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Quality Improvement Series Session 4- shaping the AIM Windy Stevenson lammersw@ohsu.edu PowerPoint Presentation
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Quality Improvement Series Session 4- shaping the AIM Windy Stevenson lammersw@ohsu.edu. Today’s Agenda. Where are we, and how did we get here? What are the pros and cons of our project? Where do we want to be, and what does that mean? . Take Home Points (review).

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Quality Improvement Series

Session 4- shaping the AIM

Windy Stevenson

lammersw@ohsu.edu

today s agenda
Today’s Agenda
  • Where are we, and how did we get here?
  • What are the pros and cons of our project?
  • Where do we want to be, and what does that mean?
take home points review
Take Home Points (review)
  • Real (sustainable) change comes from changing systems, not changing within systems
      • education alone doesn’t work
      • don’t push the current system to work harder
  • It’s your job to spot the system that isn’t working
  • Be specific about what you want to accomplish, and why; be intentional
  • Focus on patients
  • Start before you think you are ready; don’t get paralyzed
  • Don’t be the donkey
problem statement
Problem statement

The DCH ambulatory clinic problem lists are incomplete and inaccurate

Advantages

  • WE picked it, and therefore it has meaning to us
  • We know there is plenty of opportunity for improvement
  • Capacity to improve both patient safety and provider satisfaction
  • Important to OHSU
systems
Systems…

A system is a set of interdependent parts

sharing a common purpose.

  • The parts
  • The interaction of the parts
  • The people
  • Every system is perfectly designed to achieve
  • the results it achieves.
the problem list system
The Problem List “System”
  • What results is our current system designed to produce?
  • WHY?

What is the definition of CHAOS?

challenges ie barriers
Challenges (ie barriers)
  • Time
  • Culture
    • Ownership
  • Definition of accuracy
  • Lack of natural error identification
  • Lack of natural rewards
  • Need for manual audits
where do you start
Where do you start?

Problem statement: The DCH ambulatory clinic problem lists are incomplete and inaccurate.

BUT WHAT DOES THAT MEAN???

well child care
Well child care
  • 2yo WCC
  • No documented medical or surgical conditions
well child care complex kid
Well child care- complex kid
  • 4 mo WCC- former premie
acute care visit healthy kid
Acute care visit- healthy kid
  • 5yo in clinic for cough
  • No medical or surgical conditions
  • Has had 3 acute visits and one ED visit but no WCC with us
acute care visit complex kid
Acute care visit- complex kid
  • 3yo with complex hx in clinic for “dropped something on foot”
what about if they don t show
What about if they DON’T show?
  • 5 yo with asthma; no show for scheduled clinic appt
start somewhere
Start SOMEWHERE!
  • Institutional or leadership priorities
    • Clinical
    • Fiscal
  • Safety risk
  • Most annoying (therefore most motivation to fix?)
  • Most easily solved
  • Most easily measured
  • Most meaningful to customers
how do you create a smart aim
How do you create a SMART aim?
  • Specificwe are intentional and focused
  • Measurablewe can prove we’ve had an impact
  • Actionablethere are no known insurmountable barriers
  • Realisticit’s within our scope
  • Timelywe’ll do it within a time frame
where to go from here
Where to go from here
  • What do we want to do first?
    • Success begets success
  • What can we ACTUALLY accomplish?
    • What patient population(s) or problem type(s)?
    • To impact what time point (before the visit?)
  • What is our AIM?