Tools of the Trade Continuous Quality Improvement

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Tools of the TradeContinuous Quality Improvement

• Anne Mason Tonia Easton
• Workforce Capability Learning Consultant Area
  Quality Manager
• Organisational Capability Learning Clinical
  Governance Unit
• Day Two
• 2007

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Learning Objectives Day 2

• At the end of Day 2 participants will be able to
• Implement and evaluate the effect of potential
  solutions
• Develop strategies to manage the change process
  resulting from the implementation of quality
  improvement solutions
• Develop strategies to embed their solutions into
  everyday practice
• Identify methods to monitor the impact of quality
  improvement solutions
• Develop effective presentation skills

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Review of the CQI Process
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Project Phase
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Mission / Aim Statement

• Specific setting boundaries
• Measurable include a numerical goal
• Appropriate - related to the project title
• Result orientated focused on outcome
• Time scheduled defining a time period

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Team membership

• Ideally 5 9 members
• Members with fundamental knowledge
• Different perspectives
• Quality advisor on the team
• Identified team leader

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Diagnostic Phase
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Collecting Evidence

• Flow chart
• Brainstorming
• Multivoting
• Nominal Group Technique
• Customer Focus Groups
• Tag alongs

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Prioritising Information

• Cause and Effect Diagram (fishbone)
• Affinity Diagram
• Pareto Chart
• Graphs e.g. Run chart, Statistical Process
  Control chart

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Workshop 1 - Homework

• Aim / mission statement
• Team (Action minutes of meetings)
• Determine team leader
• Identify project sponsor
• Identify relevant data
• Flowchart
• Cause and effect diagram

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This is where we are up to
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The improvement process
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Intervention Phase
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Intervention Phase

• Using the causes of the problem already
  identified the team identifies opportunities for
  improvement or the changes that will lead to an
  improvement.
• CPI / CQI model is based on a trial and learning
  approach to improvement.

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PDSA (trial learning approach)

• Plan to test selected improvement or change
• Who?What?When?Where?
• Do the test (carry out the plan) and collect data
  for analysis
• Study the results. Compare data to the
  predictions. Has the test resulted in
  improvement? Can the change be implemented in a
  larger scale?
• Act on the results. Implement the improvement or
  changes or select another possible improvement to
  test.
• Running small cycles is often better that
  waiting to run large scale cycles over longer
  period of time

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PDSA Cycles
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Caution

• Testing the change is not always easy.
• Things may happen that were not planned for
• Changes may not have an impact on the problem
• There may be unwanted side effects
• Therefore to assist in implementation of change
  it is best to use the PDSA Cycle of the framework
  for an efficient trial and learning methodology.
  It begins with a plan and ends with an action
  based on the learning gained from the Do and
  Study phases of the cycle

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Making Decisions

• Identify the criteria that the decision will be
  based upon
• Identify the relative importance of each criteria
• Assign a weighted value to each criteria
• Establish a decision matrix to evaluate the
  relative value of each potential alternative.

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Decision Matrix
Criteria 1 10 Criteria 2 10 Criteria 3 20 Criteria 4 60 Total
Solution 1
Solution 1
Solution 2
Solution 3
Solution 4
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Selection Criteria
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The improvement process
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Implementation
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Implementation

• Recognise that this is a change process and
  must be facilitated.
• Recognise the complexity of the change
• Planning for the change in terms of the impact
  upon people

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Implementation (a change process)

• Consider the tools that may have already been
  developed and use them to facilitate the change
  process.
• Stakeholder analysis
• Force field analysis
• Risk management plan
• Change management action plan
• Communications plan

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Basic Steps
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Strategies to support change

• The purpose of the change is made clear and there
  is good communication during the change
• Those affected by the change are involved in the
  planning
• The appeal for change is based on professional
  reasons
• Efforts are made to reduce the impact of
  excessive work pressure

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Strategies to support change

• Anxiety over job security is relieved
• Issues of the Vested Interest of the individual
  or a subunit of the organization is addressed
• The change leader is someone who is respected or
  trusted
• Pace of change is managed to allow staff to cope.
• Past negative experience with change is addressed

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Human response to change
New World
Old World
Job Performance OR Staff Satisfaction
Acceptance
Shock
Anxiety
Depression
Anger
Staff Feelings over Time
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Resistance to change

• Reasons for resistance may include
• Uncertainty
• Weary of Change
• A belief that the change is not in the
  organisations best interest
• Concern over personal loss
• Misunderstanding (communication problems
  inadequate information)

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Workshop 2

• Have you met any resistance to the change you
  are proposing?
• What strategies have you used or might you
  use to overcome resistance to the change?

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Strategies to reduce resistance

• Manage the number of minor and uncontrolled
  changes which staff must cope with
• Provide adequate training
• Provide adequate support for staff before, during
  and after implementation
• Involve people who resist as much as possible
• Develop a plan to manage resistance

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Strategies to reduce resistance

• Reassess resistance factors throughout the change
  initiative
• Use change sponsor to assist with high level or
  complex issues
• Where appropriate keep staff associations and
  unions well informed

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The improvement process
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Impact Phase
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Measure impact

• To ensure intervention has resulted in an
  improvement
• To provide evidence to justify permanent
  implementation of the change(s)
• It is necessary to collect, analyse and display
  data for all to see.Two popular ways of
  displaying data are run charts and SPC charts.

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Run chart
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SPC Chart
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Workshop 3

• How will you measure the overall impact of the
  change?
• Have you achieved your aim or mission?
• Has the magnitude of the response met your
  expectations?

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The improvement process
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Sustaining Improvement Phase
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• Standardisation of existing systems and processes
  for performing work activities
• Documentation of associated polices, procedures,
  protocols and guidelines
• Measurement review to ensure that change
  becomes part of routine practice
• Training education of staff

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Maintaining the Momentum
Where do we want to be?
Where are we now?
Maintaining the Momentum
How do we get where we want to be?
How do we know we have arrived?
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Sustainability

• Standardisation
• Documentation
• Measurement and review
• Training and education

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Sustainability

• Standardisation
• This ensures that the new way of doing things is
  consistent over time and for different staff.

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Sustainability

• Documentation
• The changes need to be incorporated into policy
  and procedures.
• The changes need to be incorporated into the
  standards of operation or the best practice
  guidelines for the unit
• Changes need to be incorporated into education
  and training plans
• Documents such as meeting minutes, reports,
  correspondence and worksheets form the basis for
  reviews.

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Sustainability

• Measurement and review
• Measurement ensures that the changes are actually
  being implemented
• Ensures that benefits continue to occur
• Identifies is problems arise
• Some of the testing should be considered for
  permanent use
• Measurement supports the review of the
  achievements of the team
• KPIs and links with Balanced Scorecard

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Sustainability

• Training and education
• Staff must all know why the changes are
  implemented
• People must know how to implement the changes
• The extend of training and education required
  depends upon the size of the change and the
  number of people affected.

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Sustainability

• Support
• The support of managers for the change program
  needs to be very evident
• Promotion
• The manager or staff member who acts as the
  change agent needs to be very focused and aware
• Feedback
• Feedback on the progress of the change and its
  effects needs to be provided to staff.
• Need to celebrate successes

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Workshop 4

• How are you going to embed the changes you
  have made?

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Celebrate your success
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Presentation skills

• Planned
• Organised
• Written and rehearsed
• Presentation aids

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Planning the Presentation

• Define the purpose
• Analyse the audience
• Consider the context and setting
• Identify the main ideas
• Research and find supporting material
• Organise the material
• Structure

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Write for the Ear

• Practice it out loud and listen for

• A simple structure
• Active voice
• Simple tense structure
• Words that are easy
• Words that sound right together
• Breathing spaces
• Words that help to link

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Precautions

• Familiar equipment
• Face the audience
• Check the technology
• No more that 5 6 points on each slide
• Large font (at least 20pts)
• Clear and easy to read colours

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Non verbal Communication

• Posture
• Facial expression
• Appearance and dress
• Gestures
• Voice quality
• Variation in the rate of speech
• Eye contact

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Workshop 6

• Practice, Practice, Practice
• Microphone
• Powerpoint
• Non Verbals

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Presentation Format - Storyboard
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Insert Title

• Prepared by Insert name of presenter
• Insert title
• Insert Branch name
• Insert date

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Slide 1

• The Project
• Project name

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Slide 2

• Team List of team members and positions held

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Slide 3

• Mission / aim statement

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Slide 4

• List of customers and their expectations

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Slide 5

• Diagnosis of the problem process flow charts,
  customer focus groups, brainstorming etc

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Slide 6

• Prioritising the information Pareto chart,
  Cause and Effect diagrams etc.

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Slide 7

• Interventions
• Outline of the interventions chosen

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Slide 8

• Statement of plan small PDSA cycle examples etc

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Slide 9

• Impact
• Run charts, SPC and other graphs showing
  ongoing monitoring and progress

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Slide 10

• Statements of results improved care, cost
  savings, customer satisfaction etc.

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Slide 11

• Sustaining improvement
• Sustaining the gains

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Slide 12

• Future plans

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Project Progress Reports
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Outcomes of Tools of the Trade

• Use the criteria for CPI and Maggie methodology
  to determine which method should be applied to a
  particular project
• Apply the CPI methodology to a real life example
  within their own site/dept, service area, cluster
  etc
• Identify a quality improvement issue, addressed /
  solved redesigned the system to make it better
  and improved service delivery.
• Demonstrate improvements from their project.

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Outcomes of Tools of the Trade

• Link improvement to BSC reporting if BSC in place
• Develop effective presentation skills
• Develop the skills to build effective project
  teams
• Address one of the core Focus Areas in the HNE
  Strategy Map
• Completed project to be submitted to HNE Quality
  Awards.

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Conclusion

• Projects are all at different stages
• Are you all clear about where your go from here?
• Do you want to continue with Teleconferencing?
• Requirements for presentation day
• Storyboard
• Oral presentation with PowerPoint
• HNE Health Quality Awards
• NSW Health Quality Awards(Baxters)