rapid improvement strategies shirley m. moore, rn, phd, faan associate dean for research and...
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Rapid Improvement Strategies
Shirley M. Moore, RN, PhD, FAAN
Associate Dean for Research and Professor of Nursing
Case Western Reserve University
Cleveland, OH, USA
Rapid Improvement Strategies
One of the criticisms of CQI is that it can take a long time to plan, test, and evaluate an improvement
Making fast changes lasting and pervasive, rapid improvement strategies speed things up without changing the nature of necessary improvement activities
Objectives
Describe the key focuses of rapid improvement strategies
Compare traditional and rapid improvement strategies
Apply rapid improvement strategies to an improvement initiative
Making rapid improvement work....
Interdisciplinary Systems approach Throw away your hats Take risks Take ownership
As in the use of traditional improvement strategies, to help develop tests and implement changes using rapid improvement strategies, the PDSA cycle is used as a framework for an efficient trial-and-learning methodology
When using rapid improvement strategies, the goal is to speed up cycles, thus making change faster
Plan-Do-Study-Act (PDSA)
Plan--a change, preferably on a small scale
Do--carry out the plan Study--the effects of the change, making
simple measurements Act--on what you learn to plan the next
round of testing
“Trial and Learning”
Small scale tests
Simple measurements
Five steps to speed up change
Wasting time working on the wrong problem
Ineffective Meetings
Planning and not acting
Too much time collecting data
Selling change to others
1. Define the right problem
2. Rapid meetings
3. Rapid plans
4. Rapid data collection
5. Rapid whole system change
Define the Right Problem
Postpone benchmarking when problems are obvious
Waiting for data to clarify problems can delay improvement efforts
Using data you “have” may lead to an inaccurate improvement
Focus benchmarking on a “few problems”
Define the Right Problem
Creates a focus on the “system” and not the staff
Problem statement: “The inability of the ED to initiate antibiotics in a timely manner.”
Problem restated: “Delay in antibiotic administration for pneumonia patients.”
Define the Right Problem
Define the problem in terms of the customers experience, obtain information via: focus groups interviews observations questionnaires
Define the Right Problem
State the problem from different perspectives Problem statements often include the
environment for improvement Increases focus on the team’s scope
Problem statement: “Sixty percent of pneumonia patients get antibiotics in the ED.”
Problem statement: “Forty percent of pneumonia patients do not get antibiotics in the ED.”
Define the Right Problem
State the problem from different perspectives
Team exercise:• Have all team members define the problem• Compare answers to identify the various ways to
approach the problem.
Rapid Meetings
Choose a nonparticipating facilitator• keep group on track and focused• identify team problems
Meet before the meetings • present team focus and agenda to members
for feedback (electronic, telephone, etc)• initiates ideas prior to meetings, increases
interaction and problem-solving
Rapid Meetings
Postpone evaluation of ideas• increases amount and creativity of ideas.• minimizes “group think”
Think it through again• improves teams original decisions• considers all perspectives
Rapid Meetings
Meet between meetings• Electronic feedback on issues (e-mail)--
eliminates evaluation of ideas and minimizes group think
• Allows for “drafts” to be revised, updated and represented
• More meeting time available for approval of action plans, decision making, and finalizing implementation strategies
Plan Rapidly
Start with what “could be” and not “what is”....Ideal system design...Futuring
• Fits solution to system• Generates solutions before understanding constraints,
increasing creativity• Brainstorm ideal solution, then define realistic
improvement approach• Minimizes time spent flowcharting the current
process
Plan Rapidly
Know Your Cast Champions Agents Sponsors Targets
Collect data rapidly
Write outcomes reports before begin data collection, including tables and figure
Collect only data you need Representative surveys of customers Increase speed of data collection by using
numerical and subjective data
Collect data rapidly
Rely on numerical estimates made by process owners• Derive from subjective data based on
observations and feedback• Involve a cross-section of experts involved in
the process• Analyze and display outcomes• Experts discuss and re-estimate outcomes
Rapid Whole-System Changes
Cross-functional teams--interdisciplinary Internal and external experts Unfolding storyboards
• employees follow team progress• understand evolution of change• increase involvement and feedback
Rapid Whole-System Changes
Employees need to feel they are capable of change
Employees are more likely to change when they participated in the decision making process and have organizational support
Top down approach Maintain focus with reminders and updates Focus on early adopters
Strength of Evidence
Beyond reasonable doubt
Preponderance of evidence
Common Sense
Summary
Application of a set of strategies can be employed to speed up the CQI process
Rapid improvement strategies do not bypass the basic steps of the CQI process - they speed up the planning, measurement and PDSA cycle time
Using rapid improvement strategies often means getting rid of old, ritualistic organizational change behaviors
References
Alemi, F., Moore, S. M., Headrick, L., Heckelman, F., Kizys, N., & Neuhauser, D. (1998). Rapid improvement. The Joint Commission Journal on Quality Improvement, 24, 119-129.