QI Presentation: Skills and Examples Dr David Gozzard Senior Fellow, Institute for Healthcare Improvement, Boston US. Objectives of the Session. Understanding of relationship between structure and process Introduction to process mapping Driver diagram development PDSA worked examples.
QI Presentation: Skills and Examples Dr David Gozzard Senior Fellow, Institute for Healthcare Improvement, Boston US
Objectives of the Session • Understanding of relationship between structure and process • Introduction to process mapping • Driver diagram development • PDSA worked examples
System Design Every system is perfectly designed to achieve exactly the results it gets
The Healthcare System 133 People to take care of the patient The Patient
STRUCTURE + PROCESS = OUTCOME
A Simple Flowchart Dealing with a non-functioning lamp
Another Simple Flowchart Waking up in the morning
A New Tool – Driver Diagrams A tool to help us understand the messiness of life!
What changes can we make? • Primary Drivers • System components which will contribute to moving the primary outcome • Secondary Drivers • Elements of the associated Primary Driver. They can be used to create projects or a change package that will affect the Primary Driver.
Driver Diagram Exercise • Establish stakeholder group • Objectives • Discussion regarding concerns (group) • Flipchart exercise (smaller groups) • Sticky notes exercise (individual) • Coffee!! • Whilst this is taking place the notes are “themed” • Stakeholders view themes (primary drivers) • Group exercise to format driver diagram
Anaemia Management Driver Diagram Projects
How Will We Know We Are Improving?Understanding the System for Weight Loss with Measures Measures let us • Monitor progress in improving the system • Identify effective changes
Group Work • Working in pairs, for an improvement aim arising from a national audit define the following: • Primary drivers • Secondary drivers • Possible projects • Allow 10 minutes for this exercise
Guidance for testing a change concept A test of change should answer a specific question! A test of change requires atheoryand aprediction! Test on a small scale and collect data over time. Build knowledge sequentiallywith multiple PDSA cycles for each change idea. Include a wide range of conditionsin the test sequence. Don’t confuse a taskwith atest!
The Model for Improvement • Define the question • Gather information and resources (observe) • Form hypothesis Generate new hypothesis and retest Analyze and interpret data Perform experiment and collect data
Why Test? Why not just implement then spread? • Increase degree of belief • Document expectations • Build a common understanding • Evaluate costs and side-effects • Explore theories and predictions • Test ideas under different conditions • Learn and adapt
Repeated Use of the PDSA Cycle Changes That Result in Improvement Model for Improvement What are we trying to accomplish? How will we know thata A P change is an improvement? S D What change can we make that will result in improvement? DATA D S Implementation of Change P A A P Wide-Scale Tests of Change S D Hunches TheoriesIdeas A P Follow-up Tests S D Very Small Scale Test
Act Plan Study Do The Sequence for Improvement Make part of routine operations Spreading a change to other locations Test under a variety of conditions Implementing a change Testing a change Theory and Prediction Developing a change
Group Work • Working in pairs, devise a PDSA cycle to test an idea based upon a problem arising from a national audit. • Note – your driver diagram exercise will have developed some ideas for testing! • Allow 10 minutes for the exercise
Thank You Any Questions?