1. Introduction to the Model for Improvement How to Get Started with Quality Improvement Teams The Quality Academy Tutorial 12

2. 2 Learning Objectives: You Will Learn About… The Model for Improvement Steps towards starting a team Measuring the impact of improvement work Learning Objectives

3. 3 Tips for Viewing This Presentation Skip to other slides in the presentation Read along with the narrator Search for keywords in the presentation Play, rewind and fast forward Review current slide View full screen Tips for Viewing

4. 4 “By what method could new leaders bring improvement in living?” W. Edwards Deming The New Economics, 1993 Food For Thought Model for Improvement

5. 5 Key Question Now that we’ve identified an area we want to improve and set up a team to work on it, what do we do next? Model for Improvement

6. 6 Answer: You Do Three Things 1. Set the aim2. Measure3. Make changes Model for Improvement

7. 7

8. 8 Aim statement contains: Explicit description Specific actions Time specific Measurable Specific patients Model for Improvement

9. 9 Aim Statement For a Broader Improvement Effort Aim The clinic will improve care of HIV/AIDS patients by focusing on education, prevention, and early intervention. Our goals include: 80% of patients with at least one visit every three months 85% of patients with documented medication education/adherence counseling 90% of applicable patients with PCP/MAC prophylaxis Guidance The clinic will focus on the current active caseload of HIV/AIDS patients who are seen in the HIV/AIDS Early Intervention Services program at three of the center’s sites (approximately 350 patients). Team System/ Team Leadership: Primary Care Physician and Nursing Director Technical Expertise: Senior Physician Day-to-Day Leadership: Program Manager Additional team members: Community Health Nurse, Case Manager, Clerical staff Source: “HIV/AIDS Disease,” produced by the Institute for Healthcare Improvement in partnership with HRSA/HAB, 2002 Model for Improvement

10. 10 Aim Statement for a Broader Improvement Effort Aim The clinic will improve care of HIV/AIDS patients by focusing on education, prevention, and early intervention. Our goals include: 80% of patients with at least one visit every three months 85% of patients with documented medication education/adherence counseling 90% of applicable patients with PCP/MAC prophylaxis Guidance The clinic will focus on the current active caseload of HIV/AIDS patients who are seen in the HIV/AIDS Early Intervention Services program at three of the center’s sites (approximately 350 patients). Team System/ Team Leadership: Primary Care Physician and Nursing Director Technical Expertise: Senior Physician Day-to-Day Leadership: Program Manager Additional team members: Community Health Nurse, Case Manager, Clerical staff Source: “HIV/AIDS Disease,” produced by the Institute for Healthcare Improvement in partnership with HRSA/HAB, 2002 Model for Improvement

11. 11 In Setting the Aim, Be Sure To: Involve the organization’s senior leaders Base the aim on both data and organizational needs State the aim clearly and use numerical goals Include appropriate guidance on approaches and methods Model for Improvement

12. 12 Helpful Tool: The Improvement Project Memo Problem/Aim statement Improvement goal Team leader and team members Other (resources, authority, frequency of reporting, ground rules) Model for Improvement

13. 13 Improvement Project Memo Model for Improvement

14. 14 Model for Improvement

15. 15 How Will We Know That a Change is an Improvement? If the percentage of patients with at least one visit every three months increases If the percentage of patients with documented medication education/adherence assessment increases If the percentage of patients with CD4 counts < 200 who receive PCP prophylaxis increases Model for Improvement

16. 16 Model for Improvement

17. 17 Improvement Requires Action “While all changes do not lead to improvement, all improvement requires change.” Model for Improvement

18. 18 Which goal best completes this aim statement? "The clinic will improve care of HIV/AIDS patients” Our goal is to: Test Question Model for Improvement A) Get the ophthalmology clinic to be more cooperative B) Increase the percentage of patients receiving an annual dental exam to 95% C) Add to our case management staff D) Have more patients keep their appointments

19. 19 The PDSA Cycle for Learning and Improvement Model for Improvement

20. 20 Where to Begin? “What Can You Do By Next Tuesday?” Take action Things that matter Things that can be fixed (given the resources you have), where success is likely People who will be supportive Processes that aren’t undergoing other changes Learn from what others have done Starting a Team

21. 21 Tips for Measurement Plot data over time Use simple run charts (time series plots) of key measures directly related to your aim Starting a Team

22. 22 Percentage of Patients With a Visit in Past 3 Months Starting a Team

23. 23 Tips for Measurement (cont.) Integrate measures into routine processes Collect useful data as part of the normal work process Develop simple data recording forms that are integrated into the patient visit Use both words and numbers Sample question 1: how is adherence testing going? Sample question 2: how was your experience in the clinic? Starting a Team

24. 24 HIV Improvement Collaboratives Sponsored by HRSA HIV/AIDS Bureau Goals: Working collaboratively to improve HIV/AIDS care Committed to learning from each other Collaborative Demonstration Projects: Part C and D: 75 health care organizations, 2000 Part A: 5 EMAs, 2002 Part B: 8 States and Jurisdictions, 2005 Part B: 18 States and Jurisdictions, 2006 Starting a Team

25. 25 Remember… “Don’t let the perfect be the enemy of the good.” Starting a Team

26. 26 What's an effective first step in an improvement project? Test Question Starting a Team A) Looking at the data over time to see what performance is and how it's changed B) Talking to people who work in the process to learn what they think C) Going on-line to see if another organization has tackled a similar issue D) a and b E) b and c F) a, b and c

27. 27 Key Points The Model for Improvement provides a straightforward roadmap for improving quality Begin with projects that matter, but also with projects where there will be support for change Learn from others, especially from HRSA’s HIV improvement collaboratives Key Points

28. 28 Resources Langley, Gerard et. al., The Improvement Guide, San Francisco: Jossey-Bass, 1996. Improving HIV Care: A Modular Quality Improvement Curriculum. Available on the National Quality Center’s website at: http://nationalqualitycenter.org/index.cfm/5838/13732 http://nationalqualitycenter.org/index.cfm/5838/13732 HIV/AIDS Bureau Collaboratives: Improving Care for People Living with HIV/AIDS Disease Training Manual. Download at the NQC web site at: http://nationalqualitycenter.org/index.cfm/5838/13548 http://nationalqualitycenter.org/index.cfm/5838/13548 HIV/AIDS Bureau Technical Assistance Manual for Quality Management for Ryan White CARE Act Part A Programs. Download at the NQC web site at: http://nationalqualitycenter.org/index.cfm/5908/13579 http://nationalqualitycenter.org/index.cfm/5908/13579 Resources

29. 29 Please Rate This Tutorial By Indicating How Your Response To The Following Statements. Was this Tutorial helpful to you? Did this Tutorial meet your expectations and goals? Was the Tutorial clearly organized and easy to use? Would you recommend this Tutorial to colleagues of yours? Yes, a lot Yes, a little NeutralNo, not very muchNo, not at all Submit Evaluation

30. 30 Related Tutorials To learn more about the PDSA cycle, study Tutorial 13 To learn more about teams and teamwork, study Tutorial 11 To learn more about ideas for change, study Tutorial 15 To learn more about choosing improvement projects, study Tutorial 10 Related Tutorials

31. 31 The Quality Academy For further information, contact: National Quality Center New York State Dept. of Health 90 Church Street, 13 th floor New York, NY 10007-2919 Work: 212.417.4730 Fax: 212.417.4684 Email: Info@NationalQualityCenter.orgInfo@NationalQualityCenter.org Or visit us online at NationalQualityCenter.org NationalQualityCenter.org In Closing