1. The Quality Improvement Project MODULE 1: WHAT IS QUALITY IMPROVEMENT? WHY QUALITY IMPROVEMENT? February 2016

2. Quality Improvement DFM Team  Dr Liz Muggah – Director of Quality Improvement emuggah@bruyere.org  Julia Testa – Administrative Lead yr1coordinator@bruyere.org  Unit Faculty Leads: Dr Manon Denis-Leblanc: MontfortDr Todd Gauthier: Pembroke Dr Sharon Johnston: PrimroseDr Margaret Gluszynski: Riverside Dr Vanessa Murley: CivicDr Courtney Maskerine: Bruyere All faculty: WinchesterDr Ed Seale: Community (or contact your associated Academic Unit QI Lead)  BE IN TOUCH!

3. Objectives for this module 1. Introduce the domains of quality in primary care 2. Understand what quality improvement is and how it differs from quality assurance and research 3. Provide a introduction to the Quality Improvement Project

4. What is quality? First, think of top answer for each question below and write it down. Then share your answers and discuss as a group For you as a family physician? For your patients? For the health care system?

5.  accessible,  effective,  safe,  patient-centred,  equitable,  efficient,  appropriately resourced,  integrated and,  focused on population health. Quality in Primary Care – key “domains” (HQO)

6. So what is quality? Definition from the Institute for Healthcare Improvement “Triple AIM”

7. What is Quality Improvement? Moving from doing what we do to improving what we do

8. What is Quality Improvement “ the combined and unceasing efforts of everyone – to make changes that will lead to better patient outcomes, better health system performance, and better professional development” Adapted Baltaden and Davidoff, 2007

9. What is Quality Improvement? Quality Improvement Quality AssuranceResearch PURPOSETo improveTo judgeTo discover TESTSSmall tests of change No testsOne large blinded test DATA“just enough”All relevant dataAs much as possible “just in case” BIASStabilize bias from tests to test Adjust to reduce bias Control for bias HAS CHANGE RESULTED IN IMPROVEMENT? Repeated tests of change No focus on change Hypothesis testing (t-test, chi square), p-value

10. QI - what it is not…

11. What it is not…

13. Why Do We Need Quality Improvement? “ Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it” Slide from U of T DFCM A.A. Milne Illustration E.H.Shepard

14. Why Quality Improvement?  SYSTEM PERFORMANCE in CANADA  We spend a lot (5 th highest in OECD) but Canada is better than U.S. (only)  LEGISTLATION in ONTARIO  Excellent Care for All Act  Quality Improvement Plans Mandatory for Primary Care Teams  EDUCATION  CanMEDS and CanMEDS FM mandating teaching in QI and PS  PATIENT SAFETY  10-15% of all admissions (even pediatric) involve errors

15. Why Quality Improvement in Health Care?... I thought everything was working just great! If your mother or father were unwell, would you trust the system to provide the best care? Or… would you get involved?

16. What skills do you already have to do Quality Improvement?  Curiosity!  Desire to improve patient care!  Like working in teams!  Willing to lead! RESIDENTS HAVE PLAYED A KEY ROLE IN ADVANCING CLINICAL QUALITY

17. What is the QI project? Select a topic/Ask a question Collect information - review data & survey team members Identify the root problem Make recommendations Select a topic/Ask a question Collect information - review data & survey team members Identify the root problem Make recommendations Select a topic/Ask a question Collect information - review data & survey team members Identify the root problem Make recommendations Practice Audit identify gaps in care Dec Practice Improvement: Identify and plan an improvement April FMRSP : Scholarly Project in QI Further develop improvement idea, DO and evaluate improvement idea, March PGY2

18. Steps for the QI project Practice Audit  Sep-Dec  Ask question about your clinic  Review literature to identify best practice  Do a practice audit  Typically a chart audit but could do patient or provider survey  (15-20 charts ideally)  Identify gap in care & compare to best practice  Reflect on how to narrow gap  Dec 18  Written report (online with epearls or word document) Practice Improvement  Jan-Feb:  Form team and select one gap to look at  Identify root cause/system cause for gap  Find stakeholders in clinic and meet with them  Identify improvement opportunities  Feb- April  Select one improvement opportunity  Develop plan for the improvement  April 1  Submit final QI Report