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Rapid Cycle Quality Improvement. Course Outline The Quality Journey Rapid Cycle Improvement Model Change Concepts Teams Tools Barrier Busters. Group’s Prior Experience with Quality Improvement. Participant Survey Results. Very Little. 1-2 yrs. 3-5 yrs. 5-10 yrs. 10+yrs.

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Rapid Cycle Quality Improvement

Course Outline

  • The Quality Journey

  • Rapid Cycle Improvement Model

  • Change Concepts

  • Teams

  • Tools

  • Barrier Busters


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Group’s Prior Experience with Quality Improvement

Participant Survey Results

Very Little

1-2 yrs

3-5 yrs

5-10 yrs

10+yrs


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What is Quality?

Quality is a never-ending cycle of continuous improvement.

-Deming



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Group’s Tools for Quality Improvement

Participant Survey Results


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Quality Improvement Program

  • Vision, Goals, Objectives

  • Quality Indicators – Monitoring

  • Quality Project

    • Continuous Improvements

    • Solve Problems

    • Change Systems

  • Sentinel Events


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The Quality Journey

Quality Assurance

Quality Improvement

Rapid Cycle Quality Improvement


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Quality Assurance

Conform to standards

Relies on inspection

Focus on items

Quality is separate function

Departmental function

Quality Improvement

Improved performance

Monitor over time

System orientation

Quality integrated in organization

Interdisciplinary function

QA vs. QI


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Malcolm Baldrige National Quality Award



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AIM Statement

What are we trying to accomplish?

  • The Aim Statement articulates the goals, guides the improvement effort, and keeps the team focused.

    • Specific

    • Measurable

    • Challenging


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Measurement

How will we know that a change is an improvement?

  • What to measure - what will be different?

  • What are the guidelines


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Cycles of Improvement

What changes can we make that will result in an improvement?

  • It’s your opportunity to brainstorm:

    • Possible changes

    • People that are needed

    • Required resources

    • Potential for collaboration

    • Necessary leadership support


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Cycles of Improvement

Continuous improvements of multiple changes.

Hunches,

Theories,

Ideas

P D

S A

P D

S A

P D

S A

P D

S A

Change 1

P D

S A

P D

S A

P D

S A

P D

S A

Change 2

P D

S A

P D

S A

P D

S A

P D

S A

Change 3


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Rapid Cycle Improvement Model

What are we trying to accomplish?

How will we know that a change is an improvement?

What changes can we make that will result in an improvement?

Cycle 1

Cycle 2

Cycle 3


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Potential EMSC Monitors:

  • Timely management

    • Wait time to see an MD in the ER

    • Time to initiate antibiotics in fever management

    • Use of an intraosseous line when needed

    • Transfer within 2 hours when appropriate

  • Use of the Broselow, or similar, system

  • Pain management in the non verbal child

  • Asthma management

    • Obtaining a patient height

    • Peak flow measurement

  • Abuse recognition

  • Provision of injury prevention education


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What Quality Improvement activities are you working on at your hospital?

Participant Survey Results


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An Example of Rapid Cycle Planning your hospital?

Where do we begin?


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Change Concepts your hospital?

  • Change concepts are generic ideas that can be applied to your situation to spark an idea for a specific change in your situation

  • Not all change concepts apply to all aims

  • Brainstorm ways to apply these concepts to the problem at hand


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Change Concepts your hospital?

  • Enhance the Producer /Customer relationship

    • Listen to patients

    • Coach customers to use product/service

    • Reach agreement on expectations

  • Mass customize services to patient


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Change Concepts your hospital?

  • Change the work environment

    • Reduce demotivating aspects

    • Implement cross training

    • Clarify roles & expectations

  • Improve work flow

    • Synchronize

    • Find and remove bottlenecks

    • Do tasks in parallel

    • Adjust to peak demand


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Change Concepts your hospital?

  • Manage Time

    • Reduce the setup or startup time

    • Optimize maintenance

    • Reduce wait time

  • Manage Variation

  • Eliminate waste

    • Reduce or eliminate overkill

    • Recycle or reuse


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Change Concepts your hospital?

  • Optimize inventory

    • Match inventory to demand

    • Use pull systems - proactive

    • Reduce multiple brands

  • Design systems to avoid mistakes

    • Use reminders

    • Use differentiation

    • Use constraints

    • Minimize handoffs


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Composition your hospital?

Sponsor

Leader

Team member(s)

Helpful hints

Be Multidisciplinary

Assure available leadership

Include hands-on expertise & variety of skills, e.g. computer skills

Recognize progress

Clarify roles & responsibilities

Handle conflict constructively

Maintain core group for consistency

Team


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Essential Tools your hospital?

  • Meeting Agenda (every meeting)

  • Meeting Summary (every meeting)

  • Project Work plan (create 1, post & update)

  • Project Report Form (Internal - External)


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Other Helpful Tools your hospital?

  • Brainstorming

  • Run Charts

  • Flow Charts

  • Cause & Effect Diagram

  • Pareto Diagram

  • Nominal Group Technique

  • Force Field Analysis

    • Refer to Section 12 - Tab “QI Tools & Techniques”


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Example – Run Chart your hospital?


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Example – Control Chart your hospital?

Self Administered Med Project

DRG 372 & 373

Percent of Pts Receiving Darvocet

Project Implemented

Pre Project

60%

Mean: 39.4%

40%

Mean: 23.8%

Percent of Pts

20%

0%

Jul-99

Jul-00

Jul-01

Jan-00

Jun-00

Jan-01

Jun-01

Oct-99

Oct-00

Feb-00

Mar-00

Feb-01

Mar-01

Sep-99

Nov-99

Dec-99

Apr-00

Sep-00

Nov-00

Dec-00

Apr-01

Sep-01

May-00

May-01

Aug-99

Aug-00

Aug-01


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Barrier Busters your hospital?

  • Barrier - Problems with Setting an Aim

    • Is there sponsorship for the project?

    • Does project fit with organizational mission?

    • Does project conflict with our values?

    • Is Aim Statement clear and precise?


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Barrier Busters your hospital?

  • Barrier - Problems with Teams

    • Is your leader available and empowered?

    • Are you meeting weekly?

    • Does everyone know their responsibilities?

    • If you have conflicts, who can you request to facilitate your team?


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Barrier Busters your hospital?

  • Barrier - Problems with Resources

    • Suggestions:

      • Keep your team small at first

      • Use volunteers and champions

      • Collect just enough data

      • Set a dedicated meeting time

      • Huddle if needed (15 minutes is all you need!)

      • Involve senior leadership if resources are a problem


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Barrier Busters your hospital?

Barrier -Resistance :

  • “No one thinks there is a problem”

    • Take the high ground...

  • “We are different”

    • Share information and challenge assumptions...

  • “It’s too difficult”

    • Look at others (internally & externally) that have successfully made a change

    • Break ideas for change into small components

    • Present changes as a “test” - that can be accepted, refined, or abandoned

    • Use just enough data

    • Post results of the small test from the outset as proof that it can happen

  • Engage senior leadership - it is a must


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Resistance – How people respond to change… your hospital?

  • Innovators – 2.5%

  • Early Adopters – 13.5%

  • Early Majority – 34%

  • Late Majority – 34%

  • Laggards – 15%


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Barrier Busters your hospital?

  • Barrier - Problems with Ownership

    • Be sure to include all impacted areas

    • Collaborate with staff at all levels

    • Involve the people that DO the work

    • Find champions in several disciplines

    • Keep sponsors informed and involved


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Next Steps: Action List your hospital?

  • What is one problem in your work setting where you think Rapid Cycle Quality Improvement would help you?

  • What is one thing that you can do by next Tuesday?


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