CA to QI: Advanced skills session Nancy Dixon, Director of Strategic Services Healthcare Quality Quest (HQQ)

Copyright © Healthcare Quality Quest, 2014 ClinicalAudit to QualityImprovement — Advanced skills

How can benchmarking, statistical process control tools and demand-capacity analysis support clinical audit What’s involved in benchmarking What’s involved in SPC What’s involved in demand-capacity analysis The way forward

How can benchmarking, statistical process control tools and demand-capacity analysis support clinical audit What’s involved in benchmarking What’s involved in SPC What’s involved in demand-capacity analysis The way forward

Quality improvement tools — How can they support clinical audit? What is the nature of the cause of the variation in practice? Do clinical audit findings ever question — Do we have the resources needed to meet the quality expectations measured by the clinical audit? How do other NHS Trusts have so much better results on a national clinical audit?

How can benchmarking, statistical process control tools and demand-capacity analysis support clinical audit What’s involved in benchmarking What’s involved in SPC What’s involved in demand-capacity analysis The way forward

Benchmarking is the process of measuring and improving products, services and practices in comparison to the toughest competitors or those organizations that are recognized as industry leaders

Benchmarking is about searching for ‘best-in-class’, finding out how they achieve best performance and learning from the processes that produce best performance

Establish improvement objectives based on an informed view of what others do and achieve Benefits of benchmarking Learn about best practices in the field Challenge thinking about what can be achieved Learn about options for improvement

Provide a basis for decision-making on changes in practice Achieve performance that is comparable or superior to others Apply valid measures of quality Provide an evidence-based approach to test performance

Benchmarking Benchmarks Process of measuring and learning Comparative data or targets = =

Define what is to be benchmarking and the objective of benchmarking Identify the best performers Identify your organization’s performance on what is being benchmarked How to do benchmarking — properly Identify the performance of the best organization Find the ‘gaps’ in care

Learn the process of the best organization in relation to the gaps Learn your organization’s process in relation to the gaps Identify where changes can be made in your organization’s processes to be closer to the process of the best organization — and implement changes Measure the impact of the change Work collaboratively with your benchmarking ‘partner’

How could you use benchmarking with national clinical audits? Can you identify best performance from the report? Can you find the best performers? For a national clinical audit — Can you identify gaps between best and your organization’s performance? Can you arrange to learn from the best?

How can benchmarking, statistical process control tools and demand-capacity analysis support clinical audit What’s involved in benchmarking What’s involved in SPC What’s involved in demand-capacity analysis The way forward

The team has to guess at the nature of any variation Single-value statistics — such as a percentage — can hide variation The team has a method for identifying the nature of the variation SPC tools — run charts and control charts — can highlight variation

Statistical process control is a way of thinking about work processes and tools — run charts and control charts — to analyse variation in work processes

Types of variation Common cause Special cause

Common cause variation is variation in a process that – results from the way a process is usually carried out is random – no one cause

A process with common cause variation — Is stable statistically Has a known capability — you know how or how well the process works Is predictable — you can tell how the process will work in the future Is in statistical control

Special cause variation is variation in a process that – results from factors that are not the way a process is usually carried out has a special cause

A process with special cause variation — Is not stable statistically Does not have a known capability Is not in statistical control Is not predictable

A run chart is a display of data points in chronological order of the events represented by the data, that is, the data points are plotted in the order in which they occurred, for the purposes of finding the amount and type of variation

Apply rules to your run chart A rule appearsspecial cause A rule doesn’t appearcommon cause = =

Rule 1 — Shift n = Measure Median  Observations over time Measure Median = 4                                                  

Rule 2 — Trend Median = 10n = Measure Median                           Measure Observations over time

Rule 3 — Repeating pattern

How to anticipate the type of action needed Type of action Common cause Fix the process Special cause Find and fix the special cause

How could you use run charts for clinical audits? Can you identify consecutive case performance? Can you plot a run chart? For a clinical audit — Can you plan the right type of action? Can you apply the rules?

How can benchmarking, statistical process control tools and demand-capacity analysis support clinical audit What’s involved in benchmarking What’s involved in SPC What’s involved in demand-capacity analysis The way forward

A team may need to know — How much service does the current process actually deliver? How much service could the current process deliver? How much resource does this current process take? How does the current amount of service compare with the amount of service needed? What can be done to meet demand?

Demand-capacity analysis is a process to determine the demand for and the capacity of a process or service in order to make decisions on actions needed to balance demand and capacity

Demand (workload to be met) Capacity (potential workload that can be met) Activity (actual workload met)

Demand is the amount of service required — the workload to be met expressed as: Count of people or things or Amount of time needed to meet the demand, that is, provide amount of service required Demand may fluctuate — but if a process is capable of meeting demand, a smooth demand results in a smooth process flow

Capacity is the amount of service that could be delivered by a current process and available resources — the potential workload that could be met expressed as: Count of people or things or Amount of time the service is able to provide Capacity varies according to the resources available and how well a process works

Activity is the amount of service actually delivered — the actual throughput or workload met by a current process and available resources expressed as: Count of people or things or Amount of time the service was provided Activity varies by needs, number and experience of staff, functioning of needed resources and the efficiency of processes

Queue is the number of people or things that are waiting for a service to begin Queues form when a process is operating close to or at capacity or when there is a high degree of variation in demand

When to use demand–capacity analysis — to improve Continuous process flow — avoiding stopping Cycle time of a process — how long the process takes from beginning to end Access to a service including waiting timesEnsuring that resources are provided at the right time in the right amount and in the most efficient way

Demand–capacity analysis relies on — Non-value-added steps Process analysis Bottlenecks Run charts Statistical process control Control charts

How could you use demand-capacity analysis for clinical audits? Can you identify demand, capacity and activity? Can you identify shortcomings in demand, capacity and activity? For a clinical audit — Can you plan the right type of action?

How can benchmarking, statistical process control tools and demand-capacity analysis support clinical audit What’s involved in benchmarking What’s involved in SPC What’s involved in demand-capacity analysis The way forward

Benchmarking Statistical process control charts Demand-capacity analysis What are opportunities for using the quality improvement tools in clinical audit — What are the barriers?

Copyright © Healthcare Quality Quest, 2014 ClinicalAudit to QualityImprovement — Advanced skills