How to sustain Quality Improvement activities over time A brief introduction to Quality Management

Objectives Understand why there is a need for Quality Management (QM) Understand key aspects of QM to start building into clinic operations. Discuss ways to sustain and spread QI efforts

Scenario You’ve trained all of your staff in QI, everyone is enthusiastic and in the first 6 months you’ve done 3 successful QI projects. However, now the head nurse is pregnant, the counselor is going back to school, and the doctor is transferred to another OPC How can you keep your QI effort going?

Sustainability Once QI is successful in one project, one clinic or one department how can it be sustained? How can it spread across a clinic, hospital or health system?

Quality Management (QM) An organization’s overall vision and strategy for sustaining QI efforts Reflects an organization’s goals of quality and plans for quality improvement over months to years Provides leadership and supports culture of quality Ensures training and resources are in place Sets priority areas for quality improvement Increases likelihood of sustainability and spread

Quality management programs are important at all levels Area of focus Ministry of Health Sets national standards for quality Province Leadership and support for ensuring strong provincial systems and addressing cross site issues. Hospital Coordinates and leads quality of care initiatives throughout the hospital Clinic Addresses clinic specific issues

Quality management plan outlines how the QM program will work A written vision for quality and QI Annual goals for quality The QI infrastructure: A team with multidisciplinary staff involvement Dedicated time to meet Plans for measurement Documentation of meetings of QI work at the site Resources for training and monitoring progress

Quality Management Plan example (1) Hospital ABC Quality vision: Hospital ABC will maintain high standards and ensure medical care is given in accordance with MOH guidelines in all departments. It is our vision that every staff person in Hospital ABC has the responsibility to maintain patient safety and provide the highest level of care.

Quality Management Plan example (2) Hospital ABC Quality goals for fiscal year 2013 (listed for each area). Examples: HIV: By 2013 routine CD4 testing will be increased by 15% and missed visits will be decreased by 20%. Vaccination: up to date vaccinations will be increased by 15% Pharmacy: Errors in medication dosing will be reduced by 20%

Quality Management Plan example (3) Plan for implementation: Dr. Huong, Nurse Thuy, Vice Director of Planning Hung and Patient representative Hai will lead the hospital effort. They will meet monthly and minutes will be shared with the hospital staff. Each clinic will establish a QI team to focus on quality issues in that area. Measurement will be done in each clinic every 6 months.

Hospital ABC Quality Management Plan example (4) Education: All staff working at hospital ABC will be trained in quality improvement. New staff training will be available on the first Friday of every month at 10am in the auditorium along with weekly quality rounds open to all staff to share lessons learned. Monitoring: Every clinic should keep a record of measurement, QI projects and results in a 3 ring binder Hospital wide results will be shared on an annual basis Quality improvement goals will be reviewed and adjusted on an annual basis

What does quality management look like at the clinic level? Supports work to build the clinic’s capacity for improvement Provides leadership in implementation of measurement and improvement in hospital/MOH priority areas May choose additional priority quality areas Includes representatives from different disciplines (doctors, nurses, counselors, leaders, patients) Helps coordinate quality related work across the clinic In small clinics QM team may be almost the same as QI project team.

Exercise - Is there a quality management program at your facility or province? Can you think of some next steps in starting a QM team at your sites? Do you have other ideas for how to sustain QI? 10 min Be ready to share This slide and exercise is to recognize that it may take some time to implement QM. It is an exercise to get staff thinking both about how to implement QM as well as other ways to sustain QI which will be the next few slides.

Some ideas for sustaining QI efforts even before a QM program is in place

Ideas on how to sustain QI (1) Make quality important Include quality as an agenda item in meetings Recognize staff for their QI efforts Ensure process for feedback and open discussion of performance data Suggestion box: Take suggestions from staff and patients on areas to improve

Ideas on how to sustain QI (2) Document quality work Provides important tracking and can be used to measure progress, learn from what has been done, teach new staff Example: A 3 ring binder that includes: Quality Management Plan Performance measurement plans and results Priority areas to improve Notes from gap analyses QI Project plans and results Copies of trainings Notes from QM meetings

Ideas on how to sustain QI (3) Spread the word about quality Organize workshops to promote quality Share lessons learned with other departments or clinics Celebrate and share successes Post improvement results on the walls Newsletters

Summary After a successful QI project next steps include sustaining and spreading QI A quality management program provides important leadership and vision for an organization’s QI efforts Until a QM program is in place, there are many ways a clinic can begin to spread and sustain QI efforts

Thank you