QUALITY IMPROVEMENT BASICS National Coalition of STD Directors Annual Meeting 2017
CHANGE IS HARD…
THE QI PROCESS GOALS MAP PRIORITIZE WHAT & WHY? GO AND SEE IDEATE TEST Icons by: IconDots, omar vargas, Bonegolem, Aya Sofya, Numero Uno, Ben Davis from Noun Project
GOALS MAP PRIORITIZE WHAT & WHY? GO AND SEE IDEATE TEST Icons by: IconDots, omar vargas, Bonegolem, Aya Sofya, Numero Uno, Ben Davis from Noun Project
WHAT IS A SYSTEM? INPUTS PROCESSES OUTCOMES Icons by: orin zuu, Gregor Cresnar, Nirbhay, ImageCatalog from Noun Project
WHAT IS QUALITY IMPROVEMENT? Process Measurable Outcomes Continuous Improvement Icons by: Cbi icons, Blair Adams, Marie Van den Broeck, creative outlet, Ben Davis from Noun Projectc
QUALITY ASSURANCE VS. QUALITY IMPROVEMENT Quality Improvement Quality Assurance Icons by: Yanick Brezet, unlimicon from Noun Project
VAGUE PROBLEM Clarify problem Assess current condition Prioritize issues & set a target Define POSSIBLE changes T est, implement, and sustain IMPROVEMENT QI PROBLEM SOLVING Adapted from: The Toyota Way (The 8 Steps of the Toyota Business Process)
LEAN IS… LEAN IS NOT… Focused on reducing A cost-reduction program inefficiencies Budget-cutting strategy Patient/customer first People as the most valuable Trimming headcount resource A fad or flavor of the month Continuous improvement Focused on where the work is It’s all about VALUE! done
What are we trying to accomplish? How will we know if a change is an improvement? What change will result in improvement? Act Plan MODEL FOR Study Act IMPROVEMENT
WHAT MAKES QI SUCCESSFUL? Multi-Disciplinary QI Plan QI Team Leadership Champion Data Systems All Levels Involved Icons created by Mahmure Alp, Royyan Razka, Oksana Latysheva, Gautam Arora from Noun Project
THE PIG
GOALS MAP PRIORITIZE WHAT & WHY? GO AND SEE IDEATE TEST Icons by: IconDots, omar vargas, Bonegolem, Aya Sofya, Numero Uno, Ben Davis from Noun Project
THE AIM STATEMENT & MEASURES Where are we going? How will we know if we’re getting there?
THE PROBLEM: AN EXAMPLE Photo from: http://www.lolpix.com/pictures/6/Funny_Pictures_1130.htm
AIM STATEMENT Who? Increase the frequency of Lindsey What? taking out the recycling from How much? once a week to three times a week by end of January By when? Why? to reduce pile up in the kitchen.
GOALS MAP PRIORITIZE WHAT & WHY? GO AND SEE IDEATE TEST Icons by: IconDots, omar vargas, Bonegolem, Aya Sofya, Numero Uno, Ben Davis from Noun Project
UNDERSTANDING THE CURRENT STATE Go and See Be the thing as it is today . Observe and record actual process data.
GOALS MAP PRIORITIZE WHAT & WHY? GO AND SEE IDEATE TEST Icons by: IconDots, omar vargas, Bonegolem, Aya Sofya, Numero Uno, Ben Davis from Noun Project
VALUE STREAM MAP (VSM) Process Pediatric Clinic Step Current State 9/2015 Wait Time Data Boxes
LINDSEY’S RECYCLING PROCESS Recycling Take Take Prop Throw can Remove Walk can elevator elevator Replace open bag in reaches bag from down the to back to recycling recycling elevator peak can hall bottom third bag door can 1-5 fullness level floor min • Tie bag to • Force it out • Balance • Wait for • No up • Open can, • Avoid flies • Open close of the bin boxes one of two button on throw in • Plug nose under sink • Gather under one elevators the recycling as • Walk back cabinet boxes not arm and that goes elevator fast as down the • Pull out bag in the bag carry bag in to the door possible hall • Fit bag over and the other bottom • Grab a before fruit edge of breakdown hand parking garbage can flies invade trash can level to block the the door elevator from closing
Value added time (touch time) Non-value added time T otals: 65 29 8 58 6 8 12 21 10 19 8 4 6 14 3 min 21 162 min Total Time: 227 min
GOALS MAP PRIORITIZE WHAT & WHY? GO AND SEE IDEATE TEST Icons by: IconDots, omar vargas, Bonegolem, Aya Sofya, Numero Uno, Ben Davis from Noun Project
IDEATION TOOL BOX
GENERATING IDEAS FOR IMPROVEMENT
DEFER TO PROCESS EXPERTS NPs MD Champ NP MA Champ MA
IDENTIFYING THE ROOT CAUSE Photo: ttps://www.thetreecenter.com/wp-content/uploads/tree-roots.jpg
LINDSEY’S RECYCLING PROCESS Recycling Take Take Prop Throw can Remove Walk can elevator elevator Replace open bag in reaches bag from down the to back to recycling recycling elevator peak can hall bottom third bag door can 1-5 fullness level floor min • Tie bag to • Force it out • Balance • Wait for • No up • Open can, • Avoid flies • Open close of the bin boxes one of two button on throw in • Plug nose under sink • Gather under one elevators the recycling as • Walk back cabinet boxes not arm and that goes elevator fast as down the • Pull out bag in the bag carry bag in to the door possible hall • Fit bag over and the other bottom • Grab a before fruit edge of breakdown hand parking garbage can flies invade trash can level to block the the door elevator from closing
VALUE & WASTE Reduce Non-value added Value Added but necessary Non-value added
8 WASTES D efects O verproduction W aiting N on Value-Added Processing T ransportation I nventory M otion E mployee Underutilization
STANDARD WORK WHERE IN THE Maintains 1. productivity and PROCESS quality. CAN WE Reduces variation. 2. STANDARDIZE? Makes the job easily 3. carried out by anyone . Photo: https://media.wired.com/photos/5926c33d8d4ebc5ab806b66f/master/w_2400,c_limit/PSLTA.jpg
THE 5 WHY’S Quickly determines root causes of a problem Defines buckets/themes Removes layers of assumptions Photo: https://lsssdblog.files.wordpress.com/2014/11/question-kid.jpg
ROOT CAUSE ANALYSIS USING A FISHBONE DIAGRAM Process/ People Policy No defined frequency Skills No clearly defined roles Poor Short staffed Outcomes Low quality materials Physical space Equipment/ Environment Supplies
CHLAMYDIA SCREENING FISHBONE DIAGRAM Patient Clinic Staff Provider Cultural and/or Multiple priorities Not trained on language barrier Not asked for sexual history taking confidential phone Stigma/Shame Understaffed number for f/u Multiple priorities Not trained on No standard Loss to f/u minor consent Low documentation Screening Only offered Cost of materials No patient ed when PA is there No EHR Rates materials reminder for Cost of labs No standard screening documentation in EHR Equipment/ Supplies Clinic System
THE FUTURE STATE What do we need to define the future state? What do we want it to look like? How will we know if it’s working or not?
LET’S TRY IT Photo: http://s3.amazonaws.com/scribblelive-com-prod/wp-content/uploads/2017/01/content-ideation-blog.jpg
GOALS MAP PRIORITIZE WHAT & WHY? GO AND SEE IDEATE TEST
High Quick Wins Major Projects IMPACT ON THE AIM IMPACT MATRIX Fill Ins Hard Slogs Low Low High DIFFICULTY
GOALS MAP PRIORITIZE WHAT & WHY? GO AND SEE IDEATE TEST
What are we trying to accomplish? How will we know if a change is an improvement? What change will result in improvement? Act Plan MODEL FOR Study Do IMPROVEMENT
PLAN DO STUDY ACT CYCLE A ct P lan • What changes will • Objective of cycle be made? • Questions/ • Adapt? Or predictions Abandon? • Plan (who, what, • Next cycle? where, when) S tudy D o • Complete data • Carry out the plan analysis • Document problems/ • Compare data to unexpected predictions observations • Summarize what • Begin data was learned analysis
TESTS OF CHANGES IN PARALLEL Express visits for Standardizing Signing up Handing out Leaving out STI screening Sexual Risk Pre-packaged patients for Test kits and Assessment online reminders Medication for Pre-printed labels Tool For re-testing Expedited partner therapy
FUTURE CURRENT INPUTS & PROCESSES STATE STATE
ROLES 2 surgeons 2-6 clinic staff Quality manager RULES Only surgeons can implant Challenge what’s possible “Yes, if” Photo: http://deskbg.com/i/c/1920x1200/wpp/0/848/cat-mini-van-desktop-background.jpg
REFLECTIONS Photo: https://i.pinimg.com/originals/da/33/07/da33077124a10a4e2584d76138a90232.jpg
THANK YOU! All Icons from The Noun Project
Quality Improvement Success in an STD Program: A Quick Story Vanessa Lamers, MPH, MESc Assistant Director Performance Management and Quality Improvement Public Health Foundation
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