Why Quality Improvement(QI) and where do I begin?

1. Why Quality Improvement(QI) and where do I begin? Alexander Singer MB BAO BCh, CCFP Associate Professor Quality Improvement and Informatics Postgraduate Lead Rady Faculty of Health Sciences, College of Medicine, Department of Family Medicine March 27, 2019

2. Faculty/Presenter Disclosure Relationships with financial sponsors: Grants/Research Support: Canadian Institute for Military and Veterans Health Research, IBM, Calian, Research Manitoba, Manitoba Medical Services Foundation, CIHR Speakers Bureau/Honoraria: None Consulting fees: None Patents: None

3. Disclosure of Financial Support The Practice Improvement Initiative has received financial support from the College of Family Physicians of Canadain the form of Institutional Support Potential for conflict(s) of interest: Alexander Singer has not received payment/funding from any organization supporting this program nor any organization whose product(s) are being discussed in this program. There are no products that will be discussed in this program

4. Mitigating Potential Bias The CFPC has no commercial interests in the success of promoting quality improvement among Family Physicians. Practice Improvement is a strategic priority for the CFPC.

6. QI is learning from our work… …and then improving it We have two Jobs Doing the work Improving the work

8. What are the fundamentals of Healthcare Quality Improvement? What are we trying to accomplish (Aims)? How do we measure systems and change (Data)? How can we change effectively (ChangePDSA)?

9. #1 What is the Quadruple Aim? Bodenheimer T, Sinsky C. Ann Fam Med 2014; 12(6): 573-576.

10. Don Berwick on the “Triple Aim”- “It’s an elegant way to name why we’re here: better care for individuals, better health for populations, and let’s not waste.”

11. The Six Dimensions or Domains of Quality • Timely • Efficient • Equitable • Safe • Effective • Patient-Centred Institute of Medicine (IOM). 2001. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press.

12. Is this high quality care? Think about the referral process: Safety Avoid harm to patients Equity Care does not vary in quality because of personal characteristics Effectiveness Provide evidence-based services to those who can benefit, refrain for those who will not Efficiency Avoid waste of resources, ideas, and energy Patient-centredness Provide respectful care responsive to patient preferences, needs, and values Timeliness Reduce waits for those receiving and delivering care

13. #2 What can we measure?

14. #3 What is change? All improvement requires change, but not all change results in improvement Robust improvement work leads to fundamental change

15. Practice improvement approaches A spectrum of approaches A simple change “Just do it!” Basic QI approaches and tools E.g. PDSA Cycle, Model for Improvement, process mapping Advanced QI approaches and tools E.g. LEAN, Six Sigma

16. Model for Improvement What are we trying to accomplish? Specify and set an aim How will we know if a change is an improvement? Establish measures What changes can we make that will result in an improvement? Identify change ideas Small, iterative tests of change. Turns ideas into action and action into learning

17. Rapid Fire Improvement Ideas:

18. #1. Take a CFPC PIE course – Aim!

19. #2. MaPCReN– Measure!

20. #3. eConsultManitoba – Change!