L7. Using Quality Improvement Methods to Improve Care PDF

Using Quality Improvement Methods to Improve Care Patient Safety Lecture no. 7 COLOR INDEX Main Text Important Male Slides Female Slides Dr’s Notes Extra  To describe the principles of quality improvement. To introduce the...

Using Quality Improvement Methods to Improve Care Patient Safety Lecture no. 7 COLOR INDEX Main Text Important Male Slides Female Slides Dr’s Notes Extra  To describe the principles of quality improvement. To introduce the basic methods and tools for improving the quality of health care. To understand the benefits of using quality improvement methods. To apply the principles and use the tools to undertake their own improvement project. This lecture was presented by Dr. Ranyah Aldekhyyel For the required reading from Blackboard click here: I & II  The Purpose of Quality Improvement Methods (1, 2) 1 Identify a problem 3 Develop a range of interventions designed to fix the problem Test whether the interventions 2 Measure the problem 4 worked The Science of Improvement The role of measurement in improvement: (3) Measurement (collect & analyze data) is an essential component of quality Improvement. There is strong evidence to show that when people use the appropriate measures to measure change, significant improvements can be made. All quality improvement methods rely on measurement Three main types of measures: (4) Structure Processes Outcomes Measures Measures Measures Structure Measures Outcomes Measures Type Processes Measures Input Measures Output measures Measures of infrastructures, They measure if parts of Are results of overall process or capacity and system. Definition steps in the system are system performance, reflect the Basically is what you do in performing as planned impact of the healthcare service place to support your process Nursing to patient ratio in The 30-day mortality rate (does the Example Bed occupancy rate the ICU patient came back after discharge?)  Picturing The Data ○ After you measure and have your data. How do you want to present/picture these measures? ○ There are many valuable tools for interpreting & presenting data. Type of graph: 1. Bar chart 2. Pie chart 3. Line chart Type of graphs Bar chart ○ Bar charts are one of the most commonly used types of graph. ○ The bar chart displays data using a number of bars, each representing a particular category. ○ useful for looking at a set of data and making comparisons. Pie chart ○ A pie chart is a circular graph that shows the relative contribution that different categories contribute to an overall total. ○ It’s not recommended to use pie chart if you have >6 category -use bar chart- Line chart ○ A line graph, also known as a line chart, is a type of chart used to visualize the value of something over time. ○ Used when you try to mark change that are happening within a specific course of time  Performance Improvement Method Q: What are the Performance Improvement Method that we have within the quality scope that we try to apply in healthcare system? 4 Method Focus RCA PDCA BRAIN QIP STORMING Improvement model PDCA (Plan-do-study-act cycle) ◎ The IHI model has two parts: 1 2 The PDSA cycle to test and Three fundamental questions, implement changes in real world which can be addressed in any settings, the PDSA cycle guides order the test of a change to determine if the change is an improvement. Define the problem to be addressed, collect relevant Plan data, and ascertain the problem's root cause. Develop and implement a solution; decide upon a Do measurement to gauge its effectiveness. Confirm the results through before-and-after data Study comparison. Document the results, inform others about process Act changes, and make recommendations for the problem to be addressed in the next PDCA cycle. This picture is very important. There may be a question in the exam says: Q1. In which phase do we decided what data to gather? In Planning phase Q2. In which phase should we gather data? In Do phase  Performance Improvement Method cont… Root cause analysis (RCA) (ishikawa/fishbone) Is a defined process that seeks to explore all of the possible factors associated with an incident by asking what happened, why it occurred and what can be done to prevent it from happening again. A tool for solving problems. The diagram is used to explore and display the possible causes of a certain effect An effective root cause analysis requires the following components: (5) Multidisciplinary Team to come up with these category The team develops a problem statement Root cause analysis effort is directed towards finding out what happened Documentation and review (medical records, incident forms, hospitals guidelines, literature review. Site visit to examine the equipment, the surroundings and observe the relationships of the relevant staff Establishing the contributing factors or root causes are accomplished through A brainstorming process of all possible factors: Environmental factors e.g. The work environment; medico-legal issues Organizational factors e.g. Staffing levels; policies; workload and fatigue Team staff factors e.g. Supervision of junior staff; availability of senior doctors Individual staff factors e.g. Level of knowledge or experience Task factors e.g. Existence of clear protocols and guidelines e.g. Distressed patients; communication and cultural barriers Patient factors between patients and staff; multiple co-morbidities. You are not supposed to have all these factors. You may have 2 of them or all. This is based on the problem that you trying to target  Performance Improvement Method cont… Quality Improvement Plan (QIP) A Quality Improvement Quality Improvement Plan Plan is a detailed work plan includes essential information intended to enhance an about how your organization organization’s quality in a will design, implement, specific area manage, and assess quality. Brain storming Brainstorming is a technique by which a group attempts to find a solution(s) to a specific problem by amassing ideas spontaneously It is a highly effective technique for maximizing group creative potential. Dr.’s Notes 1. The most important point to understand from this lecture is Why do we conduct/apply Quality Improvement Method if hospitals? Answer: to investigate what the cause of a problem within the system in order to increase the patient safety. (NOTE: the answer should not be improving patient safety only, because every thing you do within a quality is to improve patient safety & quality of patient care -this answer is general and vague-. So when we ask this question within patient safety is because we try to find out specific thing. And in this lecture we will study how to apply quality improvement method within healthcare) 2. 1st: Identify a problem within a system. So we do this to investigate for the main problem this is causing lack of quality or patient safety issue 2nd: Measure the problem; how and when is it happening? Is it happening in the past 3 month, year? Is it happening in specific department or within specific team? 3rd: Develop a range of interventions designed to fix the problem 4th: Test whether the interventions worked within small scale. If it work then apply it to the whole general population 3. You can NOT correct what you can't measure. So measurement is very important because the understand of the scope of a problem is based on measurement and fact. You need to measure to try to identify what the problem is. 4. These measures are basically taken based on the timeframe of your process. E.g. Timeline Input process measure Output measure measure As the patient go within the healthcare At the end when the system. You have the process that have patient discharge from been followed to admit the patient the healthcare system 5. This method basically focuses on ensuring that you have specific category that represent your problem (environment, people, equipment, etc.), so this picture is an example of a problem “Why we have long test result time?”, then as a group we want to come up with “What are the causes of having this problem?” and when you answering this question you don’t rely in your thought or prediction, you actually rely on information/data that you are collecting from the unit  MCQs Q1. Root cause analysis (RCA) is a process that aims to: A. Explore possible B. Measure the D. Present data using C. Implement changes factors associated with effectiveness of different types of in real-world settings an incident interventions graphs Q2. “A detailed work plan to enhance quality in a specific area” is the definition of: C. Quality A. Brainstorming B. ishikawa D. Root cause analysis Improvement Plan Q3. The purpose of brainstorming in quality improvement is to: A. Test and implement B. Develop a range of C. Explore and display D. Gather ideas to find changes in real-world interventions to fix a possible causes of a solutions to a specific settings problem certain effect problem Q4. Which phase of the PDCA cycle involves “compare data to prediction”? A. Plan B. Do C. Study D. Act Q5. Which type of measure reflects the impact of healthcare service on patient outcomes? A. Structure measures B. Input measures C. Process measures D. Outcome measures Q6. Which type of graph is ideal for displaying the trend in temperature variations over a week? A. Bar chart B. Pie chart C. Line chart D. Scatter plot The most important point is to: A1. A A2. C A3. D A4. C A5. D A6. C 1. Summarize & understand why we implant quality improvement methods 2. What are the steps of applying quality improvement methods 3. What are the different ways/methods that we can implement to adapt all quality improvement methods For Anki cards click here  Team Leaders Aroub Almahmoud Remaz Almahmoud Lama Almutairi Team Members Farah Abukhalaf Nazmi M Alqutub Aljoharah Alkhalifah Areej Alquraini Aleen Alkulyah Moath Alhudaif Aryam Almsari Rahaf Alshowihi Mohammed Alqutub Sarah Alshahrani Aishah Boureggah Raghad Alqhatani Sultan Albaqami Lama Alotaibi Lama Alrushid Sarah Alajaji Haya Alzeer Faris Alzahrani [email protected]