Rapid Cycle Quality Improvement

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Rapid Cycle Quality Improvement

• Course Outline
• The Quality Journey
• Rapid Cycle Improvement Model
• Change Concepts
• Teams
• Tools
• Barrier Busters

2
Groups Prior Experience with Quality Improvement
Participant Survey Results
Very Little
10yrs
3-5 yrs
5-10 yrs
1-2 yrs
3
What is Quality?

• Quality is a never-ending cycle of continuous
  improvement.

-Deming
4
Quality Alphabet Soup
5
Groups Tools for Quality Improvement
Participant Survey Results
6
Quality Improvement Program

• Vision, Goals, Objectives
• Quality Indicators Monitoring
• Quality Project
• Continuous Improvements
• Solve Problems
• Change Systems
• Sentinel Events

7
The Quality Journey
Quality Assurance
Quality Improvement
Rapid Cycle Quality Improvement
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QA vs. QI

• Quality Assurance
• Conform to standards
• Relies on inspection
• Focus on items
• Quality is separate function
• Departmental function

• Quality Improvement
• Improved performance
• Monitor over time
• System orientation
• Quality integrated in organization
• Interdisciplinary function

9
Malcolm Baldrige National Quality Award
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PDSA Cycle
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AIM Statement

• What are we trying to accomplish?
• The Aim Statement articulates the goals, guides
  the improvement effort, and keeps the team
  focused.
• Specific
• Measurable
• Challenging

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Measurement

• How will we know that a change is an improvement?
• What to measure - what will be different?
• What are the guidelines

13
Cycles of Improvement

• What changes can we make that will result in an
  improvement?
• Its your opportunity to brainstorm
• Possible changes
• People that are needed
• Required resources
• Potential for collaboration
• Necessary leadership support

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Cycles of Improvement
Continuous improvements of multiple changes.
Hunches, Theories, Ideas
P D S A
P D S A
P D S A
Change 1
P D S A
P D S A
P D S A
P D S A
Change 2
P D S A
P D S A
P D S A
P D S A
Change 3
P D S A
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Rapid Cycle Improvement Model
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in an
improvement?
Cycle 1
Cycle 3
Cycle 2
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Potential EMSC Monitors

• Timely management
• Wait time to see an MD in the ER
• Time to initiate antibiotics in fever management
• Use of an intraosseous line when needed
• Transfer within 2 hours when appropriate
• Use of the Broselow, or similar, system
• Pain management in the non verbal child
• Asthma management
• Obtaining a patient height
• Peak flow measurement
• Abuse recognition
• Provision of injury prevention education

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What Quality Improvement activities are you
working on at your hospital?
Participant Survey Results
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An Example of Rapid Cycle Planning

• Where do we begin?

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Change Concepts

• Change concepts are generic ideas that can be
  applied to your situation to spark an idea for a
  specific change in your situation
• Not all change concepts apply to all aims
• Brainstorm ways to apply these concepts to the
  problem at hand

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Change Concepts

• Enhance the Producer /Customer relationship
• Listen to patients
• Coach customers to use product/service
• Reach agreement on expectations
• Mass customize services to patient

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Change Concepts

• Change the work environment
• Reduce demotivating aspects
• Implement cross training
• Clarify roles expectations
• Improve work flow
• Synchronize
• Find and remove bottlenecks
• Do tasks in parallel
• Adjust to peak demand

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Change Concepts

• Manage Time
• Reduce the setup or startup time
• Optimize maintenance
• Reduce wait time
• Manage Variation
• Eliminate waste
• Reduce or eliminate overkill
• Recycle or reuse

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Change Concepts

• Optimize inventory
• Match inventory to demand
• Use pull systems - proactive
• Reduce multiple brands
• Design systems to avoid mistakes
• Use reminders
• Use differentiation
• Use constraints
• Minimize handoffs

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Team

• Composition
• Sponsor
• Leader
• Team member(s)

• Helpful hints
• Be Multidisciplinary
• Assure available leadership
• Include hands-on expertise variety of skills,
  e.g. computer skills
• Recognize progress
• Clarify roles responsibilities
• Handle conflict constructively
• Maintain core group for consistency

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Essential Tools

• Meeting Agenda (every meeting)
• Meeting Summary (every meeting)
• Project Work plan (create 1, post update)
• Project Report Form (Internal - External)

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Other Helpful Tools

• Brainstorming
• Run Charts
• Flow Charts
• Cause Effect Diagram
• Pareto Diagram
• Nominal Group Technique
• Force Field Analysis
• Refer to Section 12 - Tab QI Tools Techniques

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Example Run Chart
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Example Control Chart
Self Administered Med Project DRG 372 373
Percent of Pts Receiving Darvocet
Project Implemented
Pre Project
60
Mean 39.4
40
Mean 23.8
Percent of Pts
20
0
Jul-99
Jul-00
Jul-01
Oct-99
Jan-00
Feb-00
Mar-00
Jun-00
Oct-00
Jan-01
Feb-01
Mar-01
Jun-01
Aug-99
Sep-99
Nov-99
Dec-99
Apr-00
May-00
Aug-00
Sep-00
Nov-00
Dec-00
Apr-01
May-01
Aug-01
Sep-01
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Barrier Busters

• Barrier - Problems with Setting an Aim
• Is there sponsorship for the project?
• Does project fit with organizational mission?
• Does project conflict with our values?
• Is Aim Statement clear and precise?

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Barrier Busters

• Barrier - Problems with Teams
• Is your leader available and empowered?
• Are you meeting weekly?
• Does everyone know their responsibilities?
• If you have conflicts, who can you request to
  facilitate your team?

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Barrier Busters

• Barrier - Problems with Resources
• Suggestions
• Keep your team small at first
• Use volunteers and champions
• Collect just enough data
• Set a dedicated meeting time
• Huddle if needed (15 minutes is all you need!)
• Involve senior leadership if resources are a
  problem

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Barrier Busters

• Barrier - Resistance
• No one thinks there is a problem
• Take the high ground...
• We are different
• Share information and challenge assumptions...
• Its too difficult
• Look at others (internally externally) that
  have successfully made a change
• Break ideas for change into small components
• Present changes as a test - that can be
  accepted, refined, or abandoned
• Use just enough data
• Post results of the small test from the outset as
  proof that it can happen
• Engage senior leadership - it is a must

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Resistance How people respond to change

• Innovators 2.5
• Early Adopters 13.5
• Early Majority 34
• Late Majority 34
• Laggards 15

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Barrier Busters

• Barrier - Problems with Ownership
• Be sure to include all impacted areas
• Collaborate with staff at all levels
• Involve the people that DO the work
• Find champions in several disciplines
• Keep sponsors informed and involved

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Next Steps Action List

• What is one problem in your work setting where
  you think Rapid Cycle Quality Improvement would
  help you?
• What is one thing that you can do by next
  Tuesday?