Instilling a Culture of Quality in Health Care through Education

Transcription

1 Instilling a Culture of Quality in Health Care through Education TWELFTH QUALITY COLLOQUIUM WASHINGTON, DC 9/19/2013 Presented by Joseph Bocchino, EdD and Ozgur Ekmekci, EdD The George Washington University School of Medicine and Health Sciences 1

2 Overview Leading a Quality Improvement Initiative In today's complex health care environment, anyone who has been assigned the task of leading a quality improvement initiative has to approach the process in a systematic way in order to succeed. The crucial success factor is often creating cultural alignment amongst components that constitute a well-articulated quality improvement proposal especially if the initiative involves an education component. This presentation highlights the four key questions that allow health care leaders to effectively envision, design, implement, and assess a meaningful quality improvement intervention that is grounded in the premise of instilling a culture of quality through education. Session Objectives Discuss challenges associated with implementing a quality improvement initiative Analyze major components of an effective quality improvement initiative Develop strategies to create cultural alignment between major components of a quality improvement proposal Analyze four key questions that drive a quality improvement proposal 2

3 The Health Care Leader s Challenge Do I have a clear vision of what health care quality looks like and means within the context of my own organization? Have I integrated my vision of health care quality with my overall vision and purpose for my organization? Does what I am trying to achieve fit with my current organizational culture? If not, do I have a plan to reconcile the fit? Can I describe quality outcomes and success in a manner that enlists passion from the workforce? Will we know what success looks like as we achieve it? How do I make sure that all of this effort to change, is leveraged across the institution and is not a one-off initiative? How can I use these initiatives for organizational learning and advancement? How can I make quality at my institution synonymous with my own leadership legacy? 3

4 Cultural Alignment of Major Components Learning Community Context (overview of the participants location, background, roles, and interests) The Problem Statement (current state of the target domain in measurable outcomes - and why this is a problem) The Statement of Significance (why it is important that the quality improvement initiative be implemented and who suffers in what way, if not implemented) The Proposed Solution (envisioned QI objectives - including the statement of tangible, measurable objectives, which tie back to the problem statement - i.e., current state) Implementation Time Line (a graphical depiction of the implementation plan, with major milestones along the way) Evaluation Method(s) (how to measure progress against set QI objectives and how it will be known when the participants finally get to the envisioned future state) KEY SUCCESS FACTOR A L I G N M E N T 4

5 Roadmap for Success Review and Revise Content Method or Schedule Conduct CAT NO Determine Effectiveness of Initiative STOP START Deliver Content Conduct Formative Assessment Delivery Complete? YES Conduct Summative Assessment Quality Improvement (QI) Initiative Time Line Provide Participant Feedback Provide Participant Feedback Define Measurable QI Objectives: Plan QI Initiative: Design QI Initiative Evaluation: Implement QI Initiative and Conduct Evaluation: - Individual Level - Change in behavior - Change in perception - Change in performance - Organizational Level - Change in outcomes - Societal Level - Change in environment - Identify participants - Select content - Develop materials - Design delivery method - Construct learning environment - Develop delivery schedule - Identify key variables to be measured at the appropriate level of analysis (i.e., individual, organizational, societal) - Decide on the most appropriate method(s) for conducting formative and summative assessments that measure the key variables - Determine frequency and timing for formative assessment and summative assessments - Plan delivery format, medium, frequency, and timing of feedback to participants - Select quantitative statistical methods that will help determine the effectiveness of initiative - Deliver content - Assess progress against set objectives - Provide feedback to participants - Analyze data using statistical methods - Determine effectiveness of QI initiative - Declare success! What do I want to change, for whom, by how much, and by when? In other words, what will success look like? How will I change what, for whom, by how much, and by when? In other words, how will I achieve success? How will I know what I am changing, for whom, by how much, and by when? In other words, how will I monitor progress against set objectives that define success? Has what I wanted to change, for those whom I wanted to change it, actually changed by the amount I had wanted it to change? 5

6 Revisiting the Four Key Questions PHASE I PHASE II PHASE III PHASE IV Define Measurable QI Objectives Plan QI Initiative Design QI Initiative Evaluation Implement QI Initiative & Conduct Evaluation What do I want to change, for whom, by how much, and by when? In other words, what will success look like? the leader will be able to contemplate and quantify the envisioned type of change, its scope (in terms of breadth, depth, and timeline), and the level at which change is to take place (i.e., individual, organizational or societal) which will help ability to monitor progress against objectives How will I change what, How will I know what I for whom, by how am changing, for much, and by when? Define Measurable In Learning whom, Objectives by how much, other words, how will I and by when? In other What do I want to change, for whom, by how much, and by when? In other words, what achieve success? will success look like? words, how will I monitor progress the instructor will be able against to contemplate set objectives and quantify the envisioned type of change, its scope (in terms of breadth, depth, and timeline), and the that define success? level at which change is to take place (i.e., individual, organizational or societal) which will help ability to monitor progress against objectives. the leader will more the leader will be able to easily identify identify key variables to participants, select be measured, decide on content, develop methods and frequency materials, design for formative and delivery method, summative assessment, construct learning plan delivery format, environment, and medium, frequency, and develop delivery timing of feedback to schedule participants, and select statistical methods that will help determine the effectiveness of the initiative Has what I wanted to change, for those whom I wanted to change it, actually changed by the amount I had wanted it to change? the leader will be able to effectively deliver content, assess progress, provide feedback to participants, and analyze data using statistical methods to ultimately determine how successful the initiative has been 6