Model for Improvement

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# Model for Improvement - PowerPoint PPT Presentation

PLAN. DO. ACT. STUDY. Model for Improvement. What are we trying to accomplish?. AIM. What can we change that will result in an improvement?. How will we know that a change is an improvement ?. CHANGE. MEASUREMENT. PDSA –testing a change. MARU. From YouTube.

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Presentation Transcript

PLAN

DO

ACT

STUDY

Model for Improvement

What are we trying to accomplish?

AIM

What can we change that will result in an improvement?

How will we know that a change is an improvement?

CHANGE

MEASUREMENT

PDSA –testing a change

MARU

What is Maru trying to achieve?

How many ideas does he try?

Is he successful?

What was the possible negative outcome?

Rapid Cycle Change

PLAN

PLAN

PLAN

PLAN

DO

DO

DO

DO

ACT

ACT

ACT

ACT

STUDY

STUDY

STUDY

STUDY

What are we trying to accomplish?

What can we change that will result in an improvement?

How will we know that a change is an improvement?

PROBLEM :

AIM of this change:

Do a PDSA

to solve a problem at home

AIM of this change:

PROBLEM : unpacking the dishwasher is inefficient

AIM: unpack the dishwasher in a more efficient way

• Tom to rearrange cupboard today
• -Mary and Tom to unpack into one cupboard for 4 days

How easy it is to unpack the dishwasher

Put half the cups and half the glasses in the cupboard just above the dishwasher

Mary – it will look horrible and I will hate it

Tom – it will be easy and Mary will like it

PLAN

DO

ACT

STUDY

Model for Improvement

What are we trying to accomplish?

AIM

What can we change that will result in an improvement?

How will we know that a change is an improvement?

CHANGE

MEASUREMENT

Measurement

Outcome measure

Are we getting closer

to our target?

Measurement

Process measure

(Bundle compliance)

Did we use

the whole bundle

in every patient

every time?

Measurement

Measuring the impact of a change

Was the change

an improvement?

Measuring over time
• a volunteer to write
• a volunteer to measure
• graph paper
Annotated Run Chart

Community Need

I

Interpreting Data: what is the story?

Before (Feb) After (Aug)

I

What is the real story?

Feb

Aug

Feb

Aug

Feb

Aug

Feb

Aug

Feb

Aug

I

Prevention of Mother to Child Transmission.

A sub-district in a province in SA

Positive PCRs at 6 weeks (target <5%)

Feb 2010 8.2%

Feb 2011 3.2%

Improvement?

Positive PCRs at 6 weeks (target <5%)

Feb 2010 8.2%

Feb 2011 3.2%

Improvement?

Median

Median

Shift: 6 points in row on same side of the median Note: A point exactly on the centerline does not cancel or count towards a shift

Rule 2

Rule 1

Trend:5points in row headed in same direction

Note: Ties between two consecutive points don’t cancel or add to a trend

Rule 3

Rule 4

Data line crosses once

Too few runs: total 2 runs

Median

Median 11.4

Astronomical Point: a obviously, even blatantly different value

Note: Every set of data will have a highest and lowest data point. This does not mean the high or low are astronomical

Runs: too few or too many runs

I

Provost and Murray

Run Charts

One of the most powerful tools for improvement

Describe a process over time

Shows trends the process is experiencing

Can be used to analyse whether the change was an improvement

Data can be used to drive change

Outcome measurement

Are we getting to our target?

Was the change an improvement?

How do we measure HAIs?

Measuring infection rates

Lessons from an ICU

Measuring Infection Rates
• Total number of infective cases per 1,000 device days:

Total No. of VAP cases

X 1,000

Numerator

Ventilator days

Denominator

Definition of VAP

“Pneumonia is considered as ventilator associated if the patient was intubated and ventilated at the time orwithin 48hrs before the onset of the infection”

“VAP is suspected when a patient on mechanical ventilation develops: a new or progressive pulmonary infiltratewith fever /leucocytosis and purulent tracheobronchial secretions”

Overcoming Numerator Issues

Numerator

Total No. of VAP cases

Patients with

X 1,000

Ventilator days

Denominator

Checklists for

Diagnosing the

HA Infection

used by the

team

Overcoming Denominator Issues

At the same time

every day the

Unit manager

counts devices

in use in the ward