QUALITY IMPROVEMENT

101

Kari Jarabek, BSN, RN

MSSIC QI Lead

We have collected all of this data and now it is time…

Slides describing specific CQI Performance Measures

• What are the high priority measures?

• What is due and when?

• Goals, benchmarks, etc.

• Any prescribed interventions by the Coordinating Center

First things, first…• Have you talked with your surgeon champion(s)

about QI Initiatives for your site?

• Meet with your Admin. Lead/Manager:

– Discuss QI ideas

– Honestly tell them how comfortable or notcomfortable you are with QI concepts and processes.

– Ask who your resources are if you have questions or run into barriers.

– If you don’t already have a working relationship with “key” players, ask them to help facilitate a meeting and even go with you to get started.

First things, first…(cont.)

• You are not alone. The Coordinating Center is here to support you. Don’t hesitate to reach out and say...

What is Quality Improvement?• Quality improvement

(QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.

A successful QI intervention should :

• Focus on systems and processes

• Focus on specific patients and patient groups

• Focus on multidisciplinary change and acceptance

• Focus on the use of the data for continuous improvement assessment

MSSIC QI Report Template

• Main components are derived from Lean A3 reporting concepts.

• Due twice a year:

– May 15th & December 29th

Using the MSSIC QI Report Template

• A problem solving approach – built around PDCA

• A concise summary of the problem and solution

• A way to structure thinking

• A communication tool to report the project’s development and movement both to MSSIC and your hospital leadership

PDCA

• The heart of Quality Improvement

• The foundation for A3 thinking

• Cycling through Plan, Do, Check and Act is essential to improving a process.

GAPYou are

here

Need to be

here

Current State

Target State

The QI report

tells this story

QI Metric/Initiative

• What initiative are you talking about?

• Name the problem.

To fix it, you have to know what is wrong• Examine your site’s current performance

• Look at your data sources:

– MSSIC Registry

– Internal data collection

• Data content considerations:

– Rates based on conditions

– Time intervals

Baseline Data:• Brief summary of where

things stand today.

• What facts or data indicate there is a problem?

• Show the facts visually: baseline run-chart.

Goal: • What specific improvement(s) in performance do you need to achieve?

• How much, by when, and with what impact.

MSSIC QI Goals-Lumbar: UR, Readmission, and SSI

• 20% Reduction in Urinary Retention

• 10% Reduction in Readmission

• 20% Reduction in SSIs

Analysis:

• Why does the problem exist?

• What is the root cause(s)?

• What are the barriers?

• Choose the simplest tool that clearly shows the cause-and-effect relationship.

Example: The MRI department is consistently running behind schedule. • Patients are regularly brought late for their MRI. Why?• The transporter was late in arriving to the floor to take the

patient to MRI. Why?• The transporter was looking for a wheel chair. Why?• There was no wheel chair in the bay. Why?• All wheel chairs were in use or were not in working order.

From this scenario, I could easily conclude that by buying more wheel chairs, all patients would be brought to MRI on time. But, would that really be true? There are other factors to consider before going out on a buying spree. For example, there are wheel chairs that aren’t in working order. Could it be that there is no maintenance plan in place to fix broken wheel chairs? If that is the case, then it is fair to assume that the problem will recur, even if you purchase more wheel chairs.

Breaking Down the Problem during Analysis:

• Focus on systems and processes- not people

• IMPERITIVE: Go to where the work takes place and talk to the people who do the work. Show them respect… they are the experts!

Proposed Countermeasures:• What do you propose and why?

• Which interventions have the greatest impact?

• What is a system-level approach that is effective and sustainable?

• Is it team-based (active involvement of front-line staff) and patient-centered?

• How will what you proposed address the specific root cause(s) in your analysis? The link should be clear.

• Who will do what, when and how?– Which staff can best address the needs? Timing?

• How will you know if the actions have been successful?

• What support and resources will be required?

• When will progress be reviewed and by whom?

QI Planning Gone Bad…

QI Planning Gone Worse…

Gantt Chart: A visual plan that shows you what has to be done, by who and when. It is the project schedule and helps the team stay focused.

9. Plan: (Timeline with who is responsible for what, when, where and how.)

What Who When Status

Follow-up:

• How will you ensure ongoing P-D-C-A?

• Is there a plan for new staff/surgeons?

• Who will monitor to assure desired outcomes are sustained?

• How often? • Is there a Process Champion to

help sustain the front-lines?

Pearls of Wisdom• It is crucial that you understand the underlying

problems for YOUR institution and patients• Know your internal resources and engage key

players• Initiate simple, low-cost, focused interventions

in sequence to ensure that you can measure the impact

• Align your efforts around and with other QI efforts that you may be aware of

Questions?