Improvement Science Made Simple Dr. Moza Alishaq-Ph.D Dr. Jameela Alajmi-MD Brought to you by Hamad Healthcare Quality Institute
Objective : To gain an understanding of: Quality Quality improvement Profound Knowledge Model of change Describe the basic principles of quality improvement introduce the methods and tools for improving the quality of health care by using Model for Improvement, PDSA and its Journey Creativity thinking & Improvement in Decision Making Brought to you by Hamad Healthcare Quality Institute
- UNDERSTAND QUALITY : Institute of Medicine, is often used: • [QUALITY is] the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Brought to you by Hamad Healthcare Quality Institute
HOW OTHERS LOOK AT QUALITY ` Institute for Healthcare Improvement (IHI): “Quality - is as outcomes management, minimizing unnecessary variation so that outcomes become more predictable and certain. Brought to you by Hamad Healthcare Quality Institute
What does quality in healthcare means? Brought to you by Hamad Healthcare Quality Institute
The Institute of Medicine has identified six dimensions of healthcare quality . These state that healthcare must be: Safe Therefore, leaders need to actively Equitable Effective consider these six dimensions when setting their priorities for improvement. Patient Efficient Centered Timely Brought to you by Hamad Healthcare Quality Institute
WHAT DO YOU THINK IS QUALITY IMPROVEMENT Quality improvement. it as a systematic approach that uses specific techniques to improve quality. They are combination of a ‘change’ (improvement) and a ‘method’ (tools), in order to achieve better outcomes. The conception of improvement better patient experience and outcomes achieved through changing provider behaviour and organisation through using a systematic change method and strategies. Brought to you by Hamad Healthcare Quality Institute
Brought to you by Hamad Healthcare Quality Institute
How can we improve a system to achieve better results in the dimensions of quality You need to : Know the place of care/service Know your patients understand the system is failing – Identify what is wrong. make sure it is the step that needs fixing. `Identify processes that can be improved and lead to better quality of care. `Then you can implement a change to the “system”. Brought to you by Hamad Healthcare Quality Institute
4 1 What would improve quality? 3 2 Brought to you by Hamad Healthcare Quality Institute
Understanding the problem , 1 what the data tell you - understanding the processes and systems within the organisation – patient pathway Brought to you by Hamad Healthcare Quality Institute
Analysing The demand, capacity and 1 flow of the service 2 Brought to you by Hamad Healthcare Quality Institute
choosing the tools to bring about change, and 1 include: leadership and clinical engagement, 3 skills development, staff and patient participation Brought to you by Hamad Healthcare Quality Institute
4 Evaluating and 1 measuring the impact of a change 3 2 Brought to you by Hamad Healthcare Quality Institute
9 Categories of Change for Quality Improvement eliminate Manage waste design systems variation to avoid improve mistakes work flow Manage Time change focus on the work product/service environment Enhance the relationship Brought to you by Hamad Healthcare Quality Institute
The Deming System Of Profound Knowledge Knowledge Knowledge Of a - Appreciation of a system : understanding the overall Of Variation System W Edwards Deming processes involving suppliers, Producers, and customers ( or recipients ) of goods and services ( explained below ); - Knowledge of variation : the range and causes of Knowledge Theory Of variation in quality, and use of statistical sampling in Of Knowledge measurements; Psychology - Theory of knowledge : the concepts explaining knowledge and the limits of what can be known. - Knowledge of psychology : concepts of human nature . Brought to you by Hamad Healthcare Quality Institute
Special cause =It is irregular causes that are not Common Variation=is always present inherent in the design of process Is inherent in the process Brought to you by Hamad Healthcare Quality Institute
Group Activity Brought to you by Hamad Healthcare Quality Institute
Reduce Outpatient Waiting Time Appreciation of a system Knowledge of variation What are the resources required to improve What is your predication about type of system? variation? Knowledge of psychology Theory of knowledge What are the ideas you would like to implement How are you going to reward the to reduce waiting time? team? Brought to you by Hamad Healthcare Quality Institute
Five Deming Principles That Help Healthcare Process Improvement 1. Quality improvement is the science of process management . 2. If you cannot measure it…You cannot improve it . 3. Managed care means managing the processes of care, not managing physicians and nurses . 4. The right data in the right format at the right time in the right hands. 5. Engaging the “smart cogs” of healthcare . Brought to you by Hamad Healthcare Quality Institute
Patients Exercise on Quality What is the benefit for: Staff Organization Brought to you by Hamad Healthcare Quality Institute
What is ‘‘quality improvement’’ and how can it transform healthcare Better patient Better (and population ) Professional Outcomes development (Health) (Learning) - better patient outcomes (health), - better system performance (care) and Everyone - better professional development (learning ). Better System Performance (Care) Brought to you by Hamad Healthcare Quality Institute
Precontemplation (Not yet Enter acknowledging that there is a problem behavior that needs to be changed) Contemplation (Acknowledging that there is a problem but not yet ready or sure of The Stages wanting to make a change) Of Preparation/Determination (Getting ready to change) Change Model Action/Willpower (Changing behavior) Maintenance (Maintaining the behavior change) Relapse (Returning to older behaviors and abandoning the new changes) Brought to you by Hamad Healthcare Quality Institute
Exercise • Thinking of not smoking but not now I still thinking about it • Stop Smoking didn’t help me to be healthy there is no difference • I am thinking of stop smoking, can you help how to do this? • It is not the time for me to stop Smoking • It is my time to keep doing exercise and follow up Brought to you by Hamad Healthcare Quality Institute
Donabedian Quality Framework Outcome Process Structure - Survival - Degree of health - Evolutions - Facilities P O - Treatments - Time to recovery S - Staff - Disability due to care - What gets done to - Equipment - Sustainability of health patients - Long-term adverse consequences of care Brought to you by Hamad Healthcare Quality Institute
The Patient Journey Through Hospital System The Patient experience is a direct result of how the different hospital systems interact and the way staff Pharmacy work within these systems to provide patient care. Medical Imaging Patient Arrives Specialist P.I.C.U Clinics Ward Theatre Emergency Department Pathology Allied Health Support Services Please note : The purpose of this diagram is to demonstrate the large number of systems that a patient could pass through on their healthcare journey. Brought to you by Hamad Healthcare Quality Institute
Interaction Brought to you by Hamad Healthcare Quality Institute
Brought to you by Hamad Healthcare Quality Institute
A female patient 23 years old was admitted to the medical intensive care unit at MBX hospital due to sudden loss of consciousness and seizures. At the time of admission observed lack of consciousness, seizures and severe critical condition was observed. Meningitis and septic shock were diagnosed. Based on computed tomography performed on the first day--inflammation of the sinuses soft tissues was diagnosed. Suspected cause of infection was performed 6 weeks earlier surgical correction of the nasal septum. In the next stage of treatment on the seventh day after admission the functional endoscopic sinus surgery was performed. Due to massive tissue hypoperfusion the necrosis in the skin of the lower limbs occurred. Due to the lack of effectiveness antimicrobial therapy use of intravenous ceftaroline was administrated. Effective treatment allowed in day 11 to wean the patient from the ventilator. At the day 26 the patient was transferred to a hospital in the place of residence. Brought to you by Hamad Healthcare Quality Institute
Break Time 15 Minutes Brought to you by Hamad Healthcare Quality Institute
Brought to you by Hamad Healthcare Quality Institute
- Have you ever attempted to make a change in your personal or professional life and failed; perhaps a New Year’s resolution? - Your failure to improve was probably not due to a lack of motivation or a desire to improve, but rather to a lack of utilizing a good method proven to be effective at implementing change. Brought to you by Hamad Healthcare Quality Institute
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