1 Quality Improvement Series Session 11 Own it! Windy Stevenson Cindy Ferrell

2 Today’s Agenda

3 YOU are relative experts.  Quality Improvement is not magic…  It is equal parts skill, timing, luck, and willingness to be deep in the weeds

4 Just to remind you what you know  What factors will you consider when you select a QI project? Erin’s dog Pablo

5 Project Selection  Do we have a problem? What is our problem?  Will fixing our problem improve quality? –IOM Dimensions- Safety, Timeliness, Equity, Efficiency, Effectiveness, Patient Centeredness  Is the outcome important? Why do we care? Why? Why? –To providers –To patients or families  Are we likely to be able to overcome foreseeable barriers?

6 Project Selection, Continued  Is the project meant to improve an actual, observable process? –Is the process relatively stable (not already undergoing other major revision)? –Is it measureable? Numerator AND denominator?  Is it within our scope to make this change?  Is this reasonable? Is it focused enough to make success likely in our timeframe?  Does the cost of effort seem to be in good balance with likelihood of returns?  Are people already passionate or curious?

7 The things you already know…  Once you pick a project, what model can you use as a guide?

8 The things you already know…  What is important about your AIM (purpose statement)?

9 Is your Aim Statement SMART?  Specific You are focused and intentional, NARROW.  Measurable You can prove you’ve had an impact  Actionable There are no known insurmountable barriers  Realistic It’s within your scope  Timely You’ll do it within a set time frame

10 The things you already know…  What do you know about measurement in Quality Improvement?

11 Measurement  POWER has a different meaning here. Measure just enough to understand and take the next step  Denominators matter, and are harder to capture  Maximize your system, but don’t underestimate the power of paper and pencil

12 The things you already know…  What’s a PDSA cycle?

13 PDSA  Plan, Do, Study, Act (over and over and over)  Fail.  What can you do next Tuesday?

14 The things you already know  What do you understand about the concept of SYSTEMS?  How about Culture?

15 Changing behavior By changing motivationBy making the right thing the easy thing Culture change Convince every provider that this is important so that he/she REMEMBERS to change behavior Systems change leading to eventual culture change Reconfigure the system so it doesn’t matter in the beginning if it is important to providers This works in a system with immediate feedback (treats or shock collar) This works when there is no natural consequence (fence) Let’s say your dog keeps running into the street

16 How do we create sustainable change?  Make the right thing the easy thing  Education is often necessary, but rarely sufficient  Engage leadership  Plan for ongoing measurement  Use rewards with caution  Maintenance is as importance as launch

17 Quality Improvement makes the right thing for the patient easy and cost effective. It makes your job easier!

18 One big PDSA that started last summer  ACGME requires that “residents participate in a quality improvement project”  We hypothesize that residents are crucial to the design and implementation of QI projects (we were right, of course)  Cindy identifies that individual projects are not sustainable  Model evolves to engage entire program in one longitudinal effort, providing noon time sessions to learn QI basics and move forward a project simultaneously

19 Next Steps 1.We envision continuing the obesity problem list project until it has run its course 2.At that point we will either move deeper into this project, or select a new project 3.In the meantime, please help us get better