1. Quality Improvement Review Food and Nutrition Learning Network July 31, 2007

2. Quality Improvement Basics Quality Improvement –opportunity for improvement exists in every process on every occasion –requires commitment to improve our operations, processes and activities –needs measurement-to demonstrate if efforts lead to the intended change –emphasizes a view of care that focuses on systems not individuals HIV Quality Learning Networks to improve the quality of HIV care and services Strengthen the quality infrastructure of HIV supportive service providers Find ways to accelerate change and improvements in F&N programs

3. The Model for Improvement ActPlan StudyDo 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 an improvement ?

4. PDSA-First Steps Starting point for quality improvement projects Forming your quality team-project participants Setting your goal/aim Establishing measures Selecting changes Testing changes

5. PDSA Cycle Rapid cycle improvement tool –Need to understand current situation –Trial and learning approach –At beginning, small-scale, short timeframe Establish measures ‘want to see increase/decrease in # of clients who…’ What (who when and where) is to be done –Assign specific tasks

6. PDSA Cycle-Elements Plan develop plan, goals Do test changes, measure Study analyze data, compare with plan Act systematize changes

7. Building Knowledge-Using Multiple Cycles of PDSAs Improve Access to HIV Primary Care AP SD A P S D AP SD D S P A DATA D S P A Cycle 1 : RD adapts new assessment form & uses with 3 patients Cycle 2 : Revise form and test with all patients Monday. Cycle 3: Cycle 4: Test form with all clients for 1 week Present refined form to all staff and document feedback Add primary care questions to assessment form Ideas, theories, hunches, predictions Aim : Ensure that all F&N clients are receiving HIV primary care. Cycle 5: Implement form for all and monitor results Food and Nutrition Programs

8. Improving Performance Learning how to make change in your organization is the purpose of PDSA Experiment: test on a small scale and build knowledge sequentially The cycles build on each other over time as you design a change that will result in improvement Reach QI goal to implement change on broader scale or throughout your organization