Quality Improvement Introduction to Reliability This material (Comp12_Unit3) was developed by Johns Hopkins University, funded by the Department of Health.

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Quality Improvement Introduction to Reliability This material (Comp12_Unit3) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

Introduction to Reliability Learning Objectives Discuss the basic concepts of reliability. Understand what makes organizations highly reliable. 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability

What Is Reliability? “The extent to which an experiment, test, or measuring procedure yields the same results on repeated trials” (Webster’s Dictionary) “Reliability principles, used to design systems that compensate for the limits of human ability, can improve safety and the rate at which a system consistently produces desired outcomes.” (Nolan, T., Resar, R., Haraden, C., Griffin, F.A.) 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability

Which Clinic Would You Prefer? 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability

How Do We Measure Reliability? Reliability = # of actions that achieve the intended result ÷ Total # of actions taken Reliability is expressed as an order of magnitude. –Unstable process More than 1-2 defects per 10 attempts – defects per 10 attempts – defects per 100 attempts 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability – defects per 1000 – defects per 10,000 – defects per 100,000 – defects per 1,000,000 –And so on…

Examples of Reliability in Health Care 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability

Strategies to Improve Reliability 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability

Example: Improvement of Diabetes Care Guideline recommendation: >3 Hemoglobin A1c every 2 years You are tasked with improving the rate patients being tested appropriately Since you are in the HIT department, you will use HIT tools to improve the reliability of the process 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability

Prevention of Failure Strategies Using intent and standardization Segmentation Tools Basic standardization Best practice guidelines, tools, techniques Memory aids, such as checklists Feedback mechanisms regarding compliance with standards Awareness campaigns 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability

Identification and Mitigation Strategies Human factor changes Redundancy Independent double checks Tools Reduce fatigue and distraction Schedule key tasks Take advantage of habits and patterns Decision aids & reminders built into the system Differentiation Constraints Affordances 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability

Redesign for Success Understand where the failure is occurring Determine the remedy –Failure modes What could go wrong? –Failure causes Why would the failure happen? –Failure effects What would be the consequences of each failure? 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability

Bundles A "bundle" is a group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually. Providing each element of care within a bundle leads to more reliable care for patients. 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability

Example: Improvement of Diabetes Care What would you include in a diabetic bundle? The example of a good diabetic bundle is that used to enhance reliability at CareSouth Carolina It includes: BMI, education, 2 HgbA1c tests, LDL test, use of statin 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability

Introduction to Reliability Summary Designing a reliable system is a stepwise process that requires the incorporation of prevention of failure, identification and mitigation of failure and system redesign from failure Different processes require different levels of reliability 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability

Introduction to Reliability References References Elgert, S. Reliability Science: Reducing the Error Rate in Your Practice. These seven principles can help ensure that your patients receive the right care at the right time every time. Fam Pract Manag Oct;12(9): Nolan, T., Resar, R., Haraden, C., Griffin, F.A. Improving the Reliability of Health Care. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; Available from: Merriam-Webster’s Dictionary. Available from: Reliability: Sepsis Management Bundle. Available from: When Good Enough Isn’t … Good Enough: The Case for Reliability. Institute for Healhcare Improvement. Available from: TheCaseforReliability.htm TheCaseforReliability.htm Charts, Tables, Figures 3_1 Which Clinic Would You Prefer? Courtesy Dr. Anna Maria Izquierdo-Porrera 3_2 Examples of Reliability in Health Care. Courtesy Dr. Anna Maria Izquierdo-Porrera Images Slide 7: Strategies to Improve Reliability. Adapted from Olan, T., Resar, R., Haraden, C., Griffin, F.A. Improving the Reliability of Health Care. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; Available from: 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to Reliability