Improvement 101 Learning Series Module 1: Fundamentals for Change Your Host: Leanne Couves Improvement Advisor Hello and welcome to the BCPSQC webinar series on improvement topics.  Thanks for listening.  My name is Leanne Couves and I will be your host today.  I am a Faculty member for Quality Academy and work on a number of improvement projects in the healthcare system.   This series is specifically designed for patient partners and volunteers who work within BC’s healthcare system to help improve care.   Authentic engagement with patient partners is not something that happens by accident. It requires planning and well-intentioned, principled actions.  A necessary shift is taking place in our health care system – inviting patients into improvement work is not something that is nice to do or a privilege to patients, but rather something that needs to be done whenever decisions that impact patients are being made. Patient Partners are recognized as part of the care team and increasingly, an important part of our improvement teams.   We hope that these learning modules will provide a deeper understanding of some of the language, methods, processes, tools and techniques that healthcare teams are using to make system improvements. There are a total of 4 modules in the series.  Each module tackles a specific improvement topic.  The first five minutes of the recording will provide an overview of the topic.  For some, this content may be enough to get you started and answer your initial questions.   For those who want to go deeper, the next 15 minutes will provide more details, information and resources. 

This is Module 1: Fundamentals for Change and Improvement This is Module 1: Fundamentals for Change and Improvement. This module explores what quality improvement means and the role of systems, culture, complexity and people.

What the heck is QUALITY IMPROVEMENT? Have you ever been in a social gathering where a friend or colleague asks, “So, what DO you do exactly?” And when you say, “Oh, I volunteer on improving the healthcare system” or “I work in quality improvement” do you get blank stares or confused looks? And then it’s usually followed up by a “So, what the heck is quality improvement anyway?”

“Identifying and defining what matters” Quality Acceptability Appropriateness Accessibility Safety Effectiveness Equity Efficiency Let’s look at the two words separately. What about quality? What does quality mean, especially in a healthcare context? When people use the term “quality”, they may be talking about lots of different things. To help define what quality means for British Columbians, the BC Health Quality Matrix was created through the collaboration of the BC Health Quality Network to provide a common language, understanding and framework for identifying and defining what quality of care means and what matters to patients, their families and people who work in the system. The first five quality dimensions listed in the matrix – acceptable, appropriate, accessible, safe and effective – are focused on the patient/client experience. Equity and efficiency focus on the performance of the system in which healthcare services are delivered. Each of these terms have been defined for the BC healthcare system. “Identifying and defining what matters”

Quality Dimensions in BC Acceptability Appropriateness Accessibility Safety Effectiveness: care is known to achieve the intended outcome Equity Efficiency: optimal use of resources to yield maximum benefits For example, effective means that care is known to achieve the intended outcome. Efficiency means that there is an optimal use of resources to yield maximum benefits. You can learn more about the BC Health Quality Matrix by downloading it on the Council’s website in the knowledge centre. www.bcpsqc.ca/knowledge-centre/

“Process of making things better” Improvement Systematic, data-guided activities designed to bring about immediate improvement in a health care setting. “Process of making things better” (Lynn et al., 2007) Dr. Donald Berwick, a pediatrician and leader in healthcare improvement, once described improvement as “activities that help performance get better in a complex system”. There are various definitions, but there are common components of quality improvement. Improvement is systematic. It is not simply a reaction to problems or fixing things that wear out. It is a pro-active and continuous way of working, work where people take the initiative and make changes in a systematic way. It has been said that “All improvements require change, but not all changes result in improvement”. There is a relationship between change and improvement. Improvement emphasizes action. It is about trying new ways of doing things. We expect our changes will have a significant and long-lasting impact. Improvement is also guided by data. Just because we changed something, doesn’t mean it is better. We have to know it’s better. Measurement helps guide us in knowing the difference.

Understanding what we do and making things better on what matters most Quality Improvement Understanding what we do and making things better on what matters most So, essentially, quality improvement is about understanding what we do and making things better on what matters most.

Health care is a SYSTEM “Every system is perfectly designed to An interdependent group of items, people, or processes working together towards a common purpose. Parts of the system are aligned by this common purpose and processes within the system help to achieve this purpose. “Every system is perfectly designed to achieve the results it gets” Now we know how quality and improvement are defined. In the next couple of minutes, we will talk about systems, complexity, culture and people. I like to call this section, tongue in cheek of course, “why the heck does this quality improvement stuff take so long with so much effort”! Dr. Paul Batalden once said “Every system is perfectly designed to achieve the results it gets.” A system is defined as interdependent components that come together for a common purpose. In a system, everything affects everything else. A change in one area may result in improvement in some ways, but could also cause harm in other parts of the system. Their may be unintended consequences. Systems have time delays and we may not see the effects of our changes right away.

Health care is COMPLEX Adaptive / Resilient / Uncertain Complex adaptive systems are composed of many interdependent, heterogeneous parts that self-organize and co-evolve. Not only is healthcare a system, it is a complex and it is always evolving and self-organizing. n a complex adaptive systems, the relationships between people or parts can be unpredictable. The same action can yield different results, depending on a number of factors. Problems do not have clear solutions; solutions are context-specific and are not easily transferred from one place to another. What works today doesn’t work next week or next year. Often, the most effective solutions often come from people who are part of the process. Which brings me to culture and people.

CULTURE matters too! “The way we do things around here…” Shared beliefs, attitudes, values and norms of behaviour between colleagues in an organization Way of making sense of the organization Way things are understood, judged and valued Culture can be thought of as “The way we do things around here”. It’s about the beliefs we share, what we expect of each other and the way we typically behave. Think about an organization that is known for their culture – such as Apple or Disney or Southwest Airlines. The culture of an organization or a team is hard to describe in precise terms, but it is very powerful in determining what is considered acceptable or unacceptable. How many times have we suggested solutions, clearly practical and obviously beneficial, only to have them rejected outright? No matter how well thought-out a quality improvement initiative may be, failing to consider the culture in an organization can destroy the best laid plans.

Improvement TEAMS Include multiple perspectives Engage patients/residents/clients and families Secure a project sponsor One way to address complexity and culture is have multiple people and perspectives working towards improvement. Improvement project teams are built strategically and include people with different skill sets, knowledge areas, and perspectives. It is important to involve patients/clients/residents and their families, content experts, local leaders, and those whose work will be affected. A project sponsor has executive authority and supports the team. They can connect with other areas of the organization to provide resources and help overcome barriers.

In summary… Quality improvement is understanding what we do and making things better in what matters most There are some fundamental principles to guide improvement Quality in health care is multi-dimensional Understanding culture and complexity is key Assembling a good team promotes success and sustainability In summary, All improvement work has some core principles, regardless of the specific methods used. There are multiple dimensions of quality in health care and efforts for improvement in the system may address some or several at once. Attending to culture and complexity can help promote success in efforts to achieve results. Being purposeful as you assemble your team can help your project to be more successful in achieving its aim and having a lasting effect.

Thank you! PatientVoicesBC.ca @PatientVoicesBC Thank you for listening to the first 5 minutes of Module 1. It hopefully provided “just enough” information to answer your initial questions about some fundamentals for change and improvement . You are welcome to stop the recording now and enjoy the rest of your day. However, if you want to dig deeper, I welcome you to continue with the recording and learn more about fundamentals for improvement.