Quality and Performance Improvement

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Quality and Performance Improvement
Medical University of South Carolina
Scholtes PR. The Team Handbook. Joiner
Associates, Juram Institute, 1997
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Quality Healthcare
The Institute of Medicine has defined quality as

• the degree to which health services for
  individuals and populations increase the
  likelihood of desired health outcomes and are
  consistent with current professional knowledge
• This is our official definition of quality at MUSC

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MUSC Medical Center

• Do the right thing the right way (informal
  definition)

(technically competent , good communication,
shared decision making, and cultural
sensitivity.)
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Do the Right Thing, The Right Way
Quality and Safety Initiative have been
integrated

• Patient Safety
• Care Processes
• Customer Satisfaction
• Care Value

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Branding Logo
Safety

1st
Customer Satisfaction
Care Value
Care of the Patient
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Do the Right Thing, The Right Way(use a model to
respond to problems/opportunities)
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Why use a Performance Improvement Model
Prescribes what tools to use
Demystifies the problem- solving process
Problem or Opportunity
Ensures Root Cause Analysis
Prevents problem solvers from jumping to
conclusions
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MUSC Problem- Solving Model Performance
Improvement I identify the opportunity or
problem M measure definitions (goals) P
problem Analysis R remedy the cause (s)
intervention O operationalize the plan V
validate the effectiveness of your
intervention E evaluate if improvement is
sustained
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Current Organizational PI Projects
Medication Processes Medical Records Adult
ventilator days C-section rates OR
efficiency Discharge planning Pneumonia Pain
Management Infection Control MRSA and VRE
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Quality TeamTeam Is Composed Of

• Team leader
• Team facilitator
• Team members
• Team recorder

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Getting Off to a Good Start
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Getting off to a Good StartFirst Meeting Agenda

• Training Call 2-0855 for Just in Time training
• Identify a project
• Discuss team project missions
• Always have an agenda

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Team Leader should haveEffective Meeting Skills

• Should take precautions to avoid dominating the
  group during meetings
• Leaves rank outside the room
• Facilitates discussion and only occasionally
  actively participates
• Manages team conflict

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Team LeaderEffective Team Functioning Skills

• Share responsibilities with other team members
• Trust the group to arrive at the best answer
• Give team members a chance to succeed or make
  mistakes on their own
• Assures team follows process
• Keeps team on track

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Team Facilitator

• Is not a team member
• Trains team in the quality process
• Keeps the team focused
• Coordinates team activities (with leader and
  recorder)
• Is a role model

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Team Facilitator

• Is a coach/consultant to the team leader
• Debriefs each team meeting with the team leader
• May act as a liaison to the IDT and among members
• Contracts with team leader regarding roles and
  responsibilities
• Does not participate in the teams work
  assignments

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Quality Toolsshould be used to assure effective
analysis
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Quality Tools

• Brainstorming
• Barriers and accelerators chart
• Benefit and Cost Analysis
• Cause and Effect Diagram
• Flow Chart
• Run Charts and Control Charts

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Brainstorming

• Phrase the statement
• Prepare for statement
• Communicate the statement ahead of time
• Provide appropriate surfaces ahead of time

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Brainstorming(continued)

• Introduce the session
• Review the rules
• no criticism or evaluation of any kind
• be unconventional
• aim of quantity of ideas in a short time
• hitchhike on others ideas

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Brainstorming(continued)

• Brainstorm
• Write issue where it will be visible to all
• Have another person write all contributions where
  visible
• Stop before fatigue sets in
• Process ideas

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Brainstorming(continued)

• Make contributions in turn
• Only one idea per turn
• You may pass
• Do not provide explanations

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Barriers Aids Chart
Barriers
Computer seen as unreliable
Some want new automated system
All others failed
Expense
Success of New Procedures
Removes big complaint
Management support
Aids
Verify reliability during pilot
Review plans with IDT to get its input
Benefit/cost analysis
Countermeasures
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Benefit/Cost Analysis
Remedy Alternative Manual Computerized One-time
cost 7,500 134,000 Annual cost of
one-time costs 1,500 26,800 Additional
annual operating costs 0 1,700 Annual cost
savings 1,462,000 1,562,000 Net annual
operating costs (savings) (1,462,000) (1,545,00
0) Total annual costs (savings) (1,460,500) (1,
518,200) Problem impact 70 75 Customer
satisfaction impact Low Low Benefit/Cost
Assessment Rank 1.7 1.3
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Cause and Effect Diagram
Procedures
Equipment
procedures vary from unit to unit
Shift to Shift Communication
not everyone reads email
too busy
verbal written communication not clear
Environment
People
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Flow Chart
Call to 9888
RC Triage Insurance Clinical
Outpatient
Pt arrives
Inpatient
Is pt regist able to help immed
Unit staff able to come immed
Yes
Yes
Staff escorts pt to unit
Staff notifies charge nurse
Pt regist
Pt registers
RC Contacts
Contact charge nurse Give info
No
No
Pt waits
Pt waits
Inform PHY
Nurse
SWS
Staff wait for pt
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Flow Chart
Chg nurse notifies unit team
Database
Pt Reg notifies AC
Chg RN has TA escort pt/family to pts room
TA-belongings check/ orients to unit
Pt arrives at Pt Reg
AC personnel escorts pt to AC
NP does physical adm orders
RN escorts pt to unit
Adm RN introduces pt/family to charge
Adm RN assess
Attending interviews pt
Introduce pt to group
Pt registered
Pt Reg notifies AC pt has registered
Attending signs order MTP
Admit completed
Chg RN has unit RN complete admission checklist
Chg Nrs hands off packet to unit security
Adm B ensures packet complete orders
Adm RN reports off to charge
Informs RN of staff ID
Pt chart completed
Pt entry
Adm B admits unit when assessment completed
obtains ID of staff member for handoff
Patient Registration
Access Center
Unit
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Control Charts
May/June 1997 27 charts audited Lower control
limit set at 90 quality competence
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Pareto Diagram
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Identify a ProjectMission Statement Is

• Specific tell what the problem is
• Observable where does it appear
• Measurable what to measure
• Manageable might be too large and have to do
  project-by-project

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Identify a Project
How to Write a Good Mission Statement

• A well-written mission statement contains two
  parts
• The problem to be resolved (i.e., what is wrong)
• The objective of the project (i.e., what the team
  is supposed to do about the problem)

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Identify a ProjectVerify the Mission

• Evaluate the mission of the project
• Validate project goals
• Modify the mission and goals if they do not meet
  criteria in 1 and 2
• Confirm with IDT
• Create a glossary

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Getting Off to a Good StartFirst Meeting Agenda

• Team members
• Participate in quality training
• Formal
• Just-in-time
• Attend all meetings, usually weekly
• Complete assignments between meetings

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Getting Off to a Good StartFirst Meeting Agenda

• Team members (continued)
• Actively participate and contribute expertise
• Listen to others ideas
• Use a model to solve problem
• Have fun

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Getting Off to a Good StartFirst Meeting Agenda

• Guidelines
• Attendance legitimate reasons for miss
• who do you notify
• Promptness meeting should start and end on
  schedule

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Getting Off to a Good StartFirst Meeting Agenda

• Guidelines
• Meeting logistics time and place
• Assignments on time
• Interruptions pages, emergencies, etc.

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Getting Off to a Good StartFirst Meeting Agenda

• Guidelines
• Courteous communication
• Impasses listen to everyones views
• allow the team to reach a decision
• Actively support implementation of final decision

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Total Quality ManagementTQM set of principles
to manage business

• Concepts Methodology
• Process ownership teams Quality improvement
• Systems thinking Quality planning
• Processes systems Quality control
• Customers suppliers Benchmarking
• Cost of poor quality Re-engineering
• Scientific approach Strategic planning
• Quality Blitz team
• of target values features
• of execution

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Key Analytic Components of TQM

• Complexity
• Mistakes/defects
• Breakdowns/delays
• Inefficiencies
• Excess variation
• Variation
• Common cause
• Special cause

Measurement and statistical experimentation Charac
teristics of service quality Benchmarking
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Quality Management Process
Scientific Method to Improve Health Care Quality

• Systematic way to learn about processes
• Decisions based on data rather than hunches
• Look for root causes rather than react to
  superficial symptoms
• See permanent solutions rather than quick fixes
  and fire fighting

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Probability of SuccessDecreasing Variation
Quality Improvement
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FOCUSPDCATQM Model

• Find a process to improve

Organize a team that knows the process
Clarify current knowledge of the process
Understand the sources of process variation
Select the process improvement
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FOCUSPDCATQM Model
Plan
Act

• To hold gain
• To reconsider owner
• To continue improvement

• Improvement
• Data collection
• KQCs
• Other

• Improvement
• Data collection
• Data analysis

• Data for
• Process for improvement
• Customer outcomes
• Lessons learned

Do
Check