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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

8 Key Steps of Implementing Quality Improvement Projects

Amelia Broussard, PhD, RN, MPH

Step 1make commitment start work

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

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

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

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

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

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

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

  • 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“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 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

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

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

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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