How to Design a Quality Improvement Project Kendiss Olafson MD FRCPC MPH Assistant Professor Section of Critical Care University of Manitoba

What is Quality Improvement? Quality improvement is a formal approach to the analysis of performance and systematic approach to improving it.

Institute of Medicine To Err is Human (1999) Brought issue of patient safety and medical errors to for front 2% of all deaths are due to preventable medical errors Crossing the Quality Chasm (2001) Urgently calls for changes to health care processes to improve quality of care Sets up framework for healthcare quality improvement Brings importance of patient and family centered healthcare to frontline

Quality Improvement versus Research Traditional Research Quality Improvement Goal is to attain new generalizable knowledge Trial new methods Data for publishing Goal to improve care Based in established knowledge and applying this to local site Data internal use (usually but not always)

How to Design a Quality Improvement Project Identify Gap in Care

Quality of Care Indicators (STEEPS) SAFE Hospital Acquired Infections (VAP, C. Dificle, CLI, Post-op Infection) Medication Errors TIMELY Waiting times (See specialist, start chemo) EFFECTIVE Patient Mortality Organ Donation rates ASA use post MI EFFICIENT Hospital LOS Health care Costs PATIENT-CENTERED (FAMILY CENTERED) Patient/Family Satisfaction STAFF WORKLOAD Staff turnover and burn out

How to Design a Quality Improvement Project Identify Gap in Care Review Literature – Identify Evidence based practices

Use Pre-existing Bundles and Toolboxes

How to Design a Quality Improvement Project Identify Gap in Care Review Literature – Identify Evidence based practices Quality Improvement Tools

Quality Improvement Strategies Continuous Improvement (PDSA) Total Quality Management Six Sigma Lean Quality Improvement Tools Process map Cause-Effect Diagram Pareto Chart Control Charts Scatter Diagram Fishbone Diagram Decision Matrix Strategies and tools to help organize, analyze and impact change within a process

Develop protocols and Bundles of Care

Educate and Engage

Reminders and Forced Function Antibiotic Auto-stop Automatic orders Surgical Checklists

Address Infrastructure Workplace Design Equipment Human Resources Audit and Feedback

How to Design a Quality Improvement Project Identify Gap in Care Review Literature – Identify Evidence based practices Quality Improvement Tools Measuring Impact

Quality Improvement Studies Challenges to Measuring Impact Involves Healthcare Systems and Health Care Delivery Not just single intervention Randomized Controlled trials of Health care systems Multiple interventions are tested over time Empiric Research with repeated measurements over time

Traditional Medical Research Time Consuming Expensive Only One intervention tested Measure Outcome Measure Outcome Measure Differences in Outcomes Intervention Data collection Data collection Time

Quality Improvement Model HOW ? Measure Difference Measure Difference Measure Difference Intervention Intervention Intervention Data collection and Measuring Outcomes Time

Statistical Process Control Manufacturing Process required to make a nut and bolt Healthcare Process required to make a sick person well Statistical Process Control measures the variation associated with the outcome of a process

Statistical Process Control Type of Illness Severity of Illness Co-morbidities Demographics Health Care Workers Resources Treatment given Complications occurring Variation in Outcomes Process required to make a sick person well Differentiate common cause variation from extraordinary variation Goal is to optimize outcomes: Identify extraordinary variation early and act on it Limiting variation associated with a process

Creating a Quality Improvement Project Identify Gap in Care Review Literature – Identify Evidence based practices Quality Improvement Tools Measuring Impact