IGNITE! Introduction to QI Methods
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The document is an introduction to the Aqua organization and its focus on quality improvement methods in healthcare. It outlines various concepts such as the Model for Improvement, PDSA cycles, and Deming's System of Profound Knowledge, highlighting their relevance to enhancing patient care and operational efficiency. Additionally, it includes interactive exercises like the Skittle Challenge to illustrate improvement methodologies and emphasizes the importance of data collection and learning from experiences in the process of change.
IGNITE! Introduction to QI Methods
- 2. Mobile Phones Fire Alarms Toilets Fire Exits 2
- 3. Your facilitator today is:- Liz Twelves Academy Programme Lead 3
- 4. What is AQuA? Advancing Quality Alliance • North West quality improvement organisation • Established 2010 • Membership: 70 organisations - Acute, Primary care, Community, Mental health and Ambulance trusts across North West England • Core team of around 30 staff plus Associates and Affiliates 4
- 6. Learning Objectives for the Session By the end of the session you should be able to: Understand aspects of the philosophy of QI Be able to apply a model for improvement Improve your ability to frame your project 6
- 7. Getting to Know You
- 8. Activity - In groups, discuss some of the following to find out what you may have in common: - Where you were born - Where you work - What you do - Where you studied - What can people do to help you to learn something new?
- 9. The aim of this chapter is to provide an outside view – a lens – that I call a system of profound Knowledge. It provides a map of theory by which to understand the organizations that we work in.” (Deming 1993 p. 92) Appreciation of a System Understanding Variation Theory of Knowledge Psychology Subject Matter Knowledge Knowledge for Improvement 9 Deming’s System of Profound Knowledge
- 10. Activity 10
- 11. © 2010 AQuA 11 The Model for Improvement A P DS Plan DoStudy Act AIM: What are we trying to accomplish? MEASURES: How will we know if a change is an improvement? CHANGE: What changes can we make that will result in improvement? © Associates for Process Improvement
- 12. PDSA Testing - simulation exercise The Skittle Challenge
- 13. The Skittle Challenge • Aim – to be left with one Skittle • Execution – Put a Skittle on each circle – Remove one to start – Jump over one at a time and remove it – Keep going until you can’t jump over any more – How many are left?
- 14. The Skittle Challenge • Aim – to be left with one Skittle • Measure – number of Skittles left • Changes – which one to remove first? – what order to remove them in? – how you work as a team? • Execution – Put a Skittle on each circle – Remove one to start – Jump over one at a time and remove it – Keep going until you can’t jump over any more – How many are left? (Plot your data and annotations) – Think about how it went and what you could improve next round. (Theory and prediction based on learning) –DO NOT EAT the Skittles – yet…
- 15. PDSA # Theory Prediction 1 Start with No. 5 empty Will have 3 skittles left 2 3 4 5 6 Number of Skittles Left 7 Numberleft 6 5 4 3 2 1 1 2 3 4 5 6 PDSA
- 16. Why Test Changes? • To increase the belief that the change will result in improvements in your setting • To learn how to adapt the change to conditions in your setting • To evaluate the costs and “side-effects” of changes Overall to minimise the resistance when spreading the change throughout the organisation.
- 17. “What will happen if we try something different?” “Let’s try it!”“Did it work?” “What’s next? ”
- 18. Cycles of Tests Build Confidence AP DS A P D S AP D S A P D S AP DSA P D S A P DS Proposals, theories, hunches, intuition Changes that will result in improvement Learning from data
- 19. Run Chart to Measure Performance Test 1 ABCXYZ Test 2 - XYZABC Test 2 123456 Tests 3-6 987654 0 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 11 12 13 skittles left skittles left
- 20. A solution…. 6-1, 4-6, 1-4, 7-2, 13-4, 2-7, 11-4, 14-5, 10-3, 3-8, 4-13, 12-14, 15-13.
- 21. The Skittle Challenge • Consistency of purpose • Prediction • Planning • Documentation • Sharing and stealing! • Learning from failure
- 22. Measurement and Data Collection during PDSA Cycles • Collect useful data, not perfect data – data for learning, not evaluation • Use a pencil and paper until the information system is ready • Record what went well and what didn’t work so well during the test of change
- 23. All improvement comes from designing, testing and implementing changes Seven Propositions of the Science of Improvement. Perla et al , 2013
- 24. The aim of this chapter is to provide an outside view – a lens – that I call a system of profound Knowledge. It provides a map of theory by which to understand the organizations that we work in.” (Deming 1993 p. 92) Appreciation of a System Understanding Variation Theory of Knowledge Psychology Subject Matter Knowledge Knowledge for Improvement 24 Deming’s System of Profound Knowledge
- 25. Getting to the root of the problem
- 26. My trip to work Mean Upper process limit Lower process limit 0 20 40 60 80 100 120 Consecutive trips Min.
- 27. Monthly data shows improvement Average length of pre-ward stay on Barnsley Stroke Ward from 01/2007 to 07/2007 0 0.5 1 1.5 2 2.5 3 3.5 1 2 3 4 5 6 7 Months 27 The chart shows the average monthly length of time before patients got to the Stroke ward 6/17/2016 © AQuA Academy 2013
- 28. Weekly data tells a slightly different story Average length of pre-ward stay on Barnsley Stroke Ward from 01/2007 to 07/2007 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 Weeks 286/17/2016 © AQuA Academy 2013
- 29. Patient level data adds another level of understanding 296/17/2016 © AQuA Academy 2013
- 30. Types of Variation Common Cause Variation • Inherent in the design of the process • Is due to regular, natural or ordinary causes • Affects all outcomes of the process • Results in a ‘stable’ process that is predictable • Also known as random or unassignable variation Special Cause Variation • Is due to irregular or unnatural causes that are not inherent in the design of the process • Affect some, but not necessarily all aspects of the process • Results in an ‘unstable’ process that is not predictable • Also known as non-random or assignable data
- 32. © 2014 AQuA
- 33. Group Work 33
- 34. Issues with lunch Patient complaints • My lunch was late • I have nowhere to eat except my bed • I got the wrong food • My food was cold/lukewarm • I didn’t like the quality of the food • I didn’t like the selection • I couldn’t eat the lunch I was given because it was the wrong kind of food for me • I wasn’t on the ward when lunch arrived and the food had gone when I got back Complaints from the catering department • No one was available on the ward to give out the lunches when they arrived • Kitchen – didn’t get the order early enough • The patient was away for tests when the food arrived and I ended up taking it back • There was nowhere to put food that couldn’t be distributed at the time • No one let me on to the ward for ages when I arrived • Staff didn’t know who was meant to be helping distribute the lunch • Some of the orders were wrong when we arrived
- 35. Fishbone diagram A systematic and structured method for identifying potential root causes of failures – Classifies potential causes for a failure into five basic separate categories (but you can also adapt these to suit your areas) – Very logical and analytical method of determining potential causes for failures
- 36. © AQuA Academy 36
- 37. Understanding the root cause 5 Whys • To get to the solution you need to understand the root cause for the most significant direct causes • This could take any number of “whys” • Do not stop until you reach what you believe is a ‘cause’ and not a ‘symptom’ • If you reach a cause that cannot be controlled, such as weather, go back one level and see if eliminating that cause will help © AQuA Academy 37
- 39. Complaints about lunches MethodsEnvironment PeopleEquipment Choices not collected accurately Menu cards not used Dietary requirements not fully understood Patients not available to receive not lunch Not correctly positioned Patients off-ward for treatment / appointment Staff not available to dispense lunches Not all staff trained Not lunch duty rota Busy ward Insufficient staff Lunch not arriving on time Orders not sent early enough Issues accessing the ward Delivery time not agreed No social space to eat lunch Miscommunication between ward and catering Food not a correct temperature No where to store hot/cold food on ward Food quality and selection not good Fixed supplier Small ward – limited facilities
- 40. © 2010 AQuA 40 The Model for Improvement A P DS Plan DoStudy Act AIM: What are we trying to accomplish? MEASURES: How will we know if a change is an improvement? CHANGE: What changes can we make that will result in improvement? © Associates for Process Improvement
- 41. Aim Statement Good Bad Ugly We aim to reduce harm and improve patient safety for all of our internal and external customers. By June of 2012 we will reduce the incidence of pressure ulcers in the critical care unit by 50%. Our outpatient testing and therapy patient satisfaction scores are in the bottom 10% of the national comparative database we use. As directed by senior management, we need to get the score above the 50th percentile by the end of the 1st Quarter of 2012. We will reduce all types of hospital acquired infections. According to the consultant we hired to evaluate our home health services, we need to improve the effectiveness and reliability of home visit assessments and reduce rehospitalisation rates. The board agrees, so we will work on these issues this year. Our most recent data reveal that on the average we only reconcile the medications of 35% of our discharged inpatients.We intend to increase this average to 50% by 1/4/12 and to 75% by 31/8/12. 41
- 42. Aim Statement Team name: ………………………. • What are you trying to achieve? – ……………………….. • By how much? – ……………………… • By when? – ………………………….. • For whom? – ……………………………………. Aim statement ……………………………………………………………………………. Adapted from 42
- 43. Aim Statement • Team name: Lunch time – on time • What are you trying to achieve? – Get the patients their lunch of choice on time everyday • By how much? – 95% of lunches • By when? – December 2015 • For whom? – Patient in Bay 1 • Aim statement 95% of patients in Bay 1 receive their lunch of choice every day by December 2015 Adapted from 43
- 44. What changes can we make that will lead to an improvement? • Knowledge • Ideas • Creativity
- 45. De Bono’s 6 Thinking Hats Managing the thinking process: Could you summarise finding so far? Information / data needs: What are the facts Ideas: Is there a different way of looking at this? Benefits / positives: Can we list them? Negatives / risk: What can go wrong? Emotion / gut feeling: What is your gut feeling?
- 46. Repeated use of the PDSA cycle Testing and refining ideas Implementing new procedures & systems - sustaining change Bright idea!
- 47. Scottish Primary Care Collaborative Borders GP Practice 0 10 20 30 40 50 60 70 80 90 BaselineM onth 1M onth 2M onth 3M onth 4M onth 5M onth 6M onth 7M onth 8M onth 9M onth 10M onth 11M onth 12M onth 13M onth 14M onth 15M onth 16M onth 17M onth 18M onth 19M onth 20M onth 21M onth 22M onth 23M onth 24 %ofPeoplewithDiabetes % of Diabetes Patients with a BP<140/80 Diabetes (blood pressure) Improvements with PDSAs PDSAs to improve shared diabetes information with Secondary Care PDSA to contact all Patients who have not had a BP check in the last year PDSAs PDSAs PDSAs PDSAs to improve current patient recall system PDSAs to Validate Diabetes Register
- 48. 48 Analysis: • 8 runs – can apply rules • Shift aligned to new menu card process New menu card process Staff briefing
- 49. Create Multiple PDSA Ramps P DS A P DS A P DS A P DS A P DS A P DS A P DS A P DS A P DS A P DS A P DS A P DS A receptionist porters Nurses
- 50. Summary & Close
- 52. Contact AQuA Via • liz.twelves@srft.nhs.uk • The website at: www.advancingqualityalliance.nhs.uk • Email at: AQuA@srft.nhs.uk • Phone AQuA on: 0161 206 8938 • @AQuA_NHS 52
- 53. Thank you and ….
- 54. 54