8 key steps of implementing quality improvement projects
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8 Key Steps of Implementing Quality Improvement Projects. Amelia Broussard, PhD, RN, MPH. Step 1Make Commitment; Start Work : . Promise time/resources to do this right. Budget time for improvement activities. Use quality tools and resources creatively,

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8 Key Steps of Implementing Quality Improvement Projects

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8 Key Steps of Implementing Quality Improvement Projects

Amelia Broussard, PhD, RN, MPH


Step 1Make Commitment; Start Work:

  • Promise time/resources to do this right.

  • Budget time for improvement activities.

  • Use quality tools and resources creatively,

  • Alter strategies as needed for staff and culture to support “ownership” of improvement work.

  • Don't do this alone. Process requires a “core team”

  • Include at a minimum of division leadership and key owners of the processes under improvement.


Step 2: Form a Team

  • What is a team?

  • A group of individuals working together for a common purpose.

  • Team shares mutual accountability for successful outcome.

  • Teams create environments in which participants can keep up with needed changes, learn more about core processes, and gain skills in collaboration


Teams are more Effective If

  • Task is complex

  • Creativity is needed

  • Path forward is unclear

  • More efficient use of resources is required

  • Fast learning is necessary

  • High commitment is desired

  • Implementation of plan requires cooperation of others

  • Task or process is cross-functional


Teams Require

  • Clearly defined purposes and goals that serve organization

  • Defined parameters within which to work

  • Communication within the organization

  • People with necessary knowledge and skills to accomplish task

  • Knowledge about how they are going to accomplish tasks


Teams and Change

  • Most teamwork involves change

  • Change is seldom easy.

  • “Laws” of organizational change:

    • People don’t resist change, they resist being changed;

    • Things are the way they are simply because they got that way;

    • Unless things change, they are likely to remain the same; and

    • Change would be easy if it weren’t for all the people!


Forming a Successful Team

  • Three to six members are typical size

  • Include people from work areas that will be impacted by changes

  • Representation of all affected areas ensures understanding of projected improvement

  • It also promotes buy-in for changes.


Team Selection

  • Composition is the most critical success factor in any improvement project

  • Division Leadership is responsible and accountable for team composition.

  • Smaller the team, the faster and better the results.

  • Five or six team members are ideal. In a small setting, four member teams are norm.

  • .

  • Team members should be prepared to meet at least twice a month; weekly is ideal


Selection Process

  • Selection process consists of three steps:

    • Identifying good candidates for the project

    • Determining the optimal team mix,

    • Recruiting the team


Who Makes A Good Team Member?

  • Potential team member, want to ask following questions:

    • Is this person respected for their judgment by a range of staff?

    • Does s/he enjoy a reputation as a team player?

    • Technically, what is person’s area of mastery


Good Team Member Cont’d

  • Is s/he an excellent listener?

  • Is this person a good verbal communicator?

  • Is person a proven problem solver?

  • Is s/he frustrated by current systems and processes?

  • Is person demonstrably open to change?


Identifying Team Leaders

  • Members in three leadership roles will guide team activities

  • Senior Leader

  • Process Champion

  • Quality Lead.

  • All three leadership roles function as team liaisons and representatives across programs and divisions.


Senior Leader

  • Has authority to allocate time and resources needed to achieve team’s aim (goal)

  • Has authority over areas affected by change

  • Will support spread of successful changes throughout organization


Process Champion

  • Is an opinion leader and is well respected by peers

  • Understands processes of work involved in change effort

  • Has a good working relationship with colleagues and day-to-day leader

  • Wants to drive improvements in system


Quality Lead

  • Drives project, ensuring that cycles of change are tested and implemented

  • Coordinates communication between team and leadership

  • Oversees data collection

  • Works effectively with champion and other team members


Teamwork Principles

  • Members need to work at active listening and respecting one another’s point of view.

  • Ground rules for group should be established, documented and reviewed periodically

  • Ground rule examples include: start on time, make no judgments, and keep confidentiality among group members, ensure that all voices are equal, use humor


Meetings Work Best When Members of Team:

  • Commit to meeting time and process

  • • Clarify roles and responsibilities each time

  • • Begin and end meetings on time

  • • Listen to and respect perspectives

  • • Do assigned “homework”

  • • Give honest feedback

  • • Evaluate and mark success

  • • Make time enjoyable


Stages of Team Growth

  • Stage 1: Forming – members cautiously explore boundaries of acceptable group behavior

  • Stage 2: Storming – teams begin to realize task is different and more difficult than they imagined, and become testy, anxious, or overzealous

  • Stage 3: Norming – team members reconcile team loyalties and responsibilities

  • Stage 4: Performing – team settles it’s relationships and expectations and starts performing


Step 3: Select and Define an Improvement Project

  • Guidelines for selecting project

  • Is important to organization and its clients or grantees?

  • Is it an area where senior leaders, division directors, and staff will cooperate in improvement effort

  • Is not already undergoing major changes or being studied by another group

  • Is relatively simple, with clearly defined starting and ending points.

  • May break complex issue into simpler task


Define the Process

  • Goal is to develop useful description of your process as it currently works.

  • May lead to discoveries of obvious improvements.

  • Allows everyone on team to come to agreement on key tasks involved


Key Methods Of Describing A Process

  • Set boundaries on the process

  • Flowchart process

  • Diagram physical workflow

  • May use Fishbone diagram to determine areas for possible improvement


Step 4: Define an Improvement Aim (Goal)

  • Where Are You Now?

  • Where Do You Want to Be?

  • Make Baseline Performance Assessments

  • Validate level of performance on selected improvement project


Write an AIM Statement:

  • An AIM (goal) statement articulates in 1 or 2 sentences what the team is trying to improve

  • Based on assessment of current performance already completed

  • Agreement with group on suitable stretch goal for improvement.

  • Important to do process well first time to keep team on track

  • It will keep team focused, re-orient members when they get off track

  • Facilitate development of simple measurements to determine if a change is indeed an improvement.


Develop measurements to evaluate your improvements

  • What is it you are trying to improve and for whom?

  • It is important to identify simple way to evaluate improvement progress over length of your project

  • Learn from consumers of your process and use these lessons to inform team’s improvements


How To Know Change Is An Improvement?

  • Remember to look at small microsystems (small replicable units) of process

  • Is there already data collection process in place that measure impact?

  • Can real time data collection be easily inserted into current flow of work?


Step 5: Cause Analysis

  • It’s critical to identify causes of problem under study before jumping to conclusions on best solutions.

  • Best to localize occurrence of problem before attempting to identify specific or root causes.

  • Important to be sure everyone agrees on definition of problem.

  • Explore “causes of causes” to make sure your addressing “upstream” issues affecting actual problem under study.

their effects.


Root Cause Analysis

  • Systematic analysis of an issue to identify the root causes rather than the symptoms.

  • Cause and effect charting is another way to clearly sort causes from their effects.


“Brainstorm” As A Group

  • Brainstorming is process of offering creative ideas that comes to mind (without any judgment attached to it).

  • Use flip chart to write down ideas that members of team feel might be addressed

  • All team members should be encouraged to participate in this process – perhaps go around the table and take turns providing one suggestion at a time.

  • Write down all ideas, some ideas may address the same

  • Combine similar themes.

  • Avoid jumping to solutions at this point.


Prioritize Ideas

  • Prioritize objectives.

  • Team should vote on which objective needs to be worked on first, second, and third

  • Plan to focus on 2 or 3 objectives at first then revise if necessary

  • Important that all team members participate in anticipated improvement within specified timeframe.

  • Each team member should be working toward this goal.


Step 6: Plan and Test Changes

  • Develop appropriate solutions

  • Test changes that lead to improvement

  • PLAN, DO, STUDY, & ACT Cycle (PDSA):

  • Simply defined:

    • Plan simple improvement project according to goals and objectives

    • Do project activities

    • Study whether project is making an improvement (or not)

    • Act accordingly, incorporating any changes or course corrections


Step 7: Implement and Sustain Successful Changes

  • Key to sustaining improvement is institutionalizing successful changes

  • Steps to be taken to secure permanent changes to make it part of the larger system:

    • Document e new process or changes to system

    • Educate and communicate changes to ALL staff involved

    • Add new process to any orientation or staff training procedures

    • Develop mechanisms to continually assess changes


Step 8: Ending Improvement Teams/Projects

  • Results checked against original goals and needs of division, staff and improvement target

  • Identified any remaining tasks to be done,

  • Established responsibility for monitoring change over time

  • Documented and trained people, when necessary, in new process.

  • Communicated changes to everyone affected by them.

  • Reviewed team’s accomplishments for areas of improvement.

  • Celebrated efforts of team with a lunch, formal announcement of team results, special presentation to the division, Quality Council, or other expression of celebration.


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