Academic Pediatric Association QUALITY IMPROVEMENT TRAINING: Module #3

1. Academic Pediatric AssociationQUALITY IMPROVEMENT TRAINING: Module #3 Initiating a QI project This work is supported by a grant from The Centers for Disease Control & Prevention.

2. National Partnership for Adolescent ImmunizationPI: Peter SzilagyiCoordinators: Christina Albertin, Nui Dhepyasuwan • Ed Marcuse (communication expert) • Cindy Rand • Jan Schriefer (QI expert) • Stanley Schaffer • Janet Serwint • William Stratbucker • Donna D'Alessandro • William Atkinson • Paul Darden • Sharon Humiston (moderator) • Keith Mann (QI expert) FACULTY & CONSULTANTS

3. This is part of the APA series on Quality Improvement. The examples focus on adolescent immunization, but the principles are widely applicable. The series includes: • Overview: The Model for Improvement and Deming’s System of Profound Knowledge • Improvement cycles and the psychology of change • Initiating a QI project • More tools to better understand the system • How will we know that a change is an improvement? An introduction to QI measurement • Changes we can make that will result in improvement

4. Module 3 Objectives After viewing this segment, you will be able to: • Identify roles and responsibilities of QI team members • Draft an Aim Statement (Describe your problem, timeline, scope, and target population) • Complete a charter • Build a driver diagram

5. 1. Identify roles & responsibilities of QI team members “Including the right people on a process improvement team is critical to a successful improvement effort.” Institute for Health Improvement

6. When putting together a QI team… • How to choose team members: • Review the general mission  What system will be affected by the improvement efforts? • Invite members familiar with different parts of the process • Size: 5-7 people at most • Executive sponsor: takes responsibility for the success of the project

7. Possible Team Members & Their Roles • Project sponsor/champion – oversee QI project (e.g., goal setting, data collection & analysis), advocate for & find resources to get project done • Clinical technical expert -- knows the subject intimately, understands the processes of care • Day to day leader– plan & deliver all training needed to implement the project; managing the implementation and testing the change • System leader -- advocate • Other team members– “voice of experience” • Outsider? • QI expert if available

8. Some characteristics that make a good team member: • Good knowledge of process, product, and customer • Access to data about the process or product • Willingness to work cooperatively with other team members • Ability to devote 3-4 hours/week to data collection and team meetings • Ability to challenge the status quo From The Six Sigma Way: Team Fieldbook PS Pande, RP Neuman, RR Cavanagh

9. QUESTION #1True or False? When developing your QI team, the project champion should emphasize that the project will take almost no time in order to attract important (i.e., busy) team members.

10. QUESTION #1(Answer) False! When developing your QI team, the project champion should acknowledge that QI takes time in order to attract team members prepared for the commitment.

11. 2. Draft an Aim Statement

12. AIM Statement • What are we striving to accomplish (measurable goal(s))? • When will this occur? (what is the timeline)? • How much? What is the specific, numeric improvement we wish to achieve? • For whom? Who is the target population? • Why is it important? See Jean Meeks on “Developing Clear Aim Statements” at http://positive-eye.com/2008/12/developing-clear-aim-statements/

13. QUESTION #2: Name at least 1 component (What, When, How much, For Whom, Why) that is missing from each of the following first draft AIM statements. A. Within the next 12 months we will increase our first dose HPV vaccination rates by 50%. B. We will strive to achieve 100% HPV vaccination of all adolescent patients in our clinic. C. Between January 1 - June 30, 2014 we will improve HPV vaccination coverage among our patients (both males and females) who are 11 or 12 years of age as of January 1, 2014.

14. QUESTION #2: Name at least 1 component (What, When, How much, For Whom, Why) that is missing from each of the following first draft AIM statements. A. Within the next 12 months we will increase our first dose HPV vaccination rates by 50%.Missing: For whom? B. We will strive to achieve 100% HPV vaccination of all adolescent patients in our clinic.Missing: When? C. Between January 1 - June 30, 2014 we will improve HPV vaccination coverage among our patients (both males and females) who are 11 or 12 years of age as of January 1, 2014. Missing: How much?

15. A Sample AIM Statement for HPV Vaccination

16. How high should we set our goals? Not so high that it paralyzes people because they know they can’t succeed But it shouldn’t be so low that it just barely exceeds the status quo “The measure of goodness is as much improvement as you can possibly accomplish.” From http://tipqc.org/qi/jit/methods/developing-an-aim-statement/

17. 3.Complete a charter for the project committee

18. What is in a project charter? (see template based on http://quality.wisc.edu/project-management-charter.htm) • AIM Statement (includes goal and timeline) • Members and their responsibilities • Meetings --Timing (e.g., every Tuesday 12:00-12:50, expectation to start & end on time) --Who will take notes, document decisions?

19. Why use a project charter? • Defines the project and organizes critical pieces of info about a project in one place • Emphasizes approval by leadership • Builds understanding, consensus, and clarity • Is a living document that evolves using a structured approach

20. 4. Build a driver diagram

21. Driver Diagram • The system can be described through a graph called a driver diagram. • Purpose: to show the factors that cause an outcome • The outcome we are interested in is our Aim, so let’s start there.

22. Desired Outcome (Aim)

23. Desired Outcome Primary Drivers (Aim)

24. Desired Outcome Primary Drivers 2ndary Drivers (Aim)

25. Desired Outcome Primary Drivers Interventions (Aim)

26. Desired Outcome Primary Drivers Interventions (Aim)

27. QUESTION #3: Match the term on the left with the phrase on the right. Aim statement Project charter Driver diagram Graphic display of a system with the outcome of interest and the major influences on the outcome An AIM Statement, the team’s members and their responsibilities, expectations for the meetings A careful description of a desired outcome with respect to its importance, the desired measurable goal(s), the timeline, the target population

28. QUESTION #3 (Answer) • Driver diagram – Graphic display of a system with the outcome of interest and the major influences on the outcome • Project charter – An AIM Statement, the team’s members and their responsibilities, expectations for the meetings • Aim statement – A careful description of a desired outcome with respect to its importance, the desired measurable goal(s), the timeline, the target population

29. Summary • QI teams should include 5-6 people familiar with different parts of the problem plus an executive sponsor. • An Aim Statementshould explicate the measurable goal, the timeline, the numeric improvement you plan to achieve, the target population and why the issue is important. • Your team chartershould include the AIM Statement, team members and their responsibilities, and details of meetings such as timing and note taking. • A driver diagram depicts the problem, the primary drivers, possibly the secondary drivers, and potential interventions to address the drivers.

30. The End of Module #3 IHI. Science of Improvement: How to Improve http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx