HEALTH CARE SYSTEMS Every system is perfectly designed to achieve exactly the results it gets

The Healthcare Process 133 People to take care of the patient The Patient

Avedis Donabedian (1919 – 2000) Outcome Process Structure

Introducing New Policy? Strategy A Strategy B Form the committee of experts Spend at least 6 months and many hours developing the perfect solution Educate all the staff over 2-3 days Implement house-wide tomorrow Look for it in 12 months! “Stack the deck” 1 doc, 1 nurse, 1patient, one PDSA Reassess and learn from initial test Repeat, progressively increasing confidence in solution then…. Test under varying conditions before…. Spread

The Centers for Medicare & Medicaid Services QI is a "set of related activities designed to achieve measurable improvement in processes and outcomes of care. Improvements are achieved through interventions that target health care providers, practitioners, plans, and/or beneficiaries."6,7 The Centers for Medicare & Medicaid Services Quality Improvement aims at “raising the bar” taking performance to a new improved level Patient Safety aims at raising existing standards of care improving safety and process that already exist The focus need be on both ends

How do we know change is an improvement? “You can’t fatten a cow by weighing it” - Palestinian Proverb Improvement is NOT just about measurement… …but you can’t improve something without measuring it!

The Improvement Skeleton Engaging Clinicians The Model for Improvement Data Collection and Analysis Understanding Variation Reliable Design