QUALITY IMPROVEMENT BASICS National Coalition of STD Directors - - PowerPoint PPT Presentation

QUALITY IMPROVEMENT BASICS

National Coalition of STD Directors Annual Meeting 2017

CHANGE IS HARD…

Icons by: IconDots, omar vargas, Bonegolem, Aya Sofya, Numero Uno, Ben Davis from Noun Project

WHAT & WHY? GOALS GO AND SEE MAP IDEATE PRIORITIZE TEST

THE QI PROCESS

Icons by: IconDots, omar vargas, Bonegolem, Aya Sofya, Numero Uno, Ben Davis from Noun Project

GOALS GO AND SEE MAP IDEATE PRIORITIZE TEST WHAT & WHY?

WHAT IS A SYSTEM?

INPUTS OUTCOMES

Icons by: orin zuu, Gregor Cresnar, Nirbhay, ImageCatalog from Noun Project

PROCESSES

Icons by: Cbi icons, Blair Adams, Marie Van den Broeck, creative outlet, Ben Davis from Noun Projectc

Process Continuous Measurable Improvement Outcomes

WHAT IS QUALITY IMPROVEMENT?

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)

Focused on reducing inefficiencies Patient/customer first People as the most valuable resource Continuous improvement Focused on where the work is done

It’s all about VALUE!

A cost-reduction program Budget-cutting strategy Trimming headcount A fad or flavor of the month

LEAN IS… LEAN IS NOT…

What are we trying to accomplish? How will we know if a change is an improvement? What change will result in improvement? Act Plan Study Act

MODEL FOR IMPROVEMENT

WHAT MAKES QI SUCCESSFUL?

Icons created by Mahmure Alp, Royyan Razka, Oksana Latysheva, Gautam Arora from Noun Project

Leadership Champion QI Plan Multi-Disciplinary QI Team All Levels Involved Data Systems

THE PIG

Icons by: IconDots, omar vargas, Bonegolem, Aya Sofya, Numero Uno, Ben Davis from Noun Project

GOALS GO AND SEE MAP IDEATE PRIORITIZE TEST WHAT & WHY?

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

Increase the frequency of Lindsey taking out the recycling from

• nce a week to three times a week

by end of January to reduce pile up in the kitchen.

Who? How much? By when? Why? What?

Icons by: IconDots, omar vargas, Bonegolem, Aya Sofya, Numero Uno, Ben Davis from Noun Project

GOALS GO AND SEE MAP IDEATE PRIORITIZE TEST WHAT & WHY?

UNDERSTANDING THE CURRENT STATE

Go and See Be the thing as it is today. Observe and record actual process data.

Icons by: IconDots, omar vargas, Bonegolem, Aya Sofya, Numero Uno, Ben Davis from Noun Project

GOALS GO AND SEE MAP IDEATE PRIORITIZE TEST WHAT & WHY?

VALUE STREAM MAP (VSM)

Pediatric Clinic Current State 9/2015

Process Step Wait Time Data Boxes

LINDSEY’S RECYCLING PROCESS

Recycling can reaches peak fullness Remove bag from can Walk can down the hall Take elevator to bottom level Prop

• pen

elevator door Throw bag in recycling can Take elevator back to third floor Replace recycling bag

• Tie bag to

close

• Gather

boxes not in the bag and breakdown

• Force it out
• f the bin
• Balance

boxes under one arm and carry bag in the other hand

• Wait for
• ne of two

elevators that goes to the bottom parking level

• No up

button on the elevator door

• Grab a

garbage can to block the door from closing

• Open can,

throw in recycling as fast as possible before fruit flies invade the elevator

• Avoid flies
• Plug nose
• Walk back

down the hall

• Open

under sink cabinet

• Pull out bag
• Fit bag over

edge of trash can

1-5 min

Value added time (touch time) Non-value added time

29 8 58 21 8 4 6 21 10 6 8 19 12 14 3 65 min 162 min Total Time: 227 min

T

• tals:

Icons by: IconDots, omar vargas, Bonegolem, Aya Sofya, Numero Uno, Ben Davis from Noun Project

GOALS GO AND SEE MAP IDEATE PRIORITIZE TEST WHAT & WHY?

IDEATION TOOL BOX

GENERATING IDEAS FOR IMPROVEMENT

MA MA

MD Champ NP Champ NPs

DEFER TO PROCESS EXPERTS

IDENTIFYING THE ROOT CAUSE

LINDSEY’S RECYCLING PROCESS

Recycling can reaches peak fullness Remove bag from can Walk can down the hall Take elevator to bottom level Prop

• pen

elevator door Throw bag in recycling can Take elevator back to third floor Replace recycling bag

• Tie bag to

close

• Gather

boxes not in the bag and breakdown

• Force it out
• f the bin
• Balance

boxes under one arm and carry bag in the other hand

• Wait for
• ne of two

elevators that goes to the bottom parking level

• No up

button on the elevator door

• Grab a

garbage can to block the door from closing

• Open can,

throw in recycling as fast as possible before fruit flies invade the elevator

• Avoid flies
• Plug nose
• Walk back

down the hall

• Open

under sink cabinet

• Pull out bag
• Fit bag over

edge of trash can

1-5 min

VALUE & WASTE

Reduce

Value Added Non-value added but necessary Non-value added

8 WASTES Defects Overproduction Waiting Non Value-Added Processing Transportation Inventory Motion Employee Underutilization

1.

Maintains productivity and quality.

2.

Reduces variation.

3.

Makes the job easily carried out by anyone.

WHERE IN THE PROCESS CAN WE STANDARDIZE?

STANDARD WORK

THE 5 WHY’S Quickly determines root causes of a problem Defines buckets/themes Removes layers of assumptions

ROOT CAUSE ANALYSIS USING A FISHBONE DIAGRAM

Poor Outcomes

Environment Equipment/ Supplies People Process/ Policy

Skills Short staffed No clearly defined roles No defined frequency Low quality materials Physical space

Low Screening Rates

Cultural and/or language barrier

Patient

Stigma/Shame Loss to f/u Not asked for confidential phone number for f/u

Clinic Staff

Not trained on minor consent Multiple priorities Understaffed

CHLAMYDIA SCREENING FISHBONE DIAGRAM

Provider

Not trained on sexual history taking Multiple priorities No standard documentation

Equipment/ Supplies

Cost of materials Cost of labs No patient ed materials

Clinic System

Only offered when PA is there No standard documentation in EHR No EHR reminder for screening

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

GOALS GO AND SEE MAP IDEATE PRIORITIZE TEST WHAT & WHY?

IMPACT MATRIX

Quick Wins Major Projects Fill Ins Hard Slogs High Low Low High

DIFFICULTY IMPACT ON THE AIM

GOALS GO AND SEE MAP IDEATE PRIORITIZE TEST WHAT & WHY?

MODEL FOR IMPROVEMENT

What are we trying to accomplish? How will we know if a change is an improvement? What change will result in improvement? Act Plan Study Do

PLAN DO STUDY ACT CYCLE

Act Plan Study Do

• Objective of cycle
• Questions/

predictions

• Plan (who, what,

where, when)

• Carry out the plan
• Document problems/

unexpected

• bservations
• Begin data

analysis

• Complete data

analysis

• Compare data to

predictions

• Summarize what

was learned

• What changes will

be made?

• Adapt? Or

Abandon?

• Next cycle?

TESTS OF CHANGES IN PARALLEL

Express visits for STI screening Standardizing Sexual Risk Assessment Tool Signing up patients for

• nline reminders

For re-testing Leaving out Test kits and Pre-printed labels Handing out Pre-packaged Medication for Expedited partner therapy

CURRENT STATE

INPUTS & PROCESSES

FUTURE STATE

RULES ROLES

2 surgeons 2-6 clinic staff Quality manager Only surgeons can implant Challenge what’s possible “Yes, if”

REFLECTIONS

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

Public Health Foundation

Mission: Strengthening the Quality and Performance

• f Public Health Practice

LEARNING NETWORK

• Over 1.5 million registered learners
• Free to join
• Thousands of training opportunities

www.train.org

www.phf.org

PERFORMANCE IMPROVEMENT TECHNICALASSISTANCE & TRAINING

• On-site services facilitated on-site by PHF’s

experts

• Accreditation preparation and support, leadership

and change management, and strategic planning www.phf.org/piservices

ACADEMIC PRACTICE LINKAGES

• Council on Linkages Between Academia and Public

Health Practice

• Core Competencies for Public Health Professionals
• Academic Health Department Learning Community

www.phf.org/councilonlinkages www.phf.org/corecompetencies

PERFORMANCE MANAGEMENT & QUALITY IMPROVEMENT

• Toolkits, case examples, articles, and papers
• Resources supporting performance improvement

www.phf.org/resourcestools

10 20 30 40 50 60 70 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

Orange Duval Hillsborough Pinellas

Orange County QI Project Begins (October 2005)

2005 2006 2004

Total Cases, All Risks

Syphilis Data Source: Florida Department of Health, STDMIS System. 2006 data for all four counties provided as of 10/13/2006.

Total Reported Early Syphilis Cases by Quarter, 2004-2006: Orange County Compared to Peer Counties in Florida

• QI teams made up of

people doing this work every day – “on the ground” practitioners

• PHF provided a coach and

support

• Throw the assumptions out

the window

• Focus on doing over

“training”

• Build momentum and peer

interest

“Maybe it’s time to try a bottom-up approach”

• Mapped processes

to identify improvement

• pportunities
• Focused on root

causes, especially staff turnover

• Brainstormed

changes within their control or influence

• Tracked monthly

data

Diary of a Successful QI Team

Diary of a Successful QI Team

• Reviewed progress as a

team

• Presented progress

quarterly to colleagues and management

• Evaluated the process
• Celebrated team success,

with local health official recognition and certificates

Total Reported Early Syphilis Cases by Quarter, 2004-2006: Orange County Compared to Peer Counties in Florida

10 20 30 40 50 60 70

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

Orange Duval Hillsborough Pinellas

Orange County QI Project Begins (October 2005)

2005 2006 2004

Total Cases, All Risks

Syphilis Data Source: Florida Department of Health, STDMIS System. 2006 data for all four counties provided as of 10/13/2006.

Orange County improved and controlled processes underpinning the team’s effectiveness

Achieved 100% conformance for field blood draw standards in two consecutive months Improved other methodology and processes (such as travel procedures and access to supplies/equipment)

Stopped DIS turner (a root cause)

Achieved zero employee turnover in the first half of 2006 (six people had left the STD team the previous year) Improved morale, teamwork, and employee job satisfaction

Syphilis declined more than 25% in 2006

STD Team Results

Public Health Improvement Resource Center: www.phf.org/improvement

• 600+ categorized resources on performance improvement topics

Quality Improvement Tools to Advance Public Health Performance:

www.phf.org/qitools

• 30+ categorized QI tools available for free download
• Includes categories such as team management, leadership, and more

Quality Improvement Quick Guide: www.phf.org/quickguide

• PDCA tutorial and resources for implementing QI

TRAIN Learning Network

• Trainings on quality improvement, and in public health topical areas such as

STD best practices, guidance, and evidence

Four Quality Improvement Resources for STD Directors and Programs