Tools for Quality Improvement

Editor's Notes

• #2: Tools available to implement Quality Improvement theories, frameworks or strategies. There are more available than this list shows, however this sampling demonstrates the wide variety and how different sectors have created or modified their own tools relevant to their need. This list is primarily from a health care focus.The bolded tools are the ones we will discuss in greater detail.**Insert tools list once confirmed with partnerReferencesBardon, R. (2011). Metoderförförbättringsarbete. Retrieved April 03, 2012, from http://www.lj.se/infopage.jsf?nodeId=31713Raisinghani, M. S., Ette, H., Pierce, R., Cannon, D., & Daripaly, P. (2005). Six sigma: Concepts, tools, and applications. Industrial Management & Data Systems, 105(4), 491-505. doi:10.1108/02635570510592389
• #3: What: a tool a measure differences in medication in useUse: to identify adverse events (AEs) is an effective method for measuring the overall level of harm from medical care in a health care organizationTraditional efforts to detect AEs have focused on voluntary reporting and tracking of errors. .Came from: Trigger Tools have been developed by the Institute for Healthcare Improvement to prioritize a list of triggers that can be used to detect adverse drug events in a variety of care settings, including the hospital and ambulatory care Problem: Can be applied to any issuecausing patient harm. Common methods for uncovering problems in health care requires that health care workers voluntarily report events, both actual and near miss. Problem with voluntary reporting: Voluntary reporting will inherently be incomplete because of time pressure, fear of punishment, and other problems. Alternative means of detecting drug therapy related–problems have been developed. In nursing home care: Adverse drug events (ADEs) are a common cause of morbidity and mortality in the nursing home setting. Despite their frequency and potential impact, current methods of ADE detection leads to a significant number of undetected events ReferencesHandler, S. M., Hanlon, J. T., Perera, S., Roumani, Y. F., Nace, D. A., Fridsma, D. B.,...Studenski, S. A. (2008). Consensus list of signals to detect potential adverse drug reactions in nursing homes. Journal of American Geriatrics Society, 56(5), 808-815. Retrieved from http://www.medscape.com/viewarticle/578209Institute for Health Care Improvement. (2012). Trigger tools ADEs tour. Retrieved April 04, 2012, from http://app.ihi.org/Workspace/tools/trigger/TourTriggerToolADEs.htmThe National Academies. (2012). http://www.nationalacademies.org/
• #4: What: Patients - Our reason for doing our work. (who are they, how do you know what they want from you, how do you communicate with them informally)Professionals/People - Our staff who work in the trenches to take care of patients (Who is in your team? What skills do you all have? How can you make the most of everyone)Patterns - Our way of doing our work (Measurements, Data, Run Charts, How do things vary? What happens when things go wrong? How could it be better)Processes - Our system of inter-related events that constitute the microsystem. (How do things happen in the team? What systems do we have and are they right for us now)Purpose - Our aim and mission. (Is what we do clear to everyone? Are there competing demands on our service)Came from: Microsystems are thebuilding blocksthat come together to form Macro-organizationsUse: a framework to organize, measure, and improve the delivery of careProblem: Used to examine the quality of care patients receive on a unit once a patient care issue has been identified. Ie. Numerous documentations of miss-communication between health care team has come to light. This has been identified as a quality problem but the actually problem is embedded not only in the professionals but also in the patters and process and even possibly the purpose of the unit.ReferencesGill, M., & Gray, M. (2006). Using Clinical Microsystems and Mesosystems as enablers for service improvement in mental health services. Retrieved from http://www.lj.se/info_files/infosida31595/micro_mesosystems_mjg_mdg.pdfNelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.
• #5: What:  ”hospital standardized mortality ratio” Amethod to measure mortality at the hospital Came from: Developed in the United Kingdom in the 1990’s as a tracking methodUse: Is now used internationally go monitor the ratio of deaths in hospitals against other hospitals. This tool allows for concrete data to show how well a hospital is doing for mortality rates and can motivate change when the ratio becomes too high. inpatient deaths and improving care. Tracking tool to indicate when change is needed.Problem: Hospital administration has noted a high number of deaths over the last few months. They are wondering if this is a trend so they look at the HSMR statistics for their hospital and compare them to other hospitals. They can also see the trend over time. They will see that their current mortality rate is higher than the average at the neighboring hospital which initiates an investigation into what is causing the increase.ReferenceCanadian Institute for Health Information. (2012). HMSR. Retrieved April 04, 2012, from http://www.cihi.ca/CIHI-ext- portal/internet/EN/TabbedContent/health+system+performance/quality+of+care+and+outcomes/hsmr/cihi022025
• #6: What: A chart that helps organizations prioritize ideas for improvement by determining what is the most useful during the Identify and Prioritize Opportunities Phase of a Lean Six Sigma project. Horizontal line represents level of payoff and vertical line represents the level of difficulty. Came from: Developed by Martin Lockheed who is also the author of numerous books on the application of Six Sigma. He originally developed the chart for use in the Lockheed Martin Aeronautics Company.Use: This chart can be applied into any situation where there are multiple improvement ideas that need to be narrowed down.Problem: Nursing managers meet to discuss ways to improve nursing care on the orthopaedic unit. All have a number of ideas of how to do this but to address all is not feasible so they can use the PICK chart to identify the easiest ideas with the highest level of payoff to focus on.ReferencesBardon, R. (2011). Metoderförförbättringsarbete. Retrieved April 03, 2012, from http://www.lj.se/infopage.jsf?nodeId=31713George, M. L. (2003). Learn six sigma for service: How to use lean speed and six sigma quality to improve services and transactions. NY, NY: McGraw-Hill.
• #7: What: A tool for effective, time efficient and non-repetitive communication.SituationIdentify yourself the site/unit you are calling fromIdentify the patient by name and the reason for your reportDescribe your concern BackgroundGive the patient's reason for admissionExplain significant medical historyYou then inform the consultant of the patient's background: admitting diagnosis, date of admission, prior procedures, current medications, allergies, pertinent laboratory results and other relevant diagnostic results. For this, you need to have collected information from the patient's chart, flow sheets and progress notes. AssessmentVital signsContraction patternClinical impressions, concerns  RecommendationExplain what you need - be specific about request and time frameMake suggestionsClarify expectationsCame from: Adapted to application in health care from original military setting.Use: Used in health care settings, especially between health care workers ie. Nurses and doctors to ensure quick and appropriate knowledge transfer without repetition. Problem: Yukon Health example-phone call between Dr’s and nurses ReferencesBardon, R. (2011). Metoderförförbättringsarbete. Retrieved April 03, 2012, from http://www.lj.se/infopage.jsf?nodeId=31713Permanente, K. (2012). SBAR technique for communication: A situational briefing model. Retrieved April 03, 2012, from http://www.ihi.org/knowledge/Pages/Tools/SBARTechniqueforCommunicationASituationalBriefingModel.aspxPope, B. B., Rodzen, L., & Spross, G. (2007). Raising the SBAR: How better communication improves patient outcomes. Nursing, 38(3), 41-43. doi:10.1097/01.NURSE.0000312625.74434Wentworth, L., Diggins, J., Bartel, D., Johnson, M., Hale, J., & Gaines, K. (2011, November 28). SBAR: Electronic handoff tool for noncomplicated procedural patients. Journal of Nursing Care Quality, 27(2), 125-131. doi:10.1097/NCQ.0b013e31823cc9a0
• #8: What: Assumption: Relationships can have unforeseen value known as generative potentialThe STAR tool identifies the generative potential of a relationshipAccounts for complexities of change within relationships such as at the structural (employees) and conceptual (product) levels.Relationships with more generative potential are seen to have longer points on the generative relationship STAR. Each point of the STAR represents one key aspect of generative relationships and is a continuum from very low to very high levels of this aspect or attribute of a generative relationship.S - Separateness or differences. There need to be differences in the background, skills, perspectives, or training of the parties as this will increase the likelihood that they will not neglect portions of the project from being too similar. With difference they can challenge each other’s assumptions.T - Talking and listening (“tuning”). There needs to be real opportunities to talk and listen to each other with permission to challenge what is taken as fact by the other partner. This allows for a learning process through exposure to alternate view or context.A - Action opportunities. The parties need to be able to act together to co-create something new instead of just talking about it.R - Reason to work together. There needs to be some mutual benefit to each parties involved in order for them to share their resources with each other. Came from: Proposed by Brenda Zimmerman and Bryan Hayday as a tool for determining the potential value of a relationship in business.Use: Originally for application for business ventures to determine if a partnership will create value.Problem: This tool can be used by businesses or business-model run organizations such as health care to predict the value of establishing new business relationships or to re-evaluate existing ones.ReferencesBardon, R. (2011). Metoderförförbättringsarbete. Retrieved April 03, 2012, from http://www.lj.se/infopage.jsf?nodeId=31713Zimmerman, B., & Hayday, B. (1999). A board’s journey into complexity science: Lessons from (and for) staff and board members. Group Decision and Negotiation, 8, 281-303. Retrieved from http://www.change-ability.ca/A_Boards_Journey.pdf
• #9: What: Is a four-step management method to control and create continuous improvement of processes and products. Plan: Identify the objectives and processes needed to attain the desired end result.Do: Implement the plan including data collection.Check: Check the data collected to see if the goal was met or what the result was.Act: If there is a discrepancy between desired outcome and actual outcome, create improvement plans and implement them.Came from: Adapted from the scientific method by Dr. Edwards Deming, who is considered the father of quality control. The tool is used as a guide to identify short falls and create change. Initially business oriented.Use: Has expanded from initial business background into many fields including health care as a way to improve care.Problem:ReferencesCleary, B. A. (1995). Supporting empowerment with Deming′s PDSA cycle. Empowerment in Organizations, 3(2), 34-39. doi:10.1108/09684899510089310Nelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.