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Introduction to Quality Improvement

Introduction to Quality Improvement. Grace Gorenflo Jack Moran. The ABCs of PDCA. Session Goal and Objectives. Goal :  To provide a foundation for COP-PHI awardees’ quality improvement efforts     Learning Objectives :

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Introduction to Quality Improvement

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  1. Introduction to Quality Improvement Grace Gorenflo Jack Moran

  2. The ABCs of PDCA

  3. Session Goal and Objectives Goal:  To provide a foundation for COP-PHI awardees’ quality improvement efforts     Learning Objectives: - Understand the distinction between quality improvement and other, related activities - Understand the phases of a Plan-Do-Check-Act cycle

  4. Definition of QI In Public Health “Quality improvement in public health is the use of a deliberate and defined improvement process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health.  “It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.” This definition was developed by the Accreditation Coalition Workgroup (Les Beitsch, Ron Bialek, Abby Cofsky, Liza Corso, Jack Moran, William Riley, and Pamela Russo) and approved by the Accreditation Coalition on June 2009.

  5. They Are Not the Same Quality Assurance and Quality Improvement Evaluation and Quality Improvement

  6. They Are Not the Same Quality Assurance • Reactive • Works on problems after they occur • Regulatory usually by State or Federal Law • Led by management • Periodic look-back • Responds to a mandate or crisis or fixed schedule • Meets a standard (Pass/Fail) Quality Improvement • Proactive • Works on processes • Seeks to improve (culture shift) • Led by staff • Continuous • Proactively selects a process to improve • Exceeds expectations

  7. They Are Not the Same Evaluation • Assess a program at a moment in time • Static • Does not include identification of the source of a problem or potential solutions • Does not measure improvements • Program-focused • A step in the QI process Quality Improvement • Understand the process that is in place • Ongoing • Entails finding the root cause of a problem and interventions targeted to address it • Focused on making measurable improvements • Customer-focused • Includes evaluation

  8. Plan – Do – Check– Act vs. Plan – Do – Study– Act

  9. Continuous Improvement

  10. PLAN www.adesblog.com/category/getting-things-done/ Identify and prioritize quality improvement opportunities

  11. Identify / Prioritize Opportunities Example: Vital Statistics Customer average wait time more than 28 minutes

  12. PLAN Develop an AIM Statement • WHAT are we striving to accomplish? • WHEN will this occur (what is the timeline)? • HOW MUCH ? What is the specific, numeric improvement we wish to achieve? • FOR WHOM ? Who is the target population?

  13. AIM Statement Example: Reduce Vital Statistics customer wait time to 15 minutes

  14. PLAN Describe the current process

  15. Describe the Current Process for Vital Statistics: Limited number of cashiers to process transactions

  16. PLAN Collect data on the current process

  17. Vital Statistics Collect Data On: Number of cashiers and the wait time per customer

  18. PLAN Identify all possible causes

  19. Identify Possible Causes: No. of cashier windows open, Printer/network issues, Incomplete documentation etc.

  20. PLAN www.talentt.com/productFile/1196704593.jpg Identify potential improvements

  21. Identify Potential Improvements: Increase the number of cashier windows open(especially at rush hour)

  22. PLAN scipp.ucsc.edu/theory/theoryhomepage.htm Develop an improvement theory IF…THEN…

  23. Develop Improvement Theory: Create trigger system for supervisor to improve customer flow. Maintain wait time to 15mins.

  24. PLAN Develop an action plan

  25. Develop Action Plan: Pilot Program: One additional cashier added from Correspondence and additional cashier/s when wait time exceeds 15 minutes

  26. DO • Implement the improvement • Collect and document the data • Document the problems, unexpected observations, lessons learned, and knowledge gained

  27. Implement the Improvement: Implementation of Pilot Program for a week Collect and Document the data: Wait time reduced by 50%

  28. Problems, Observations, Lessons Learned Pilot Program Implementation Day 1: Ran a snag – 4 staff out Day 2: Successfully implemented Pilot Program (5 cashier windows open)

  29. CHECK • Analyze the results: was an improvement achieved? • Document lessons learned, knowledge gained, and any surprising results that emerged.

  30. Reflect on the Analysis: Data obtained for wait time - 1 Week pilot program. Cashier Survey data Document Problems: Unavailability of Staff and Communication issues. Observation: Smooth running of pilot Lessons learned: Customer Wait time directly proportional to # of cashier window open

  31. ACT • Take action: • Adopt - standardize • Adapt – change and repeat • Abandon – start over • Once you’ve adopted – monitor and hold the gains!

  32. Blue Team: Vital Stats Plan Check/ Study 7. Develop Improvement Theory: Create trigger system for supervisor to improve customer flow. Maintain wait time to 15mins. 1. Identify / Prioritize Opportunities: Customer average wait time more than 28 minutes 8. Develop Action Plan: Pilot Program – One additional cashier added from Correspondence and additional cashier/s when wait time exceeds 15 minutes 1. Reflect on the Analysis: Data obtained for wait time - 1 Week pilot program. Cashier Survey data 2. AIM: Reduce customer wait time to 15 minutes 2. Document Problems: Unavailability of Staff and Communication issues. Observation: Smooth running of pilot Lessons learned: Customer Wait time directly proportional to # of cashier window open 3. Current Process: Limited number of cashiers to process transactions Do 1. Implement the Improvement: Implementation of Pilot Program for a week 4. Collect Data On: Number of cashiers and the wait time per customer Act: 5. Identify Possible Causes: No. of cashier windows open, Printer/network issues, Incomplete documentation etc. 2. Collect and Document the data: Wait time reduced by 50% Adopt Standardize 3. Problems, Observations, Lessons Learned Pilot Program Implementation Day 1: Ran a snag – 4 staff out Day 2: Successfully implemented Pilot Program (5 cashier windows open) Day 2-5: Pilot Successfully implemented Adapt Do 6. Identify Potential Improvements: Increase the number of cashier windows open(especially at rush hour) Abandon Plan

  33. Decide to do QI PLAN DO CHECK ACT: Achieve Results? Yes - Adopt No/Maybe - Adapt Standardize No - Abandon

  34. QI Myths and Truths • Myth: QI is about weeding out the bad apples • Truth: QI is about processes - series of steps or actions performed to achieve a specific purpose

  35. QI Myths and Truths • Myth: If I don’t achieve my goal, I’ve failed • Truth: When doing QI, there is no such thing as failure

  36. QI Myths and Truths • Myth: All change = improvement • Truth: All improvement = change

  37. Download “The ABCs of PDCA” Article http://www.naccho.org/topics/infrastructure/accreditation/upload/ABCs-of-PDCA.pdf http://www.phf.org/resourcestools/Pages/The_ABCs_of_PDCA.aspx

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