11/14/2012 Public Health Quality Improvement 101 Public Health - - PDF document

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11/14/2012 Public Health Quality Improvement 101 Public Health - - PDF document

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11/14/2012 Public Health Quality Improvement 101 Public Health Quality Improvement 101 Learning, Experiencing, & Doing Quality Improvement Learning, Experiencing, & Doing Quality Improvement Workshop 2 Workshop 2 November 14th, 2012

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Public Health Quality Improvement 101 Public Health Quality Improvement 101

Learning, Experiencing, & Doing Quality Improvement Learning, Experiencing, & Doing Quality Improvement

Workshop 2 Workshop 2 November 14th, 2012

Welcome!

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Congratulations…you’re paving the way for improvement in NC Public Health!

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Objectives of Workshop 2

  • Reflect on experience, celebrate successes, and share

lessons learned

  • Gain a deeper understanding of how to use QI tools

and methods E i t t l l t ROI

  • Equip teams to calculate ROI
  • Discuss strategies to overcome barriers/challenges
  • Develop a plan to sustain QI project and spread QI

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Workshop 2: Agenda

  • Today’s Focus: Celebrate and Re‐Connect

– Putting the Pieces Together – QI Tool Time – Share Your Improvement Stories

  • Tomorrow’s Focus: Sustaining

– Share Your Improvement Stories – Holding What You Gained: Sustaining Improvements – Return on Investment (ROI) Calculation – Problem Solving to Resolve your QI Issues

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Workshop 2: Agenda

  • Friday’s Focus: Preparing to Return Home

– Spreading Improvements to Others – Team Planning Time – Wrap‐up

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Workshop Overview Workshop Overview

Guiding Principles/Ground Rules

– Participation is essential – Agenda as a guide – “Share seamlessly and steal shamelessly” – Silence your cell or blackberry

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Housekeeping Items Housekeeping Items

  • Meeting Space Layout
  • Take Breaks as Needed
  • CEU Credits
  • Feedback

– “Bright Ideas” Cups

  • Questions

– Green Index Cards

  • Course Handouts

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Introductions Introductions

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Hopes and Hesitations Hopes and Hesitations

Write on an index card:

  • One Hope you have for the Workshop
  • One Hesitation you have about the Workshop

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HOPE HESITATION

Assignment: Newspaper Headline Assignment: Newspaper Headline

Each team is paired with a partner team

(Look on inside of your tent card)

Instructions: Instructions:

– Listen to your partner team’s report out – Create a headline to summarize their experience – Think of a picture to accompany the headline

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CH Nurse Consultants CH Nurse Consultants

Created by Scotland County Created by Scotland County

“Dreaming for Rainbows, the NC Child Health ‘Bright Futures’ Program is Following the Yellow Brick Road”

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Public Health Quality Improvement 101 Public Health Quality Improvement 101

Putting the Pieces Together

Presenter: Claire See& Kerri Ward

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Where You’ve Been Where You’ve Been

THE MODEL FOR IMROVEMENT

(The QI Roadmap)

GETTING STARTED Select a QI Project Assemble a QI Team What are we trying to accomplish? AIM H ill k th t h How will we know that our changes are an improvement? MEASURES TEST ideas with Plan‐Do‐Study‐Act cycles for learning & improvement SPREAD and SUSTAIN change ideas that are successful What changes can we make that will result in an improvement? IDEAS CONTINUOUS QI (Big QI) QI Projects (Small qi)

Creating a Culture of QI  Create the urgency for improvement  Form a quality council  Create a vision for improvement  Communicate the vision  Remove obstacles, train and empower staff  Prioritize and create early wins  Build on successful projects  Hardwire quality into your culture and strategic plan What are we trying to accomplish? (AIM) How will we know that a change is an improvement? (MEASURES)

nt

K A  Aim Statement  Charter Collect Data  Measurement Plan  Customer/Staff Surveys Display Data  Run Chart  Gemba Walk

QI Tools

What changes can we make that will result in an improvement? (IDEAS) TEST IDEAS IMPLEMENT/SUSTAIN/SPREAD

Model for Improvemen

I Z E N E V E N T  Sustainability and Spread Checklists  PDSA Cycles  PDSA Cycles Understand Current Condition  Gemba Walk  Value Stream Map  Spaghetti Diagram  Swim Lanes Identify Change Ideas  8 Wastes (DOWNTIME)  Evidence Based Guidelines  General Change Concepts  Feedback from Clients/Staff Prioritize Change Ideas  Impact Matrix (PACE Chart)  Pareto Chart  5 Whys  Fishbone Diagram

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QI Style QI Style QI Style QI Style

Team Song Title Team Song Title‐Wake Wake

  • Share Your:

– Health Department Name – Team Aim – Team Song Title (or song)

  • Why did you choose this song title?

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Team Song Title Team Song Title‐Albemarle Albemarle

  • Share Your:

– Health Department Name – Team Aim – Team Song Title (or song)

  • Why did you choose this song title?

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Team Song Title Team Song Title‐Columbus Columbus

  • Share Your:

– Health Department Name – Team Aim – Team Song Title (or song)

  • Why did you choose this song title?

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Break Time... Break Time...

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Public Health Quality Improvement 101 Public Health Quality Improvement 101

QI Tool Time

Presenter: Gene Smith & Amanda Cornett

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Session Objectives Session Objectives

  • Briefly review previously introduced tools and

concepts thru question and answer

  • Introduce and use new tools and concepts
  • Discuss how to apply new tools to current QI

project

Industrial Extension Service www.ies.ncsu.edu 22

New Tools New Tools

  • Spaghetti Diagrams
  • Layout Design
  • Functional Flowchart/Swim Lanes Chart
  • Kanbans

Spaghetti Diagram Spaghetti Diagram

A layout showing equipment and personnel and their movement through the area

Supplies Patient Flow RN Flow Drug Scale Central Nurses Station Exam Room Exam Room Exam Room Supplies Room

  • Dr. Office

Procedure Room g Samples Dr. Flow

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Before = 662 steps and 16 stops After = 252 steps and 13 stops

Spaghetti Diagram ‐ Travel Distances

p Waiting Room Trips went from 5 down to 3.

Functional Flowchart (AKA Swim Lanes) Functional Flowchart (AKA Swim Lanes)

Mail Room Process

Sorter Courier

Sort the thicks from the thins & the smalls Slice thin & small envelopes on machine C t thi k Start P t l Put envelopes in trays & pull out labels Unload bins from cages Bring cages into mailroom

Industrial Extension Service www.ies.ncsu.edu 26

Value Add Non-Value Add

Lead Extractor S

Count thick envelopes, labels and stack Pick up tray from shelf, go to desk Thick opened manually, sorted by type Thin envelopes have claims extracted & sorted Pick up trays & place on cart QC each tray take trays to input prep End Put claims in trays by type Put envelopes on the shelf

The Pizza Place: Current State Scenario

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Spaghetti Diagram Scenario Spaghetti Diagram Scenario

  • Draw a Spaghetti Diagram for the work flow at our Pizza Place
  • Draw a Swim Lane Chart for the work flow at our Pizza Place

The Pizza Place

Current State Layout

Functional Flowchart AKA Swim Lane Chart Functional Flowchart AKA Swim Lane Chart

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Tips for Layout Design Tips for Layout Design

Basics to improve flow:

  • Keep continuous flow concept as a focus when

designing a new layout.

  • Physical location of work stations and/or

equipment should correspond to work sequence. equipment should correspond to work sequence.

  • Identify facility constraints (electrical outlets, etc.)
  • Determine which staff need access to which

equipment.

Tips for Layout Design Tips for Layout Design – cont’d cont’d

Basics to improve flow:

  • U‐Shaped or C‐Shaped (aka cellular) designs are
  • ften most efficient in Lean.
  • Test layout designs to make sure they’re working.
  • Establish pre and post measurements to

p p document flow improvements.

  • Do not create a layout that cannot be changed.

Flow & Layout Flow & Layout

Before After

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Layout Layout – Future State Exercise Future State Exercise

Instructions

  • Review the current state of The Pizza Place’s layout
  • Apply layout design principles and design the future

state layout

  • Create the future state using a flip chart and post‐its

Create the future state using a flip chart and post its

  • List measures that would show if improvements

were made to the layout

  • Create a future state swim lane chart for your new

layout

The Pizza Place

Future State Layout

Before After

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Functional Flowchart AKA Swim Lane Chart Functional Flowchart AKA Swim Lane Chart

Kanban System Kanban System

  • Visual signal
  • Creates a “pull” of material
  • Can be a card, tag, folder, empty slot,

vacant location designated and located th fl il li t i

  • n the floor, email, line on a container,

a container, etc.

  • Must be accompanied by standard

work

Kanban for Supplies Kanban for Supplies

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Example of a 2 bin system and layout changes in healthcare ‐ Play video

Industrial Extension Service www.ies.ncsu.edu 40

One Point Lesson One Point Lesson Team Report Team Report‐Outs Outs

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