You Don’t Have to Write Like Hemingway: How to Communicate Your Quality Journey Denise Remus, PhD, RN Cynosure Health

What is Quality Writing?

ClearConciseCompellingConsistentCorrect Scott White, The Five C’s of Quality Writing: articles/the-five-cs-of-quality-writing html

4 What Does HRET and FHA HEN Expect? Completion of Progress Report - Tool to communicate plans, progress and results (short-term, long-term) of your quality improvement project to stakeholders Update monthly

5 Applying the Five C’s to Progress Reports Understandable Do not use jargon Be careful of abbreviations When read by someone who is not familiar with the project will they “get it”? Does your Aim Statement include What (metric), How Good (expected improvement) and By When? Clear

6 Applying the Five C’s to Progress Reports Be precise – do not overwrite Remove extra words, for example instances of “that” Full sentences are not needed Does your text fit within the space without reducing font size? Concise

7 Applying the Five C’s to Progress Reports Why is it important? Use motivating language Reflect a sense of urgency Consider your elevator speech Compelling

8 Applying the Five C’s to Progress Reports Tests of change Are you updating tests of change? If abandoning a test, is there a lesson learned? Linkage to next steps? Consistent

9 Applying the Five C’s to Progress Reports All content accurate and current Self-assessment score reflects current status Run charts Outcome metric Process metric Correct

10 A 6 th “C” for Progress Reports All information provided Date Hospital Name State Self-Assessment Score Team Member list Complete

Let’s Review... ClearConciseCompellingConsistentCorrectComplete

12 Where Can we Improve?

Self-Assessment Score Where are you? 1)Forming a Team to Planning 2)Activity with No or Little Changes 3)Modest Improvement to Improvement 4)Significant to Sustainable Improvement 5)Outstanding Sustainable Results Where are you? 1)Forming a Team to Planning 2)Activity with No or Little Changes 3)Modest Improvement to Improvement 4)Significant to Sustainable Improvement 5)Outstanding Sustainable Results

Tests of Change Test—Implement—Spread T = Test small scale, 1 patient, 1 nurse, etc. I = Implement only after successful testing under a variety of conditions S = Spread to other units once after successful implementation / sustained performance

Baseline Data

Measures Outcome Examples: – HAPU – SSI – READMISSION Want rates to go down! Process Examples: – Turn every 2 hours – Antibiotic timing – Teach back Want rates to go up!

Run Charts and Control Charts Tools to determine if improvement strategies have had the desired effect Intended to understand variation over time and whether controlled or special cause Consider: – How much data do you have? – Skill set and tools available to display data

18 Creating Charts – Line Graph If less than 10 data points, make a simple line graph Can use CDS – monthly data points Current capability is only print image but future updates will allow download of graph

19 Creating Charts – Run Charts If 10 to 12 data points, can convert to a run chart – Plot time along x-axis – Plot variable along y-axis (watch scale) – Label X and Y axes – Calculate & show median – Add other info; annotate changes

20 Annotated Run Charts Annotate test of change and other process changes that may effect data

21 Creating Charts – Control Charts > 12 data points (ideally 15 or more) More sensitive than run charts Adds control limits to determine if process is stable (common cause variation) or not stable (special cause variation)

22 Increasing Data Points If possible, collect additional data to increase the number of data points available to monitor the potential impact of change patients days weeks months

23 Progress Report Examples

Increase compliance with appropriate antibiotic timing and weight dosing administration of the appropriate antibiotic prior to surgery by10% by December 31, 2012 and 20% by December 31, Because surgical site infections are associated with significant patient morbidity and mortality this is an important project to monitor and improve. Surgical site infections are the 3 rd most reported health care associated infection. : Aim Statement Changes being Tested, Implemented or Spread Recommendations and Next Steps Lessons Learned Run Charts  Educate physicians to the appropriate antibiotic selection and weight dosing national guidelines.  Educate physicians and nurses on appropriate antibiotic selection, dosing, timing, and infusion duration to decrease incidence of surgical site infections. Even though we have a low SSI rate we know that we have improvement in this area due to chart abstraction and compliance rates with both dosing selection and timing Educate surgeons and anesthesiologists on the appropriate use of prophylactic antibiotic for surgical procedures based on national guidelines. Educate and involve all surgical nurses on the appropriate use of prophylactic antibiotic for surgical procedures based on national guidelines. Develop an audit tool that will identify non- compliance by selection, dosing, timing, infusion duration, and practitioner Display data to improve compliance, patient safety and quality of care. Project Title: Surgical Site Infections Project Champion: XXXXX Senior Leader Sponsor: XXXXX © 2012 Institute for Healthcare Improvement Team Members XXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXX Self Assessment Score (1-5) = _____ Date:

Aim: Provide reliable & safe perinatal care processes to effectively reduce elective deliveries prior to 39 weeks gestation to <3% by December Why is this project important?: Elective delivery prior to 39 weeks gestation, in the absence of a medical condition is frequently associated with higher level of nursery care for the newborn. Aim Statement Changes being Tested, Implemented or Spread Recommendations and Next Steps Lessons Learned Run Charts Implement medical reason for delivery < 39 weeks form that must be completed prior to scheduling an induction or cesarean section. (T) Gradual improvement over time but need for a hard stop policy to reach goal We will work with Executive Champion to obtain support for a hard stop policy Next Steps: Create hard stop policy for elective delivery <39 weeks Reducing Elective Delivery <39 Wks Gestation XXXXX and XXXXXX XXXXXX Hospital XX State © 2012 Institute for Healthcare Improvement Team Members Self Assessment Score (1-5) = _____ Date: June 12, 2012 XXXXX, Executive Champion XXXXX, Physician Champion XXXXX, Project Leader, Data XXXXX, Quality Leader XXXXX, Perinatal CNS XXXXX, L&D Manager XXXXX, L&D Director

26 Now is the Time to Share Your Story…

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