How-to Guide: Starting a Student Run Quality Improvement Project

1. How-to Guide:Starting a Student Run Quality Improvement Project TMIT Student Projects QuickStart Package ™

2. Objectives • List overarching global aims of improvement • Form a multi-disciplinary team • Begin to innovate, design, and implement a student-run quality improvement project • Use Plan-Do-Study-Act cycles for improvement initiatives

3. Outline • Introduction to Quality Improvement • From Innovation to Design • The Pilot • Implementation

4. Outline • Introduction to Quality Improvement • Aims for improvement • Multi-professional teamwork • Students role

5. So You Want To Create Change? “While all changes do not lead to improvement, all improvement requires change.” - Institute for Healthcare Improvement

6. From Theory to Practice:“Check a Box. Save a Life.” The First Global Student Sprint to Improve Healthcare • We will use this example to illustrate how students can design, pilot, and implement a project • The Innovation- • Students taking the lead with efforts in spreading the WHO Surgical Safety Checklist

7. Aims for Improvement We need healthcare that is: • Safe • Avoid injuries to patients from the care that is intended to help them. • Effective • Match care to science; avoid overuse of ineffective care and underuse of effective care. • Patient-Centered • Honor the individual and respect choice. • Timely • Reduce waiting for both patients and those who give care. • Efficient • Reduce waste. • Equitable • Close racial and ethnic gaps in health status.

8. Multi-Professional Teamwork

9. Students Role • There are hundreds of processes that can be improved in a system. • What you can do? • Gain Knowledge • Raise awareness and share knowledge of the System • Be Active • Pilot and implement a safe practice • Use Evidence • Research latest evidence-based improvement strategies • Collect data before and after improvement strategy

10. Example: Multi-Disciplinary Student Involvement Safe Surgery Student Sprint Pharmacy: Track antibiotic use and costs for surgical patients. Engineering: Examine patient flow and fit checklist into OR processes. Health Admin: Determine the cost savings in your hospitals from the checklist. Public Health: Track patient outcomes and measure impact. MD//DO/RN: Engage your classmates to learn it, use it, and seek advice from others.

11. Outline • Introduction to Quality Improvement • From Innovation to Design • The Pilot • Implementation

12. Outline II. From Innovation to Design • Forming Your Team • Setting Aims • Creating a Strategy • Change Concepts • Project Proposal

13. Innovating, not reinventing • If you are talking to the right people, chances are you will stumble across someone who has had similar thoughts about changing the current system • Connect early and discuss methods that are already in place or being researched • Your greatest barrier can be your attempt to do this on your own • Get a team on board and work together!

14. Forming Your Team • Collaborative Partners • Multi-disciplinary team • Each member with different expertise • Recruit key opinion leaders and advisors • Find a mentor who is connected to your project through a department affiliation or quality improvement committee

15. Example:Recruiting Key Opinion Leaders Safe Surgery Student Sprint • A student used an evidence-based improvement strategy such as the WHO Surgical Checklist • Introduced checklist to key opinion leaders of hospitals, including: • Superintendant of Hospital • Chair of Surgery • Chief of Quality Assurance

16. Forming Your Team Leadership • Responsibility Charting • Distinguish individual roles with listed activities • Using this tasking method gives the whole team a global view of the project’s evolution • Logistics • Create short deadlines • Have frequent update meetings • Team work! Team work! Team work!

17. Example: Responsibility Charting Safe Surgery Student Sprint

18. Setting Aims • State your aim clearly • Identify the population and system to be improved • Set numerical goals • To better measure outcomes • Set Stretch Goals • Give yourself a timeline • Ex: Reduce infections by 50% in 6 months • Avoid Aim Drift • Focus on your goal and try not to steer away

19. Creating an Improvement Strategy • Critical thinking about the current system • Benchmarking • Using technology • Creative thinking • Using change concepts

20. Change Concepts An approach to change that has been useful in developing ideas for improvement efforts: • Eliminate Waste • Improve Work Flow • Manage Time • Focus on Variation • Change the Work Environment • Error Proofing

21. Example:Using a Change ConceptChanging the work environment • Building a new type of network • Instead of Hospital Administrators, in this project, Students were the Change Agents in spreading this quality improvement tool • Students used new social networking features as a primary means of building their project network

22. Project Proposal • Vision/Mission • Setting Aims • Proposal Outline • Background • The Intervention • Strategy for Implementation

23. Outline • Introduction to Quality Improvement • Innovation to Design • The Pilot • Implementation

24. Outline • The Pilot • Using PDSA Cycles • Communication • Data Collection

25. The Pilot • Start as a pilot • Small scale with a few individuals testing your improvement method • Use Plan-Do-Study-Act (PDSA) cycles during this pilot phase

26. The Pilot: Using PDSA Cycles • Run a test trial on a small scale • Follow a simple “PDSA” cycle for pilot • Plan • Do • Study • Act

27. Example: Using PDSA CyclesSafe Surgery Student Sprint One student. One hospital. Three operating rooms. • Plan: • Introductory seminar and teaching with hospital administration and residents. • Do: • One week trial using 3 ORs • Study: • Feedback session given to residents and surgical staff.. • Act: • Continued piloting the checklist in 3 operating theaters with improvements in place.

28. The Pilot: Communication • Background education • Share the facts • Answer questions ahead of time • Energize your team • Get them excited about change! • Communication • Ensure that all of those participating in pilot are aware of their roles and project aims

29. The Pilot: Data Collection • Plot data over time • Seek usefulness • Use sampling • Integrate measurement into daily routine • Use qualitative and quantitative data

30. ExampleData CollectionSafe Surgery Student Sprint Wales, UK Jan – June 2009 • Students were data collectors in OR • 25 students observed 83 operations • Reported observations into an online data form • Evaluated 5 items of standard procedure • Data used to encourage implementation

31. Outline • Introduction to Quality Improvement • Innovation to Design • The Pilot • Implementation

32. Outline V. Implementation • Pilot to Implementation • Keys to Successful Adoption • Project expansion • Leadership Changes

33. Implementation • After the pilot, evaluate for ways you can make the project successful on a larger scale • Create a step-by-step process outline for easy engagement • Be ready for resistance • Be prepared to address counter arguments • Champions can lead the way • Continue to Collect Data

34. Keys For Successful Adoption • Relative Advantage • Degree to which an innovation is perceived as being better than the idea it supersedes • Compatibility • Degree to which an innovation is perceived to be consistent with the existing values, past experiences and needs of potential adopters • Complexity • Degree to which an innovation is perceived as difficult to use • Trialability • Opportunity to experiment with the innovation on a limited basis • Observability • Degree to which the results of an innovation are visible to others

35. Example: Spreading your project“Check a Box. Save a Live.”

36. Leadership ChangePassing the Torch • Remember handoffs are a leading cause of error! • Ensure members of the original team will be able to continue carrying out efforts • Document logistical challenges and recommendations for the next leader • Keep lines of communication open

37. Summary Objectives • List overarching global aims of improvement • Form a multi-disciplinary team • Begin to innovate, design, and implement a student-run quality improvement project • Use Plan-Do-Study-Act cycles for improvement initiatives • Be Bold. Be a Change Agent!