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QI toolkit Oct 2020 v6

Christie QI toolkit

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QI toolkit Oct 2020 v6

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  1. QI toolkitContent • Definition and overview of QI journey • Getting started and planning to measure improvement • Driver diagrams, The Model for Improvement • Aims and measures • Testing changes with the PDSA cycle • Measurement - demonstrating change with SPC charts • Reporting and publishing QI • Top Tips • Key QI tools and when to use them • Further QI education To follow hyperlinks, please view in presentation mode Last updated Nov 2020

  2. Healthcare quality • There are 6 dimensions of healthcare quality: • Safe • Effective • Patient-centred • Timely • Efficient • Equitable • Topics for improvement come from a wide variety of sources including: • clinical incidents, claims, complaints, clinical audits, peer review, staff concerns, surveys, benchmarking, national best practice, new technology, research and innovation….

  3. What is quality improvement? • Use of a structured process and tools to systematically measure and improve outcomes and experience for patients …. and staff! • Popular tools include Clinical audit, the Model for Improvement… • Purpose of measurement for QI differs: Improvement: small tests of change, measures variation over time (drives improvement, may be innovative) Research: tests if an intervention works (aims to derive new knowledge) Assurance: tests performance against an agreed standard (assurance of quality of care)

  4. Summary of the Improvement journey Start with a situation you want to improve… 2. 1. 3. 4. 5. 6. Thanks to BTS Quality Improvement Methodology Overview / NHS Education for Scotland

  5. Getting startedBuild the will and conditions for change Teamwork is associated with higher quality care, better staff wellbeing andlevels of patient satisfaction and lower avoidable patient mortality* 1. • Build a team, including data support • Agree a Lead, consider an Exec sponsor • Identify those affected (stakeholders) • Think about patient involvement • Consider a name for the project • Plan communications • Raise awareness of the need for change • Work with enthusiasts Don’t forget to register the project! Proposal form Help is available! *Caring for doctors, Caring for patients, GMC, Dec 2019

  6. Planning to measure improvement in careUnderstand the system 2. • Healthcare is complex • Consider outcomes of care and processes involved • Outcomes are usually dependent on processes • Process mapping is an insightful tool • Potential for unintended consequences of change!

  7. The Model for ImprovementDevelop aim & change theory Develop change ideas and test 3. This is not the only QI tool, but it is a simple approach to continuous improvement, testing changes in small cycles IHIOpenSchool...The Model for Improvement Part 2

  8. Agreeing an improvement aim • Reason for undertaking QI project • What problem/gap are you trying to resolve • Do you have all the information you need? • SMART goals • Keep it focused: start small and scale up • Maintain motivation to improve • It’s ok to refine the aim as you go • Need to measure progress towards aim….

  9. Driver diagram:a ‘theory of change’ and a plan on a page Develop aim and change theory 4. 3. • Highly recommended QI tool as an aid to planning and communication • Agree SMART aim • Identify influences (drivers) on aim • Develop change ideas to impact on drivers • Start testing and measuring! • Guidance on Driver Diagram • Christie Driver Diagram template

  10. Developing change ideas 3. 4. • Use your understanding of the current system • Understand the causes of problems (try fishbone analysis) • Can you describe the ideal system? • What works elsewhere? Use networks, do lit search • What ideas do the team have? • Seek patient feedback (their experience, what matters to them) • Ask staff, eg try a whiteboard • Try QI tools to help with problem solving and creativity • eg Root cause analysis using the 5 Whys, Six Thinking Hats© https://improvement.nhs.uk/resources/quality-service-improvement-and-redesign-qsir-tools-type-task/#thinking

  11. Test and refine in context 4. Test with the PDSA cycle • Methodical process to test improvement ideas • Record results over time (eg line or SPC graph) • Study is the element least often completed: • Did the test achieve the results you expected? • If not, why? What else could you try? • Plan next test or change to implement • It is a cycle; refine and repeat to increase assurance

  12. Implementing new procedures & systems - sustaining change ACT ACT ACT ACT ACT ACT PLAN PLAN PLAN PLAN PLAN PLAN DO DO DO DO DO DO STUDY STUDY STUDY STUDY STUDY STUDY Testing and refining ideas Accumulating information, data and knowledge Bright idea! 5. • Implement locally, using PDSA cycles to build in sustainability Testing ideas: repeated use of the PDSA cycle • Start small and build • Reduce risk • No cycle is too small • “Trial and learning” • Rapid change Picture courtesy of NHS Scotland

  13. 6. • Scale up and spread where relevant Scale up, spread and sustainability • Scale up: changes tested in other teams/locations to increase degree of belief that they work • Spread: best practice distributed consistently across a system • Sustainability: new way of working becomes the norm • NHS Innovation and Improvement sustainability model can be considered throughout to help strengthen elements • Communications support sustainability

  14. Measuring change (1) • Measurement is a key element supporting the improvement journey • Identify what should and can be measured • What measures will enable you to demonstrate improvement? • Measure baseline before implementing changes • Understand and act on variation over time • Include data expertise in project team

  15. Measuring change (2): Collecting data • Planyour data collection in advance • Sources: What structured data is available electronically? Eg CWP, Christie Data Insights • Manual data collection is time consuming, so only collect data that is really needed to meet aims & measures • Consider who will collect data • Aim for consistency: ensure data definitions are clear to all • Consider online data collection tool (support is available!) • Pilot data collection tools whenever possible • Check the data collected answers your questions • Modify the tool to make the data as robust and easy to collect as possible

  16. Measuring change (3): A family of measures • Examples: • % patients completing planned treatment • No. patients with a treatment plan • No. patients starting treatment • No. patients with no treatment • Average waiting time

  17. Demonstrating a changeUsing Statistical Process Control (SPC charts) Measuring change (4): • SPC chart - line graph with mean, process control limits and rules to identify non random changes • At least 15 data points for robust conclusions • 99% of data will occur between process limits • Annotate to record when changes were made

  18. Key tools and when to use them

  19. Top tips for successful QI project • Clearly defined, focused statement of intent • Driver diagram recommended for plan on a page! • Manageable scope for available resources – start small! • Committed lead and mix of staff with time to undertake and Exec support • Engage and communicate with staff • Data support • Clearly defined measures • Just enough data to measure tests of changes over time

  20. Documenting, sharing and publishing your QI project There is learning in sharing what didn’t work too Share learning internally first, but …We encourage QI project teams to write up their completed and successful improvement work and submit for publication. • Share your work on a poster Click here to see some complete project posters Click here to download a poster template • Write your project up for publication • 4 Christie QIP’s have been presented at conferences See the published Christie QI projects and their posters on the next slide • Why not consider: submitting to the NHS England Beneficial Changes Network publishing on the BMJ Case Reports publishing on the BMJ Open Quality site

  21. Published projects Conference posters and journals

  22. Advice for Publishing QI projects • Reporting and publishing Quality Improvement projects • Authors of improvement reports are strongly encouraged to consult the SQUIRE guidelines (Standards for Quality Improvement Reporting Excellence) regarding the format and content.   • BMJ Open Quality have also produced the downloadable SQUIRE template which combines the SQUIRE guidance with their guidance to authors. • See table below for a useful check list of recommended elements of a QI report: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857497/ • How to Write Up Your Quality Improvement Initiatives for Publication • Brian M. Wong, MD, FRCPC and Gail M. Sullivan, MD, MPH, J Grad Med Educ. 2016 May; 8(2): 128–133. • ‘Sharing results of improvement work’ webinar with Editor-in-Chief BMJ Open, Helen Crisp: Advice on publication of Quality improvement work

  23. Quick educational resources • The Science of Improvement on a Whiteboard • Institute for Healthcare Improvement • The Model for Improvement (Part 1) • Watch the videoRead the transcript • And more short videos… • Short E-learning course on ESR • Harm Free Care 01: An Introduction to The Model for Improvement For further information see QICA pages on HIVE or contact the QICA team

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