expert at improvement methods and coachingProgramme design and structureand leadership

Acceptance of pragmatic scienceRoyal College and professional bodies supports PSA Programme

PrimaryDriversOutcome

SecondaryDrivers

Ideas for ProcessChanges

AIM:A New

ME!

Calories In

Limit dailyintake

TrackCalories

CaloriesOut

Substitutelow calorie

foods

Avoidalcohol

Work out 5days

Bike towork

PlanMeals

Drink H2ONot Soda

drives

drives

drives

drives

drives

drives

drives

drives

• Weight• BMI• Body Fat• Waist size

• Daily caloriecount

• Exercisecalorie count

• Days betweenworkouts

• Avg drinks/week

• Runningcalorie total

• % ofopportunitiesused

• Sodas/week

• Meals off-plan/week

• Avg cal/day

Exercise

Fidgiting

HackySack inoffice

Percent of dayson bike

Etc...

HOW WILL WE KNOW WE ARE IMPROVING?

UNDERSTANDING THE SYSTEM FOR WEIGHT LOSS WITH MEASURES

Measures let us• Monitor progress in improving

the system• Identify effective changes

Source: Richard Scoville, Ph.D.

Aim:

Outcome Measures:

1.

2.

3.

Primary Drivers Secondary Drivers

What is it?

Force Field Analysis is a QI tool designed to identify driving (positive) and restraining (negative) forces that support or work against the solution of an issue or problem.

When the driving and restraining forces are identified, steps can be taken to reinforce the driving forces and reduce the restraining forces

What does the Force Field do?

Allows comparisons of the “positives” and “negatives” of a situation

Enables easy comparisons

Forces people to think together about all the aspects of making the desired change a permanent one

Encourages people to agree about the relative priority of factors on each side of an issue

Supports the honest and open reflection on the underlying root causes of a problem and ways to break down barriers

OVERCOMING BARRIERS - FORCE FIELD ANALYSIS

1. Draw a letter “T” on a flipchart page

2. Write the name of the issue or project across the top of the page

3. Label the left column “Driving Forces” and the right column the “Restraining Forces”

4. Use brainstorming or nominal group technique (NGT) to generate the list of forces or factors that are driving the issue or project and those that are restraining or the holding things back

5. Eliminate duplicate ideas and clarify any ideas that are vague or not specific

6. If the team feels the need, they can use rank ordering to set priorities for the driving and restraining forces

7. Generate a list of ideas about actions that can be taken to reduce the restraining forces

HOW DO I SET UP A FORCE FIELD

ANALYSIS?

FORCE FIELD ANALYSIS WORKSHEET

ISSUE OR PROJECT: ______________________________________Driving Forces (+) Restraining Forces (-)

Actions to reduce the Restraining Forces:

•

•

•

14

AIM (Why are you measuring?)

Concept

Measure

Operational Definitions

Data Collection Plan

Data Collection

Analysis ACTION

The Quality Measurement Journey

Source: Lloyd, R. Quality Health Care. Jones and Bartlett Publishers, Inc., 2004: 62-64.

The Improvement Guide, API, 2009.

A MODEL FOR

LEARNING AND

CHANGE

When you combine the 3 questions with the…

…the Model for Improvement.

PDSA cycle, you get…

• Outcome Measures: Voice of the customer or patient. How is the system performing? What is the result?

• Process Measures: Voice of the workings of the system. Are the parts/steps in the system performing as planned?

• Balancing Measures: Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures (e.g. unanticipated consequences, other factors influencing outcome)?

THREE TYPES

OF MEASURES

MEASUREMENT FOR IMPROVEMENT

CurrentState

Measurement of Improvement

Future State

ANALYSING THE PROCESS MAP

• How many steps in your process?• Where is the waste?• How many duplications?• How many hand-offs?• What is the approximate time of or between each step?• Where are possible delays?• Where are major bottlenecks?• How many steps do not add value for staff and

customers?• Where are the problems for staff what causes the

frustration?

GUIDANCE ON DATA COLLECTION FOR IMPROVEMENT• A few key measures that clarify the aim of the improvement

effort and make it tangible should be regularly reported throughout the life of the project (daily, weekly, or monthly, depending on the length of time for the project)

• Be careful about over-doing process measures, A balance of outcome , process and balancing measures is important

• Plot data visually on the key measures over time

• Make use of existing databases and data already collected for developing measures

• Annotate your charts – tell the story

• Whenever feasible, integrate data collection for measurement into daily work routine

(Associates in Process Improvement and Corporate Transformation Concepts, 2008)

Improvement Idea / PDSA / Action Person Responsible

Target Date

Process mapping template