1. Quality Improvement and the Nurse

2. Identified Need for Improvement in Health Care
30-45% of patients not receiving care according to scientific evidence
20-25% of care provided is not needed or potentially harmful
Choosing Wisely funded by RWJF to promote conversations between providers and patients about care
17 years to move research into practice
(Schuster et al., 1998; Grol 2001)
Have we improved?

3. How does Research and EBP connect to Quality Improvement and Safety?

4. QSEN: Quality & Safety Education for Nurses
Community that provides comprehensive, competency-based resources to empower nurses with the knowledge, skills and attitudes necessary to continuously improve the quality and safety of the healthcare systems in which they work.
6 Competencies that align with IOM Competencies required for all health care providers
Focus: Improve care for patients through competent care
The Goal:
…I would like to talk about the QSEN journey – past present and future

5. QI History Origins in manufacturing 1980’s Healthcare initiative
Deming Post WWII rebuilding industry
“Constancy of Purpose” to improve
Donabedian Structure: availability and quality of services
Process: measures deliver of care
Outcome: final result; mortality
Healthcare initiative
1993 HMO Group conference on Total Quality Management
Operations Focus

6. What is Quality Improvement in Health care?
…..the combined and unceasing efforts of everyone– healthcare professional, patients and their families, researcher, payers, planner and educators– to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning)…..
Batalden, P; Davidoff, F (2007)

7. QI Theory: Improvement Knowledge
1) Knowledge of a system
2) Knowledge of variation
3) Knowledge of psychology
4) Theory of knowledge

8. Quality Improvement (QI)
Look at waste and variation and eliminate it
Identify where to make changes in the system
Resource for Learning Tools and Strategies for Quality Improvement and Patient Safety -

9. Model for Improvement
PDSA Plan idea for action Do make the change Study test it and collect data Act adjust actions
PDSA (Plan, Do, Study, Act)
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in improvement?

10. Using Sequential PDSA Cycles to Build Knowledge and Improve Care

11. Essential Features For Quality Improvement
Systems thinker
Data
Leadership skills
Theory of improvement
Creativity
Industry assessment

12. Quality Improvement Assignment
Student Assignment using Model for Improvement
Improve something about yourself
Presentation of data:
Describe Aim
PDSA (Plan, make the change, test it, study it, adjust actions)
Use of Tools (flow charts, check sheets, run charts, bar graphs)
IHI Toolkit for Reporting Data
PDSA (Plan, Do, Study, Act)
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in improvement?

13. Grading Rubric

14. Example of data points

15. References:
Batalden, P. & Davidoff, F. (2007). What is quality improvement and how can it transform healthcare. Quality and Safety in Healthcare;16: 2-3 Grol, R. (2001). Improving the quality of medical care: Building bridges among professional pride, payer profit, and patient satisfaction. JAMA; 286(20): Schuster,, M. A., McGlynn, E. A., & Brook, R. H. (1998). How good is the quality of health care in the United States? Milbank Quarterly;76(4):517-63, 509.