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Wednesday, September 11, 2013

Wednesday, September 11, 2013. Virtual Session #2 Track 1: Better Quality Through Better Measurement Part 1. Sue Gullo , RN, Director Jane Taylor, Ed.D., Improvement Advisor Institute for Healthcare Improvement. Faculty. Sue Gullo , IHI Jane Taylor, IHI Cheryl Ruble, Cynosure.

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Wednesday, September 11, 2013

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  1. Wednesday, September 11, 2013 Virtual Session #2 Track 1:Better Quality Through Better Measurement Part 1 Sue Gullo, RN, Director Jane Taylor, Ed.D., Improvement Advisor Institute for Healthcare Improvement

  2. Faculty Sue Gullo, IHI Jane Taylor, IHI Cheryl Ruble, Cynosure

  3. Reflections onVirtual Session #1 August 21, 2013 • If you and your clinical buddy were able to work with the unit(s) on falls injury prevention or preventing pressure ulcers – what were you able to do this month that was different? • Based on how you applied what we learned in August, what advice might you give a colleague? • What are you curious to learn about now?

  4. General Objectivesfor Virtual Session #2 • To revisit Question 2 in the Model for Improvement (How will you know that a change is an improvement?) • To understand the differences between using data to improve, for research or for accountability • To build increased knowledge and comfort with understanding variation with run charts. • Appreciate the value of sensitive process measures for learning • Explore the relationship with your clinical buddy and learning from data

  5. Session #2 Prework(Track 1 & 2) IHI Open School Modules QI 103 Lesson 1: Measurement Fundamentals QI 103 Lesson 2: Displaying Data IHI On Demand video by Dr. R. Lloyd Building Skills in Data Collection and Understanding Variation http://www.ihi.org/offerings/virtualprograms/ondemand/datacollection_variation/Pages/default.aspx

  6. The Lens of Profound Knowledge Appreciation of a system Thisprovides a new way to understand our organizations (Deming, Out of the Crisis) Theory of Knowledge Human Behavior QI Understanding Variation Aim or Values

  7. A Model for Learning and Change Our focus today The Improvement Guide, API, 2009

  8. From the Prework QI 103 : Lesson #1 Topics (Measurement Fundamentals) 1. Project-level measures versus PDSA-level measures 2. Why are you measuring? 3. Key elements of a data collection plan 4. Building a families of measures (FOM). QI 103 Lesson #2 Topics (Displaying Data) 1. The value of plotting data over time 2. The basic elements of a run chart 3. Elements of a run chart and how to interpret a run chart 4. Detecting patterns in the data 5. The difference between common cause and special cause variation 6. The difference between a run chart and a Shewhart chart Questions? Observations?

  9. QI 103 Tips for Building Effective Measurement Systems 1. Plot data over time. 2. Seek usefulness, not perfection. 3. Be practical – sample when needed. 4. Integrate measurement into the daily routine. 5. Use qualitative and quantitative data.

  10. Why are you measuring? Research? Judgment? Improvement?

  11. The Three Faces of Performance Measurement byLief Solberg, Gordon Mosser and Sharon McDonaldJournal on Quality Improvement vol. 23, no. 3, (March 1997), 135-147.

  12. Let’s hear from a team working on Falls and Injury Prevention What process measures were you able to collect? What did you learn? What if anything surprised you about what was happening on the unit(s)? How do you interpret the data? Team Presentation #1

  13. Terre Haute Regional Hospital Sonja Rebeck, RN, BSN, MSM, CPHQ, C-LSSBB Improvement Leader Fellowship September 11, 2013

  14. Data Nov-2012: Implementation of Fall Bundle Based on Inpatient Falls (includes Behavioral Health Unit)

  15. What are you learning and who are you learning with? • Front Line Staff Engagement & Staff Governance Is Critical For Success • Key Character Traits Embraced Contribute to Pathway for Mission Fulfillment • It Takes a Village: We are learning from within our hospital; we are learning from our Division/Corporate associates; and we are learning from national sharing & mentoring

  16. Highlights and what has gotten in the way? • Leadership & Staff Turnover-Learning Curve Adjustment • Keeping Balance (Many Safety/Harm Reduction Initiatives & All Are Important) • Continued Communication to Keep All Staff Aware of the Status of Our Ongoing Journey (Keep It Simple—To the Point)

  17. What do you need help with? • Maintaining Current Best Practices/Evidence Driven Protocols • Creativity With Presenting Information in an Engaging Manner • Ability to Increase “Hands-on-Board” without Increasing FTEs

  18. Point … Common Cause does not mean “Good Variation.” It only means that the process is stableand predictable. For example, if a patient’s systolic blood pressure averaged around 165 and was usually between 160 and 170 mmHg, this might be stable and predictable but it is unacceptable against the goal.

  19. Point … Similarly Special Cause variation should not be viewed as “Bad Variation.” You could have a special cause that represents a very good result (e.g., a low turnaround time), which you would want to emulate. Special Cause merely means that the process is unstableand unpredictable. You have to decide if the output of the process is acceptable!

  20. Appropriate Management Response to Common & Special Causes of Variation Is the process stable? YES NO Special + Common Only Common Type of variation Change the process if unacceptable Investigate the origin of the special cause Right Choice Change the process Treat normal variation as a special cause (tampering) Wrong Choice Consequences of making the wrong choice Increased variation! Wasted resources!

  21. Attributes of a Leader WhoUnderstands Variation Leaders understand the different ways that variation is viewed. They explain changes in terms of common causes and special causes. They use graphical methods to learn from data and expect others to consider variation in their decisions and actions. They understand the concept of stable and unstable processes and the potential losses due to tampering. Capability of a process or system is understood before changes are attempted.

  22. How do we analyze variation for quality improvement? RunChartsare a robust tool to determine if our improvement strategies have had the desired effect.

  23. 1. Make process performance visible Three Primary Uses of Run Charts 3. Determine if we are holding the gains 2. Determine if a change is an improvement

  24. Elements of a Run Chart The centerline (CL) on a Run Chart is the Median Measure Time

  25. Non-Random Rules for Run Charts Source: The Data Guide by L. Provost and S. Murray, Austin, Texas, February, 2007: p3-10. A Shift: 6 or more A Trend 5 or more Too many or too few runs An astronomical data point

  26. Let’s hear from a team working on Falls and Injury Prevention What process measures were you able to collect? What did you learn? What if anything surprised you about what was happening on the unit(s)? How do you interpret the data? Team Presentation #2

  27. Saint Joseph Mount Sterling Becky Dotson MSN, RN Med Surg/ ICU Manager Donna Rhodes BSN, RN Quality Manager September 11, 2013

  28. SJMS Falls

  29. In summary, measurement is central to a team’s ability to improve • The purpose of measurement in QI work is for learningnot judgment! • All measures have limitations, but the limitations do not negate their value for learning. • You need a balanced set of measures reported daily, weekly or monthly to determine if the process has improved, stayed the same or become worse. • Link measures to the team’s Aim. • Measures should be used to guide improvement and test changes. • Measures should be integrated into the team’s daily routine. • Data should be plotted over time on annotate graphs. • Focus on the Vital Few!

  30. Virtual Session #3 Pre-workSept. 25, 2013 • IHI Open School QI 103: Lesson 3: Learning from Measures • IHI On Demand video, “Using Run and Control Charts to Understand Variation” http://www.ihi.org/offerings/VirtualPrograms/OnDemand/Run_ControlCharts/Pages/default.aspx • Nolan T, Resar R, Haraden C, Griffin FA. Improving the Reliability of Health Care. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2004. (Available on www.IHI.org)

  31. Session #3 ObjectivesSept. 25, 2013 The focus in Track Two will be on: Understanding scale up, implementation and basics of reliable design. How to develop a focused plan based on your results Evaluating the reliability of your processes and how to make your changes more reliable

  32. Thanks for joining us today. Please join us again on September 25th 1:00 – 3:00 PM CT

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