MCCP Online Orientation

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2 To gain an understanding of: Quality Quality improvement The Model for Improvement The PDSA cycle 2

3 Institute of Medicine: Quality of Care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Institute for Healthcare Improvement (IHI): Quality is turning into outcomes management, and involves minimizing unnecessary variation so that outcomes become more predictable and certain. Quality Digest: Quality is meeting the customer's needs in a way that exceeds the customer's expectations. 3

4 Patient Safety- Quality Improvement: A formal approach to the analysis of performance and systematic efforts to improve it. 4

5 Safe Effective Patient-centered Timely Efficient Equitable IHI, 2011a How can we improve a system to achieve better results in the dimensions of quality? 5

6 You need to : Know your customers (patients/residents). Understand where the system is failing - Identify what is wrong. Identify step that needs fixing. Implement change. 6

7 Step 1: Three questions + Step 2: PDSA cycle = Model of Improvement API,

8 Step I: Questions What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? The Aim The Measure The Change Step 2: PDSA MODEL FOR IMPROVEMENT API,

9 Plan a change Do the change Study the results Act on the results Walter Shewhart was the first person to propose a version of the PDSA cycle. W. Edwards Deming modified Shewhart's cycle to PDSA, replacing "check" with "study."

10 Eliminate Waste Improve Work Flow Optimize Inventory: Change the Work Environment Producer/Customer Interface Manage Time Focus on Variation Error Proofing Focus on the Product or Service IHI,

11 All improvement will require change, but not all change will result in improvement 11

12 To test your change use the PDSA cycle. Start with a PLAN Objectives Questions and predictions A Plan to carry out the cycle who, what, where, when A Plan for data collection 12

13 Do: the action part of the process document problems and unexpected results collecting and analyzing data meeting with involved parties 13

14 Study Analyze process improvement data Compare data to prediction Summarize what was learned Some focus areas of improvement are: Clinical Outcomes Cost Access to Care Satisfaction Community Service Regular Satisfaction Surveys 14

15 Act What changes are to be made Start the next cycle? 15

16 Start small and think ahead a few steps. Test changes. Continuous improvement often requires a few sequential PDSA cycles. Ideal Situation Present Situation 16

17 Change usually comes after a series of successful tests Educate and train everyone involved. Make changes to job descriptions, policies, procedures, forms. Address supply and equipment issues. Assign day-to-day ownership for the maintenance of the new process. (Langley, Moen, Nolan, Nolan, Norman & Provost, 2009) 17

18 Agency for Healthcare Research & Quality (AHRG). (2013) Quality and Safety. Retrieved from Associate Process Improvement (API). (2010). Model for Improvement. Retrieved from Deming, W. E. (2000). The New Economic. Cambridge, MA: The MIT Press. Institute of Health Improvement (IHI). (2011). Science of Improvement. Retrieved from ove.aspx Institute of Medicine (IOM). (n.d.)crossing the quality Chasm: The IOM Health Care Quality Initiative. Retrieved from The-IOM-Health-Care-Quality-Initiative.aspx Institute for Health Improvement (IHI). (2011a). Across the Chasm: Six aims for changing the healthcare. Retrieved from hangingthehealthcaresystem.aspx 18

19 Institute of Health Improvement (IHI). (2012). Using Change Concepts for Improvement. Retrieved from spx Institute of Medicine (IOM). (1999). Measuring the quality of health care. IOM. Langley, G. L., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2 nd ed.). San Francisco, CA: Jossey-Bass Publishers. Lloyd, R. (2004). Quality Health Care: A Guide to Developing and Using Indicators. Sudbury, MA: Jones and Bartlett Publishers. Patient Safety Quality Improvement. (n.d.). What is Quality Improvement? Duke University Medical Center. Retrieved from Quality Digest (2001). Definition of Quality: How do you define it? Retrieved from 19