Quality Improvement Tools to support Your Improvement Work

CHECK POINTS IN DEVELOPING AN AIM STATEMENT AIM Content Explicit over arching description Specific actions or focus Goals AIM Characteristics Measurable (How good?) Time specific (By when?) Define participants and customers

The Primary Drivers of Improvement Will Ideas Execution Having the Will (desire) to change the current state to one that is better Developing Ideas that will contribute to making processes and outcome better Having the capacity to apply CQI theories, tools and techniques that enable the Execution of the ideas QI

Driver Diagrams, a useful tool to help us understand the system and the messiness of life. Driver Diagrams

PURPOSE OF DRIVER DIAGRAMS Helps you to set priorities Identifying the drivers that will have the biggest impact Help organize your theories about what it takes to achieve improvement Leads you to the third question in the model for improvement – What changes can you make that will result in improvement? Helps you then understand your current level of performance on these drivers Essentially is a set of concepts – to make these concepts operational you will need to identify measures

PRIMARY DRIVERS Ideally should be straight forward statements, not desired end states or wishes These are the things that need to be done or put in place to achieve the outcome

SECONDARY DRIVERS Processes, cultural norms or structures that lead to improvement Supported by evidence Differ in relative impact on outcome Should be necessary and sufficient to achieve goal – or why bother?

Inventory national programmes and measurements Meet with programme leader to understand programme intent, audience, history Harmonize our metrics Improve Safety and reliability of Hospital Healthcare Services in Scotland Scottish Government Sets Patient Safety as Strategic Priority Boards Accept Safety as Key Strategic Priority for Effective Governance Robust, evidence based proven clinical changes IHI/QIS Team Expert at Content, Coaching and Programme Management Align SPSP with national improvement programmes and measures Primary Drivers Demonstrable results to community Clear, shared measurement set Visible on all senior leader agenda PSA represents & demonstrates cohesive, united programme National Policy alignment Secondary Drivers Ownership of agreed upon set of outcomes Review of outcomes at each meeting Quality and safety comprises 25% of agenda Recovery plans for unmet outcomes Infrastructure supports improvement and measurement Involve patients in safety Scottish Patient Safety Programme Driver Diagram International and national expert clinical faculty Faculty expert at improvement methods and coaching Programme design and structureand leadership Acceptance of pragmatic science Royal College and professional bodies supports PSA Programme

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 Source: Richard Scoville, Ph.D.

Aim: Outcome Measures: Primary Drivers Secondary Drivers

What is it? Force Field Analysis is a QI tool designed to identify driving (positive) and restraining (negative) forces that support or work against the solution of an issue or problem. When the driving and restraining forces are identified, steps can be taken to reinforce the driving forces and reduce the restraining forces What does the Force Field do? Allows comparisons of the “positives” and “negatives” of a situation Enables easy comparisons Forces people to think together about all the aspects of making the desired change a permanent one Encourages people to agree about the relative priority of factors on each side of an issue Supports the honest and open reflection on the underlying root causes of a problem and ways to break down barriers OVERCOMING BARRIERS - FORCE FIELD ANALYSIS

1.Draw a letter “T” on a flipchart page 2.Write the name of the issue or project across the top of the page 3.Label the left column “Driving Forces” and the right column the “Restraining Forces” 4.Use brainstorming or nominal group technique (NGT) to generate the list of forces or factors that are driving the issue or project and those that are restraining or the holding things back 5.Eliminate duplicate ideas and clarify any ideas that are vague or not specific 6.If the team feels the need, they can use rank ordering to set priorities for the driving and restraining forces 7.Generate a list of ideas about actions that can be taken to reduce the restraining forces HOW DO I SET UP A FORCE FIELD ANALYSIS?

FORCE FIELD ANALYSIS WORKSHEET ISSUE OR PROJECT: ______________________________________ Driving Forces (+)Restraining Forces (-) Actions to reduce the Restraining Forces:

14 AIM (Why are you measuring?) Concept Measure Operational Definitions Data Collection Plan Data Collection Analysis ACTION The Quality Measurement Journey Source: Lloyd, R. Quality Health Care. Jones and Bartlett Publishers, Inc., 2004:

The Improvement Guide, API, A MODEL FOR LEARNING AND CHANGE When you combine the 3 questions with the… … the Model for Improvement. PDSA cycle, you get…

Outcome Measures: Voice of the customer or patient. How is the system performing? What is the result? Process Measures: Voice of the workings of the system. Are the parts/steps in the system performing as planned? Balancing Measures: Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures (e.g. unanticipated consequences, other factors influencing outcome)? THREE TYPES OF MEASURES

MEASUREMENT FOR IMPROVEMENT Current State Measurement of Improvement Future State

ANALYSING THE PROCESS MAP How many steps in your process? Where is the waste? How many duplications? How many hand-offs? What is the approximate time of or between each step? Where are possible delays? Where are major bottlenecks? How many steps do not add value for staff and customers? Where are the problems for staff what causes the frustration?

GUIDANCE ON DATA COLLECTION FOR IMPROVEMENT A few key measures that clarify the aim of the improvement effort and make it tangible should be regularly reported throughout the life of the project (daily, weekly, or monthly, depending on the length of time for the project) Be careful about over-doing process measures, A balance of outcome, process and balancing measures is important Plot data visually on the key measures over time Make use of existing databases and data already collected for developing measures Annotate your charts – tell the story Whenever feasible, integrate data collection for measurement into daily work routine (Associates in Process Improvement and Corporate Transformation Concepts, 2008)

Improvement Idea / PDSA / Action Person Responsible Target Date Process mapping template