Plan-Do-Study-Act Cycle and QI Tool Refresher March 27, 2014

WELCOME BACK!

Today’s Agenda PDSA Refresher Quality Improvement Application Quality Improvement Fundamentals Plan-Do-Study-Act Cycle Quality Improvement Application Wrap-up – Questions and Training Post-assessment

QI Fundamentals Definition Quality Assurance vs. Quality Improvement Benefits Four Basic Principles 3 Key Questions

QI in Our Terms “QI is the use of a deliberate and defined improvement process, such as Plan-Do-Study-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.” Bialek, R., Beitsch, L. M., Cofsky, A., Corso, L., Moran, J., Riley, W., & Russo, P. (2009). Proceedings from Accreditation Coalition Workgroup: Quality Improvement in Public Health.

QA and QI are Not the Same Quality Assurance Quality Improvement Guarantees quality Raises quality Relies on inspection Emphasizes prevention Uses a reactive approach Uses a proactive approach Looks at compliance with standards Improves the processes to meet standards Requires a specific fix Requires continuous efforts Relies on individuals Relies on teamwork Examines criteria or requirements Examines processes or outcomes Asks, “Do we provide good services?” Asks, “How can we provide better services?”

QI Can… Reduce cost and redundancy Eliminate waste Streamline processes Enhance ability to meet service demand Increase customer satisfaction Improve outcomes!

QI - Four Basic Principles Develop a strong customer (client) focus Continually improve all processes Involve employees Mobilize both data and team knowledge to improve decision-making

QI – Three Key Questions What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement?

Where do we begin? The Plan-Do-Study-Act (PDSA) Cycle PDSA (also known as Plan-Do-Check-Act (PDCA), was made popular by Dr. W. Edwards Deming Is widely used by quality professionals, process improvement engineers, & health care professionals Science based, data driven, iterative process improvement methodology Turns ideas into action and connects that action to learning

PDSA – An Overview Four Stages Nine Steps Repeatable Steps Can be used by one person, a team, or an agency Used to improve existing processes

Step 1 Step 2 Step 3 Step 4 Step 5 Stage One - PLAN Getting Started Assemble the Team Step 2 Examine the Current Approach Step 3 Identify Potential Solutions Step 4 Develop an Improvement Theory Step 5

Stage Two - DO Test the Theory Step 6

Stage Three - STUDY Study the Results Step 7

Step 8 Step 9 Stage Four - ACT Standardize the Improvement or Develop a New Theory Step 8 Establish Future Plans Step 9

QI Toolbox for the PLAN Stage Team Charter - A Tool to Keep You Organized Aim Statement - A Tool to Define the Goal Process Mapping - A Tool to Examine Current Process Flow Fishbone Diagram - A Tool for Identifying Root Causes Affinity Diagram - A Tool to Identify Potential Solutions

A Tool to Keep you Organized: Team Charter

QI Team Charter What is it? One to two page document that describes the team’s purpose and targeted improvement. Serves as your team’s roadmap Helps reduce the “now what?” feeling Helps the team come to agreement regarding: Communication Accountability Delivery of products Evolves over the course of the project

What to Include: Team sponsor Team members and roles Problem, issue, or opportunity statement Description of the process improvement Aim statement Customers and their needs Timeline for completing each stage of the PDSA cycle Timeline and frequency of team meetings Internal and external stakeholders Improvement theories (If…Then)

A Tool to Define the Goal: Aim Statement A concise, specific, written statement that defines precisely what the team hopes to accomplish with its QI efforts. Remember the three fundamental questions when writing your aim: What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement?

Aim Statements Include a numerical measure for the target Are time specific and measurable Define the specific population that will be affected

A Tool to Examine Process Flow: Process Mapping Analyze and improve processes Identify areas of complexity and re-work Generate ideas for improvement Illustrate process improvements

Preparing to Process Map 1. Assemble your QI team 2. Determine which process needs to be documented 3. Agree on where the process begins and ends 4. Agree on the level of detail that will be displayed 5. Create a list of the steps taken in the current process 6. Construct your process map by ordering the steps 7. Identify additional staff to review or provide input on your process map

Symbols used to Process Map Start & End: An oval is used to show the materials, information or action (inputs) to start the process or to show the results at the end (output) of the process. Activity: A box or rectangle is used to show a task or activity performed in the process. Although multiple arrows may come into each box, usually only one arrow leaves each box. Decision: A diamond shows those points in the process where a yes/no question is being asked or a decision is required. Flow: An arrow shows the direction or flow of a process.

A Few Hints and Tips Map the current process! It’s okay if team members have different ideas about how the process works. Keep steps simple; begin each step with an action verb. Process mapping is dynamic! Post-it notes, dry-erase markers, & pencils are your friend!

A Tool for Root Cause Analysis: Fishbone Diagrams

Fishbone Diagrams - Purpose To identify and examine underlying or root causes of a problem To identify a target for your improvement that is likely to lead to change To explore possible causes of a problem

Fishbone Diagrams: Construction Step 1 Write the Problem/Effect in a box on the far right side of your paper, dry erase board, etc. Step 2 Draw an arrow (backbone) leading to that box Step 3 Draw smaller arrows (bones) leading to the backbone, and label these arrows with your major causes Step 4 For each cause, brainstorm minor causes related to each major cause and note them on the diagram by placing lines on each of the major bones.

A Tool to Identify Potential Solutions: Affinity Diagrams Group 1 Group 2 Group 3 Group 4 Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea Idea

Affinity Diagram: Purpose Creatively generate a large number of ideas and organize them into natural groupings among them to understand possible solutions to a problem.

Affinity Diagrams: When to Use To generate consensus When you need your team to think creatively To breakdown communication barriers To allow breakthroughs to emerge naturally To overcome “team paralysis”

Affinity Diagrams: Step by Step Phrase the issue under discussion as a full sentence Step 2 Brainstorm at least 20 ideas or issues A “typical” Affinity has 40-60 items, but 100 or more are not unusual Step 3 Simultaneously and quickly sort ideas into 5 to 10 related groupings Step 4 For each grouping, create summary or header cards using consensus Strive to capture the essence of all the ideas in each grouping

Questions?

Break

PDSA Application

Lunch

PDSA Application, con’t

Next Steps

Questions?

Evaluation and Adjourn Thank you!