“Mind the Gap” The Journey

Slides:

Advertisements

Similar presentations

P D S A REVIEW ACT PLAN STUDY DO Plan Continuous Improvement

Advertisements

SEM Operations PE - Utilize project-management skills to improve workflow and minimize costs PI – Develop project plan.

Measurement for Improvement. Why we look at data graphed over time Change Made Change to process made in June.

Problem 16-12, Page 529 In testing the cutoff of accounts payable at the balance sheet date, explain why it is important that the auditors coordinate their.

Learning Objectives LO5 Document an accounting system to identify key controls and weaknesses in order to assess control risk. LO6 Write key control tests.

Developing Learning Cycles. Insights from Science of Improvement Understand interdependencies in the components of the system where the changes are being.

Baseline Assessments Hospital: Pressure ulcer Incidence 8-13% Pilot Ward (Anglesey): Baseline incidence rate - 4.5% Nutritional assessment - 50% Pressure.

Swami NatarajanJune 17, 2015 RIT Software Engineering Reliability Engineering.

Simple brief By: Ayat Farhat

Is your organisational quality system supporting you to meet the new accreditation requirements? Dr Cathy Balding

Enhanced Patient-Safety Intervention To Optimize Medication Education (EPITOME) Carl Sirio, MD Professor Critical Care Medicine, Medicine and Pharmacy.

QA Best Practices Tool Kit Task Force The Back Story QA Summit The Healthcare Documentation Quality Assessment and Management Best Practices Tool Kit.

The pitfalls of pragmatic research: Pharm-assist: Using PDAs to assist in Pharmacy decisions Pip Divall Clinical Librarian University Hospitals of Leicester.

How to create a Scientific poster for the Group 4 presentation.

Program Implementation MM.DD.YY. To comply with the OHSA and regulations To demonstrate management's commitment to health and safety To show employees.

Improvement Tools Part 2 Flowchart A picture of the separate steps of a process in sequential order. Click here.

SEM Operations PE - Utilize project-management skills to improve workflow and minimize costs PI – Develop project plan.

Using Bayesian Nets to Predict Software Defects in Arbitrary Software Lifecycles Martin Neil Agena Ltd London, UK Web:

Traditional Economic Model of Quality of Conformance

Courtesy Reminders: During the webinar, you may select *7 on your phone to speak, and use *6 to mute. Please refrain from placing the phone on HOLD during.

The Implementation of Medication Reconciliation in PAC Enhancing Patient Safety The Implementation of Medication Reconciliation in PAC Enhancing Patient.

Switching to Celsius Kimberly Montague RN, MSN Fishbone Diagram: Process Maps and Flowcharts: Global Aim: The global aim of this project is to improve.

Courtesy Reminders: During the webinar, you may select *7 on your phone to speak, and use *6 to mute. Please refrain from placing the phone on HOLD during.

Department of Defense Voluntary Protection Programs Center of Excellence Development, Validation, Implementation and Enhancement for a Voluntary Protection.

At a Glance: Omitted Doses 1. Before signing the drug chart, ask… Why is the patient unable to take the dose? Is this medicine a time critical medicine?

Context and Problem Effects of Changes Strategy for Change Aim: To reduce the length of handover by standardising the quality of information transmitted.

Southern Health Productive Mental Health Ward Adult Mental Health Inpatient Services.

Analyze Wrap Up and Action Items

Fall Improvement Team, Veterans Health Unit

Remove this white box to use the template

Best Practices for Workflow, Dialogs and Business Process Flows

Names of Project Lead and Audit Team

Six-Sigma : DMAIC Cycle & Application

Risk Assessment Meeting

Chapter 7 Process Control.

Total quality management

Outcomes from the Secondary Care COPD Audit 2014

Medication Reconciliation ROP Compliance

Unemployment Insurance Optimizing Staff

Welcome Using SBAR in handovers Main title slide page

Implementing the NHS KSF Action Planning and Surgery Session

Remove this white box to use the template

10 Quality Control.

Remove this white box to use the template

Symptom Management: Terminal Agitation L21

Remove this white box to use the template

Remove this white box to use the template

Rest of Project Management

Unit 4 Project Design, implementation and evaluation

Engagement Follow-up Resources

Engaging with leaders Thursday 8th March 2011 Tim Heywood

DMAIC Roadmap DMAIC methodology is central to Six Sigma process improvement projects. Each phase provides a problem solving process where-by specific tools.

The present Whether you are using paper and pen to currently gather and store information either clinical or administrative the transition into an Electronic.

Engagement Follow-up Resources

Data Collection Training, Part I Outcome Data

Surrey Medical Centre PHO and Facilitator: Procare Waiana Collier

Learning To Make a Difference

Lecturette 2: Continuous Improvement Continuous Improvement

Chapter 10 Quality Improvement.

Trading Live Online Annual Mastery Program Probabilities and Trade Execution High probability of pot knocked over.

Process Improvement Overview

The CUSS Communication Tool

Project Management Office Tool

4 Steps to Safety Violence Reduction Programme. Implementation

EGR 2131 Unit 12 Synchronous Sequential Circuits

Welcome Main title slide page

QI Problem Primary Care Quality Committee Annual Report, Fill in Health Center, SFDPH, Date.

SEM Operations PE - Utilize project-management skills to improve workflow and minimize costs PI – Develop project plan.

Your QI Headline (120 pt min.)

Title of NHSmail for Care TIPS REGARDING FORMATTING

Presentation transcript:

“Mind the Gap” The Journey 24/11/2016

Theory of Improvement PDSA cycles. (we all do…) Clear objectives. Test of change. Continuous audits and data gathering.

Reasons to Test Changes To decide which of several proposed changes will lead to the desired improvement and whether they will work in the environment of interest. To evaluate how much improvement can be expected from the change. To decide which combinations of changes will have the desired effects on the important measures of quality. - To minimize resistance upon implementation.

Run Charts Complex statistical tools Study time to understand statistical analysis Help you test the changes made Help to quantify improvement / worsening Easy to understand graphics Sigma limits (Random & Non-random) To improve a process we must reduce variation

Highlight previous data to keep track of progress Safety cross help to visualize performance at a glance Account time of administration missed Highlight previous data to keep track of progress

People dependent process!! NR Occurrences NR Occurrences Trans. resp Mind the gap & safety cross Segregated data (21.5) Name and shame Handover checks(3.8%) Back to old shifts (4.15%) Transfer of responsibility Handover checks Staff meeting (12.97%) New poster (10.5%) Transfer of responsibility Reduced Variation OP!! Safety cross stopped! (19.44%) Safety cross back (5.16%) Error reporting (14.3%) Name and shame stopped! People dependent process!!

Implementation Advice Nursing team must take lead and accountability. Pharmacy in supporting role (data analysis) It is a cultural change so will take time Little changes may go a long way… Use small but significant sample to start with The more data the better!! (3+ years of weekly audits) Praise / challenge appropriately Avoid spreading too early!

Results so Far… Reduction of blank boxes 40% (80% AIB) Time consuming but can be rewarding (sometimes!!!) Scared of my green pen and pink highlighter  Currently transferred to nursing team (still counting though)