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Implementing a Large-Scale Quality Improvement Project. Doug Salvador MD MPH Patient Safety Officer Maine Medical Center. Game Plan. Where we were…. Quality Strategy and Planning Change Management Leadership - Engagement Collaboration Logistics – Project Management. Where we were….

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implementing a large scale quality improvement project

Implementing a Large-Scale Quality Improvement Project

Doug Salvador MD MPH

Patient Safety Officer

Maine Medical Center

game plan
Game Plan
  • Where we were….
  • Quality
  • Strategy and Planning
  • Change Management
  • Leadership - Engagement
  • Collaboration
  • Logistics – Project Management
quality

Quality

Design of reliable systems of care in advance for planned excellence in clinical outcomes

current reliability in health care
Current reliability in health care
  • Less than 80% despite:
    • Solid evidence based guidelines
    • Good intentions
    • Talented people
  • By definition, unreliable processes: Chaos
reliability of health care processes
Reliability of health care processes
  • Next level of Reliability
    • Success rates of 80 - 90%
    • Represents 1 or 2 failures out of 10 opportunities
    • Key to this level is the understanding that no articulated process exists
    • If 5 frontline individuals are asked to describe the process, less than 5 will be able to do so
reliability of health care processes1
Reliability of health care processes
  • Next level of Reliability
    • Success rates of 95%
    • Represents 5 or fewer failures out of 100 opportunities
    • Key to this level is the understanding a articulated process does exists
    • If 5 frontline individuals will commonly be able to describe the process at this level of reliability
comprehensive quality program
Comprehensive Quality Program
  • Leadership
  • Accountability
  • Transparency
  • Measurement
  • Toolkit
    • Systems design
strategy and planning1
Strategy and Planning
  • Large-scale improvement projects must be in the strategic plan
  • How do I get something into the strategic plan?
    • What is your strategic planning process?
    • Who sits at the table?
glycemic control program proposal
Glycemic Control Program Proposal
  • Aim Statement
  • Problem Statement
  • Description of Program
  • Data Collection and Reporting Plan
  • Project Timeline
  • Justification of alignment to strategic plan
  • Pro-Forma
stages prochaska and diclemente
Pre-contemplation

Contemplation

Preparation

Action

Make current state less desirable

Raise awareness of problem

What’s in it for me?

Reason to change

Show people how to change

What is needed for change?

Small tests of change

Just DO it

Stages (Prochaska and DiClemente)
structures
Structures
  • Steering Committee
  • Working group
  • Subgroups
  • Who’s going to do the work?
project management tools
Project Management Tools
  • Meeting management skills
    • Ground rules
    • Leader, facilitator, timekeeper
    • The work before the work
  • Action planning documents
  • Gantt Charts
  • Communicate, communicate, communicate
slide26

How Organizations Succeed

CUSTOMER REQUIREMENTS

ORGANIZATIONAL PURPOSE

Structures

Systems

Processes

Information

Resources

Leadership

Professionalism/Respect

Communication

Commitment

Teamwork

Customer-centered Care

Organizational

Design

Organizational

Behavior

CULTURE

The Interaction of Design

And Behavior Produces

Rich Fitzpatrick,

Fitzpatrick Consulting

Together They Produce

RESULTS