Quality Improvement 101

Transcription

1 Oregon Office of Rural Health Medicare Beneficiary Quality Improvement Project Training Series Quality Improvement 101 Jennifer Wright, NHA, CPHQ Carrie Beck, MPH, RDN January 31, 2017

2 Welcome Project introduction Communication 2

3 Speaker introduction Licensed nursing home administrator Lots of regulations Staff that wear lots of hats Quality improvement professional Teach and use root cause analysis and rapid cycle improvement Work with communities to improve care coordination 3

4 HealthInsight Oregon Formerly Acumentra Health Health care quality consulting firm, holding multiple contracts & subcontracts Medicare 11 th Statement of Work External quality review of CCOs for OHA Oregon Care Partners (sub) 4

5 Agenda Root cause analysis (RCA) Institute for Healthcare Improvement Model for Improvement Rapid cycle improvement using Plan-Do-Check-Act (PDSA) Wrap-up 5

6 Objectives This session will enable participants to Refresh their knowledge of basic quality improvement principles Gain ideas for approaching challenges using rapid cycle improvement Explain why reporting is important 6

7 What Is Root Cause Analysis? RCA seeks to identify the primary cause(s) of the problem, so that you can Determine what happened Determine why it happened Figure out what to do to reduce the likelihood that it will happen again 7

8 Philosophy of RCA Focuses on systems and processes. NOT on individuals! The true problem must be understood before action is taken. I.e., causal factors or root cause(s) 8

9 RCA Uses a Systems Focus Symptom Approach Errors are often a result of worker carelessness. We need to train and motivate workers to be more careful. We don t have the time or resources to really get to the bottom of this problem. Systems Approach Errors are the result of defects in the system. People are only part of the process. We need to find out why this is happening, and implement mistake-proofing so it won t happen again. We need to fix it for good, or it will come back and burn us. 9

10 RCA Addresses Underlying Causes How do you kill a weed? 10

11 Gather Initial Information & Define the Problem The initial information may be an incident report, or complaint/concern. What are you trying to correct? Define who, what, when, where, how Brainstorm to discover a single problem 11

12 Investigate to identify contributing factors 12

13 Fill in the Gaps Consult your interdisciplinary team What other sources might have additional information regarding the problem? 13

14 Analyze/identify the root cause(s) What conditions allowed the problem to occur? What other factors impact the problem? What are the underlying reasons each causal factor exists? Can you can impact the contributing factor? 14

15 Getting to the Root Cause The 5-Whys A question-asking method used to uncover the underlying causes of an event Ask "Why?" questions until all logical causes (and/or root causes) can be identified Uncovering the root cause leads to an Action Plan that is more likely to prevent the event from happening again 15

16 5-Whys Example

17 Action Plan Development Model for Improvement a simple yet powerful tool for accelerating improvement Developed by Associates in Process Improvement Two parts Three fundamental questions PDSA 17

18 The Model for Improvement 18

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20 Example: Question 1 What are we trying to accomplish? By March 31, 2017, we will reduce our door-to-diagnostic evaluation time (OP-20) by 10%. Think SMARTS: S Specific M Measurable A Achievable R Realistic T Time frame S Supported 20

21 Example: Question 2 How will we know that a change is an improvement? We will track our door-to-diagnostic evaluation time by reviewing data weekly. 21

22 Example: Question 3 What changes can we make that will lead to improvement? Hire para-professionals to perform initial diagnostic tasks. 22

23 Recommend & Implement Solutions How will the solution be implemented? Who will be responsible for it? Follow up to determine whether the solution was effective Monitor on an ongoing basis and modify as necessary 23

24 Using the Plan-Do-Study-Act (PDSA) Cycle Simple Reduces risk by starting small Guides planning, development, implementation of change 24

25 The PDSA Cycle 25

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27 Plan What is your first test of change? Hire temporary NP or PA Schedule to work during traditionally busy time (based on previously collected data) Track door-to-diagnostic (dx) evaluation time 27

28 Do & Study New NP works in ER evenings for 2 days before, during, and 2 days after the full moon Door-to-dx times are tracked Team reviews data and compares to last month s full moon average door-to-dx times The data show an 8% decrease in average time 28

29 Act Options are to Adopt, Adapt, or Abandon the plan Team decides to run the test for a full month and see what the data show at that time 29

30 Monitor and Modify for Effectiveness 30

31 Additional Resources Institute for Healthcare Improvement - Science of Improvement HowtoImprove.aspx Associates in Process Improvement 5 Whys History - Toyota Oregon Critical Access Hospital Quality Reporting Overview Guide - July Reporting-Guide-Last-Updated pdf 31

32 Questions Comments 32

33 BUT WAIT, THERE S MORE! 33

34 Reporting MBQIP Measures: What s in It for Me? Reporting can satisfy QAPI efforts under the conditions of participation. Each year, minimum requirements to be eligible for Flex funds will increase. It will eventually be required. Use the data for comparisons, to see trends, and to inform your improvement efforts. 34

35 What we covered today Refreshed knowledge of basic quality improvement principles Discussed ideas for approaching challenges using rapid cycle improvement Explained why data reporting is important 35

36 Roundtable Peer-to-Peer Sharing Monthly calls Review previous webinar Share successes and challenges Seek advice from peers 36

37 Conclusion Evaluation will be ed. Next meetings: Roundtable Peer-to-peer sharing call Feb. 14, 11 a.m. noon PT Webinar 2: MBQIP program overview Feb. 28, 11 a.m. noon PT 37

38 Contact Carrie Beck Project Lead Jennifer Wright