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What is Quality Improvement? What are the Quality Expectations from HAB?

Quality Institute Session 1. What is Quality Improvement? What are the Quality Expectations from HAB?. Aug 26, 2008 Clemens Steinbock, MBA Director, National Quality Center. Agenda. - Opening Remarks - Overview and Introduction - Quiz – Group Activity

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What is Quality Improvement? What are the Quality Expectations from HAB?

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  1. Quality Institute Session 1 What is Quality Improvement? What are the Quality Expectations from HAB? Aug 26, 2008 Clemens Steinbock, MBA Director, National Quality Center

  2. Agenda - Opening Remarks - Overview and Introduction - Quiz – Group Activity - Principles of Quality Improvement - Scenario – Group Activity - HAB Expectations on Quality - QI Resources - Evaluations and Wrap-up

  3. “How can you make this topic entertaining and keep everyone from falling asleep?”

  4. What are my options? • Use humor

  5. What are my options? • Use my kids

  6. What are my options? or • Use the audience… via the Audience Response System

  7. Quiz

  8. 1) What does CQI stand for? • Community Quality Initiative • Case Management Quality Ideas • Continuous Quality Improvement • Circular Quantum Invention

  9. 2) Why does Quality Improvement become increasingly important in health care? • Quality Improvement has been proven to be successful • Increasing requirements by regulatory agencies • Increasing accountability by programs for the quality of services • All of the above

  10. 3) What is the main difference between Quality Assurance and Quality Improvement? • Quality Assurance uses mainly a team approach • Quality Improvement focuses on statistical outliers for improvements • Quality Assurance and Quality Improvement is practically the same • None of the above

  11. 4) What is the most important principle for Quality Improvement? Quality Improvement focuses on… • Individual performers • Routine measurement of performance • Training of providers • System’s issues

  12. 5) Which of the following statement by HAB is INCORRECT? • QM programs need to look beyond clinical services to consider both supportive services and outcomes • QM programs assess the extent to which HIV health services are consistent with the most recent Public Health Service guidelines • The primary focus of the QM program is on performance measurement to assess clinical and non-clinical services • Quality is the degree to which a health or social support service meets or exceeds established professional standards and user expectations

  13. 6) HAB describes the following characteristics of Quality Management Programs. Which ones are CORRECT? • Be a systematic process with identified leadership, accountability and dedicated resources • Use data and measurable outcomes to determine progress toward relevant, evidenced-based benchmarks • Focus on linkages, efficiencies and client expectations in addressing outcome improvement • Ensure that data are fed back into the quality improvement process to assure that goals are accomplished • All of the above • None of the above

  14. 7) The following performance data report is presented: PPD 95%, GYN 85%, and PCP Prophylaxis 55%. You advise the program to continue to measure… • only PCP Prophylaxis • GYN and PCP Prophylaxis • All three indicators

  15. 8) The results of an adherence QI project are presented after 10 months of work, improving the rate to 98% and it was kept between 95%-100% for the last 4 months. You advise the program to… • Discontinue routine measurements • Switch to quarterly measurements • Keep monthly measurements

  16. 9) Due to the high rate of Mental Health screening (95%), the QI team stopped meeting but continued to measure the rate monthly. Recently the score declined. When should the MH QI team to re-start? • 90% • 80% • 70%

  17. Couple more questions…

  18. 10 What is your professional background? • Clinical Provider (MD, NP, PA) • Nurse • Case Manager/Social Worker • Administrator • Other

  19. 10 How do you rate your own quality improvement knowledge? • Novice • Beginner • Intermediate • Proficient • Expert

  20. 10 How do you rate your HIV Quality Management Program? • Not existing • Beginning • Sufficient • Good • Excellent

  21. Quality Improvement Principles Clemens Steinbock, MBA 212.417.4730 Clemens@NationalQualityCenter.org NationalQualityCenter.org

  22. Success is achieved through meeting the needs of those we serve.

  23. Most problems are found in processes, not in people.

  24. Do not reinvent the wheel – Learn from best practices.

  25. Learn through small, incremental changes to achieve continual improvements.

  26. Actions are based upon accurate and measured data.

  27. Infrastructure enhances systematic implementation of improvement activities.

  28. Set Priorities and Communicate clearly

  29. Infrastructure Balance between Data Collection and Quality Improvement Activities

  30. ‘QI is not QA’

  31. Three Faces of Quality Improvement

  32. HAB’s Working Definition of Quality “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 of Medicine. Medicare: A Strategy for Quality Assurance. Vol. 1. (1990)

  33. In 1601, James Lancaster successfully conducted an experiment to illustrate the effectiveness of lemon juice to prevent scurvy. When did the British Navy adopt this treatment? • 1602 • 1689 • 1757 • 1796

  34. Treatment of Scurvy • Stephen J. Bown - Scurvy: How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail; St. Martin's Press, 2004 • In 1601 lemon juice, as a protective against scurvy, is recorded by James Lancaster. • In 1612, Woodall recommended citrus fruit for protection against scurvy on sea voyages. • In 1753 James Lind published A Treatise on the Scurvy which portrays his experiment on-board the ship Salisbury in 1747. • From 1772 to 1775 sailors on historic voyages with Captain James Cook remained free from scurvy. • In 1796 lemon juice was officially introduced in the British Navy as a prophylactic against scurvy. • In 1865 British Board of Trade adopted the policy for the merchant marine.

  35. How long did the NIH take to recommend the treatment of ulcer as suggested by Dr. Marshall in his 1984 Lancet Article? • 2 years • 5 years • 10 years • 20 years

  36. Treatment of Ulcer – Marshall Timetable: 1979: Dr. Robin Warren, pathologist at Royal Perth Hospital, Australia found bacteria in stomach of patients 1981: Dr. Barry Marshall starts residency 1982: Marshall cultivates bacteria: Helicobacter pylori, 100% in Duodenal Ulcer and 77% in Gastric Ulcer 1984: first publication in Lancet; presents treatment of ulcer with common antibioticum 1994: National Institute of Health recommends treatment of ulcer as suggested by Dr. Marshall

  37. In a recent article in the Journal of Quality Improvement 92 QI projects were compared. What was the timeframe from problem identification to completion of first pilot? • 23 days • 60 days • 397 days • 504 days

  38. Survey of 92 Quality Improvement Projects in Journal of Quality Improvement • Alemi F, Safaie F, Neuhauser D. “A Survey of 92 Quality Improvement Projects.” Journal of Quality Improvement 2001, 27(11): 619-632 • 504 days from problem identification to completion of first pilot • 397 days from first team meeting to the end of first cycle • 75 days to describe current situation in flowchart • 62 days for data collection if change was improvement

  39. Model for Improvement How can we accelerate change and improvements in HIV programs?

  40. Model for Improvement Act Plan Study Do 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? Model for Improvement

  41. Model for Improvement 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?

  42. 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? Model for Improvement

  43. 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? Model for Improvement

  44. The PDSA cycle for learning and improvement Act Plan Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) What changes are to be made? Next cycle? Study Do • Complete the • analysis of the data • Compare data to • predictions • Summarize what • was learned Carry out the plan Document problems and unexpected observations Begin analysis of the data

  45. D S P A A P S D D S P A A P S D A P S D PDSA Cycle to incorporate the use of a new CM form Improve Access to HIV Primary Care DATA Cycle 1E: Implement and monitor the standards Cycle 1D: Revise and test tool with all clients for one week Cycle 1C: Present refined tool to all 3 case managers and document feedback Introduce new CM Intake/Assessment Form Cycle 1B: Revise tool and test with Karl’s clients next Monday Cycle 1A: Adapt new CM form and test with one of Joanne’s patients

  46. Tips for PDSA Cycles • “What change could you implement by next Tuesday?” • Use the “Rule of 1”: • 1 facility • 1 office • 1 provider • 1 patient

  47. Tips for PDSA Cycles • Volunteers at first • Useful, not perfect, data • Use “huddles” to report • Learn from others (‘Steal shamelessly, Share senselessly’)

  48. References • Moen, Ronald, Thomas Nolan; “Process Improvement” Quality Progress, 1987, p62 • Langley, Gerald, Kevin Nolan and Thomas Nolan; “The Foundation of Improvement,” Quality Progress, June 1994, p. 81 • Langley, Gerald, Kevin Nolan, Thomas Nolan, Cliff Norman, and Lloyd Provost; “The Improvement Guide” San Francisco, CA; Jossey-Bass, 1996 • Nolan, Kevin; “ASQs Accelerating Change Collaborative Series: A Challenge for Industry,” Quality Progress, Jan 1999, p55

  49. HRSA’s 9-Step Model to Quality Goal of Manual: • provide the tools to develop and implement a quality management program • outline a step-by-step process that can be applied in any care setting • applicable for both the experienced and non-experienced grantee Developed by HIV/AIDS Bureau Quality Institute

  50. HRSA’s 9-Step Model to Quality • Commit Leadership & Supportive Organizational Structure • Establish support of program leadership for Quality Management • Delineate specific QM responsibilities of staff • Establish Quality Management Plan • Establish Quality Committee to oversee the QM program • Develop an organizational QM plan which delineates goals and objectives for the QM program • Determine Performance Measures & Collect Data • Based on QM priorities, develop/adopt indicators to measure performance • Determine method of data collection and collect data

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