Quality Improvement: Overview of Principles and Techniques

1. Quality Improvement: Overview of Principles and Techniques Phavinee Thongkhong-Park, PhD, RN Adjunct Faculty, The University of Michigan School of Nursing Project Director, Department of Standards, JCAHO

2. Quality Improvement • Performance Improvement as a Management Philosophy • Data driven • Focuses on changing critical process steps • Bottom up decision making as well as top down • Teams as organizational unit

3. Quality Improvement • Plan-do-check-act (PDCA) cycle • model is easy to use and understand • underlying philosophy is to continually raise the quality bar • Measurement continues until tools, techniques and behavior patterns part of daily practice

4. Quality Improvement • It starts with values….. • Vision • Mission • Goals • “What are we trying to accomplish and how does the action support that?”

5. Quality Improvement • Identify important processes • relates to and support the mission and goals • attach indicators to each important process • outcome data • special indicators that measure the end of a process

6. Quality Improvement • Process Indicator Selection • Locate the points of variability and measure them • Indicator Examples: • Left without being seen • Patient wait times • Medication errors

7. Quality Improvement • Selection of Improvement Projects • Which indicator or outcome data tells you to act because it exceeds thresholds? • Do you have new processes to put in place? • Do you have imperatives preselected by management to improve?

8. Quality Improvement • Improvement Project Characteristics • Clearly defined and measurable objectives • Utilizes a minimum of one indicator with a known baseline • Rearranges or restructures the basic process steps • Trials the process redesign before full implementation

9. Quality Improvement • Teams as organizational unit • Two types • Product or output teams (permanent teams) • Process Improvement Teams (project teams)

10. Quality Improvement • Essential elements for team success • Training, training, training • Common vision • Data and measurable goals • Facilitation

11. Quality Improvement • Formation of improvement teams • Team is assigned one project • Team is trained • Team establishes ground rules, objectives, and timetables • Team reports progress

12. Quality Improvement • Team Roles • Facilitator does not make decisions or affect the output of the team • Leader is a team member who chairs meetings and coordinates activities

13. Quality Improvement • Plan • Assess the current indicator information • Analyze the process to be improved • Identify the steps in the process to be eliminated or changed

14. Quality Improvement • Plan • Look for variation • Flow chart important processes as a group • Generate multiple options for improvement • Select one • Select evaluation tool

15. Quality Improvement • Do • Set up and initiate the pilot phase of the change • This is the experimental phase

16. Quality Improvement • Check • At the end of the pilot (or sooner) • Did this work the way we thought it would? • Evaluate the whole process to ensure that the change did not negatively impact another process

17. Quality Improvement • Act • Fully implement the selected change • Continue to monitor the process