Choose Your Own Adventure to Quality Improvement

THE IHI ESSENTIALS TOOLKIT

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Introduction

Learning Outcomes

At the conclusion of this session, participants will be able to:

1. Discuss the Centers for Medicare & Medicaid Services (CMS) definitions of quality measurement and quality improvement.
2. Implement the PDSA (Shewhart) cycle for continual improvement of processes and products.
3. Examine the tools contained in the Institute for Healthcare Improvement (IHI) toolkit and select the appropriate one to utilize when approaching a specific challenge.
4. Value quality improvement in healthcare.

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Background Information

• The business of healthcare continues to emphasize quality improvement (QI) which can mean many different things to different people and different organizations.
• Without training and experience in QI, it can be daunting and it’s easy to become overwhelmed.
• We will review the Institute for Healthcare Improvement (IHI) QI toolkit and then utilize it in a “Choose Your Own Adventure” style experience to work an EMS specific QI question.
• The goal is for participants to start down the pathway to becoming comfortable with QI utilizing the tools that are standard in other domains of healthcare.

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The Players

• The Agency for Healthcare Research and Quality (AHRQ) is the lead federal agency charge with improving the safety and quality of healthcare for all Americans.
• The Centers for Medicare & Medicaid Services utilizes quality improvement and quality measures to achieve goals and priorities of meaningful use through standardization.
• The Joint Commission is a healthcare accrediting body with expectations regarding quality improvement.

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What is Quality Improvement?

• “Quality improvement is the framework used to systematically improve care. Quality improvement seeks to standardize processes and structure to reduce variation, achieve predictable results, and improve outcomes for patients, healthcare systems, and organizations.”

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• -Agency for Healthcare Research and Quality (AHRQ)

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Drivers of QI

• 1999: To Err Is Human: Building a Safer Health Care System
• 44,000 to 98,000 Americans dying due to medical errors each year
• Equivalent to three jumbo jets crashing every other day; statistics widely reported by the media
• 2001: Crossing the Quality Chasm: Health Care in the 21st Century
• Six dimensions of US health care that need improvement

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Six Dimensions of Health Care Quality

How Can We Improve?

• “Every system is perfectly designed to get the results it gets.”
• The “science of improvement” focuses on changing systems — not people
• “Science of improvement”
• “Health care delivery science”
• “Implementation science”
• “Systems strengthening”
• “Systems engineering”

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System of Profound Knowledge

• Theory of improvement from W. Edwards Deming
• Framework for understanding key aspects of systems
• Predecessor of the Model for Improvement

Essentials of QI

How Can We Improve?

1. Will. You must have the will to improve

2. Ideas. You must have ideas about alternatives to the status quo.

3. Execution. You must make it real.

Improvement Methods

• Models for Improvement
• Lean
• Six Sigma
• Model for Improvement

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• Having a standard road map for improvement — rather than the specific framework you decide to use — is what’s most important

Three Questions and a Cycle

The PDSA Cycle

• Plan
• Questions & predictions
• Who/what/where/when?
• Do
• Observe the test
• Document results
• Study
• Draw run charts
• Analyze the data
• Act
• Refine the change and plan for the next cycle

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SMART Goals

The Donabedian Model

Sample Change Concepts

1. Eliminate waste
2. Improve workflow
3. Optimize inventory
4. Enhance the producer-customer relationship
5. Change the work environment
6. Manage time
7. Manage variation
8. Design systems to prevent errors
9. Focus on the design of products and services

Using Data for Improvement

Defining Measures: Three Types

• Use unambiguous operational definitions

Acting on Tests of Change

The Toolkit

Cause & Effect Diagram

• Helps teams explore and display causes contributing to a certain effect or outcome.
• Also known as the Ishikawa diagram
• Also known as a fishbone diagram
• Includes materials, methods, equipment, environment, and people

Driver Diagram

• Visual display of a teams theory of what contributes to achievement of a project aim
• Shows the relationship between the project aim, the primary drivers, the secondary drivers, and the specific change ideas

Failure Modes and Effects Analysis (FMEA)

• Tool for conducting systematic, proactive analysis of a process in which harm may occur
• Reviews, evaluates, and records the following:
• Steps in the process
• What could go wrong (failure modes)
• Why would the failure happen (failure causes)
• What would be the consequences of each failure (failure effects)

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Flowchart

• Visual representation of the sequence of steps in a process
• Also known as a process map
• Especially useful in early phases of process work

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Histogram

• Type of bar chart used to display variation in continuous data
• Time
• Weight
• Size
• Temperature

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Pareto Chart

• Uses the Pareto principle
• The 80/20 rule
• 80% of the effect comes from 20% of the causes
• Type of bar chart which arranges the contributing factors in order from larges to smallest contribution

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Problem Analysis

Identifying a Problem

In Conclusion

https://www.healthcatalyst.com/insights/improvement-science-in-healthcare-yields-real-change

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Resources

• https://www.ihi.org/resources/Pages/Tools/Quality-Improvement-Essentials-Toolkit.aspx?PostAuthRed=/resources/_layouts/download.aspx?SourceURL=/resources/Knowledge%20Center%20Assets/Tools%20-%20QualityImprovementEssentialsToolkit_e14261f9-05ff-4a7b-ba25-58c85c4c9e9a/QIEssentialsToolkit.pdf
• http://www.phf.org/focusareas/qualityimprovement/Pages/Quality_Improvement_Resources.aspx

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References

• https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/mms/quality-measure-and-quality-improvement-#:~:text=Quality%20improvement%20is%20the%20framework,%2C%20healthcare%20systems%2C%20and%20organizations.
• https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/quality-improvement.html
• https://www.ahrq.gov/tools/index.html?search_api_views_fulltext=&field_toolkit_topics=14170&sort_by=title&sort_order=ASC

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Thank you!

Melodie J. Kolmetz, MPAS, PA-C, EMT-P

melodie@amedicaltypeperson.com

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www.amedicaltypeperson.com

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@AMedTypePerson

Melodie-Kolmetz