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# Model for Improvement - PowerPoint PPT Presentation

PLAN. DO. ACT. STUDY. Model for Improvement. What are we trying to accomplish?. AIM. What can we change that will result in an improvement?. How will we know that a change is an improvement ?. CHANGE. MEASUREMENT. PDSA –testing a change. MARU. From YouTube.

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## PowerPoint Slideshow about ' Model for Improvement' - keitha

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Presentation Transcript

DO

ACT

STUDY

Model for Improvement

What are we trying to accomplish?

AIM

What can we change that will result in an improvement?

How will we know that a change is an improvement?

CHANGE

MEASUREMENT

MARU

What is Maru trying to achieve?

How many ideas does he try?

Is he successful?

What was the possible negative outcome?

PLAN

PLAN

PLAN

PLAN

DO

DO

DO

DO

ACT

ACT

ACT

ACT

STUDY

STUDY

STUDY

STUDY

What are we trying to accomplish?

What can we change that will result in an improvement?

How will we know that a change is an improvement?

AIM of this change:

to solve a problem at home

AIM of this change:

PROBLEM : unpacking the dishwasher is inefficient

AIM: unpack the dishwasher in a more efficient way

• Tom to rearrange cupboard today

• -Mary and Tom to unpack into one cupboard for 4 days

How easy it is to unpack the dishwasher

Put half the cups and half the glasses in the cupboard just above the dishwasher

Mary – it will look horrible and I will hate it

Tom – it will be easy and Mary will like it

DO

ACT

STUDY

Model for Improvement

What are we trying to accomplish?

AIM

What can we change that will result in an improvement?

How will we know that a change is an improvement?

CHANGE

MEASUREMENT

Outcome measure

Are we getting closer

to our target?

Process measure

(Bundle compliance)

Did we use

the whole bundle

in every patient

every time?

Measuring the impact of a change

Was the change

an improvement?

• a volunteer to write

• a volunteer to measure

• graph paper

Community Need

I

Before (Feb) After (Aug)

I

Feb

Aug

Feb

Aug

Feb

Aug

Feb

Aug

Feb

Aug

I

A sub-district in a province in SA

Positive PCRs at 6 weeks (target <5%)

Feb 2010 8.2%

Feb 2011 3.2%

Improvement?

Feb 2010 8.2%

Feb 2011 3.2%

Improvement?

Median

Median

Shift: 6 points in row on same side of the median Note: A point exactly on the centerline does not cancel or count towards a shift

Rule 2

Rule 1

Trend:5points in row headed in same direction

Note: Ties between two consecutive points don’t cancel or add to a trend

Rule 3

Rule 4

Data line crosses once

Too few runs: total 2 runs

Median

Median 11.4

Astronomical Point: a obviously, even blatantly different value

Note: Every set of data will have a highest and lowest data point. This does not mean the high or low are astronomical

Runs: too few or too many runs

I

Provost and Murray

Run Charts Change

One of the most powerful tools for improvement

Describe a process over time

Shows trends the process is experiencing

Can be used to analyse whether the change was an improvement

Data can be used to drive change

Outcome measurement Change

Are we getting to our target?

Was the change an improvement?

How do we measure HAIs?

Lessons from an ICU

Quality Improvement 101 Change

Problem?

• Total number of infective cases per 1,000 device days:

Total No. of VAP cases

X 1,000

Numerator

Ventilator days

Denominator

Definition of VAP Change

“Pneumonia is considered as ventilator associated if the patient was intubated and ventilated at the time orwithin 48hrs before the onset of the infection”

“VAP is suspected when a patient on mechanical ventilation develops: a new or progressive pulmonary infiltratewith fever /leucocytosis and purulent tracheobronchial secretions”

Numerator

Total No. of VAP cases

Patients with

X 1,000

Ventilator days

Denominator

Overcoming Numerator Issues – Changediagnosing the HAI (workbook)

Checklists for

Diagnosing the

HA Infection

used by the

team

At the same time

every day the

Unit manager

counts devices

in use in the ward

Measuring HAI Change

Percentages and rates

% (or rate) = Numerator/ denominator

eg

Rate of infection = readmissions for septic caesarian section wounds per week / number of Caesarian Sections performed per week

Rate of infection = Number of VAP / 1000 device days

Safety Calendar ChangeWelsh 1000 lives campaign

I

Developed by Annette Bartley

Measuring HAI Change

For measure ‘rare’ events (occur < 10%)

The concept of

‘days between’ infections

Off the internet, Change

Maternal deaths – Malawi Change

For the “NO Maternal Death” Campaign

a colorful, laminated A4 paper

that said “Days without a Maternal Death: ______”.

were hung in every Labour Ward

for all (providers, patients and guardians) to see

and the number was filled in daily with a dry erase marker

Days between icecreams Change

25

Days

between

icecream

20

15

10

5

1st

2nd

3rd

4th

5th

Icecream

25

Days

Between

events

(eg

Infection)

20

15

10

5

1st

2nd

3rd

4th

5th

Sequence of events (eg Infection)

Neonatal deaths – Malare Health Centre, Change5’s Alive! Project, Ghana

I

James Benneyan IHI

I

Use the tools to Change

Display the data

Days Change

Be-tween

Infection

Sequence of Infections

# Days since

last infection

Date of

infection

So far we have: Change

• Mapped the size of the project in your facility

• Written an aim

Now, write down: Change

• Process Measures(Bundle compliance)

• The outcome measures

• Rate = numerator/denominator (describe)

• Days between

• Welsh Safety Cross calendar

• Other

• How you will feedback the data every month to

• The frontline staff

• Management

• Mark with a * areas that you want to strengthen

1) Numerator

Standardised diagnosis of infection

2) What is the measure for HAI?

Rate = Infection/device day

Days between (CLABSI, VAP, UTI)

Days or cases between SSI

3) Collecting and collating data:

What (definition)/ Where/ How (tools)/ Who/ When

4) Presenting the data:

Format - Safety Cross, Graphs

Feedback/presentation - Management platform

• Process Measures (Bundle compliance)

• The outcome measures

• Rate = numerator/denominator (describe)*

• Days between

• Welsh Safety calendar*

• Other

• How you will feedback the data every month to

• The frontline staff *

• Management *

• * Areas that need strengthening

• Select a priority area for improvement

• resolving it will have a big impact

• it is under your control to test a change

• you can start on Monday

PLAN Change

DO

ACT

STUDY

Plan a PDSA using the

Model for Improvement

What are we trying to accomplish?

aim

What can we change that will result in an improvement?

How will we know that a change is an improvement?

change

measurement

PROBLEM : Change

AIM of this change:

Design a PDSA to improve one of the areas with a *

PROBLEM : Changestaff aren’t engaged in the project

increase awareness through measurement

AIM

What

When

Where

Who

How

AIM: the Welsh Safety Cross is completed

Staff know what it means

AIM: use the Welsh Safety Cross

Welsh Safety Cross will improve the profile of the project.

Will need to engage staff with colouring it in or they won’t take any notice