1. – Set the vision for improvement – Understand the problem – Identify Areas for Improvement – Devise a Measurement Strategy – Prioritize small tests of change Measure change – Sustain the change 11:05 Using a QI framework to improve care

2. Why measure change? Allows you to understand the impact of your changes Allows you to feedback performance to those doing well & those struggling to improve performance Allows group to see progress to goal

3. Case Example: Run Chart Audit & Feedback Tee time implemented Case Manager on leave Baseline

4. Improvement in Pain Scores Weeks 1-12 Avg. Max. Min. 58% 100% 35% Weeks 13-24 Avg. Max. Min. 68% 95% 40% Pitfall of averages: Aggregate data dilutes measurements Does not allow evaluation over time

5. Improvement in pain scores Day 1 to Day 2 Did We Improve? 100 80 60 40 20 0

6. Goal = 57% 44%

7. Try the next test of change

8. – Understand the problem – Convince others there is a problem – Identify areas for improvement – Prioritize small tests of change – Devise a measurement strategy – Measure change Sustain the change 11:15 Using a QI framework to improve care

9. Coaching & Celebrating Success Identify early wins Recognition does not have to be big Recognize this is a marathon – small wins to a big goal

10. How do we engage others in the problem? Appeal to both sides of our doctor brain:

11. Finding your story

12. Data visualization

13. Inspiring data

14. Your data should tell your story 1854 in London. Cholera strikes. In just 10 days, over 500 people have been killed in one neughborhood. No one understands the source. Except John Snow, an epidemiologist who realized the pump at the corner of Cambridge & Broad street must be the source.

15. Take home Lessons

16. Fishbone Diagram EquipmentProcessPeople Materials Environment Management The Problem primary cause secondary cause The effect The Cause

17. Identify Areas for Improvement PCS Rounds Call the primary team after each patient is seen with clear to-do now recs Informal ✔ in w/ primary teams Write notes with “official recs” Offer to write orders for the team if they are busy? Call the bedside nurse to let him/her know of new orders? One team member does PM check in Gives patient information card on their pain regimen Write note with updated PM recs Page team with updated recs Nurse updates the card for patient

18. Process: (actions) Process: (actions) Outcomes (patient level results) Outcomes (patient level results) Structure (adherence to the program) Structure (adherence to the program) - Antibiotics Stocked - EMR alert created - Changes to ED staffing - Sepsis Mortality - Cost - LOS - Lactate drawn - Blood cultures prior to antibiotics - Time to sepsis bundle delivery - Time to MD evaluation Balancing Measures (potential harm) Balancing Measures (potential harm) - Allergic Reactions - Antibiotic Resistance - C. Difficile Remember the three measurements Four

19. High Effort High Impact Low Effort Low Impact Thankless tasks Easy Wins Call the primary team after each patient is seen with clear to-do now recs One team member does PM check in Gives patient information card on their pain regimen Write note with updated PM recs

20. Improvement in pain scores Day 1 to Day 2 Did We Improve? 100 80 60 40 20 0

21. Coaching & Celebrating Success Identify early wins Recognition does not have to be big Highlight how these short term wins are contributing to the bigger vision

22. Questions / Comments ? Michelle Mourad: michelle.mourad@ucsf.edumichelle.mourad@ucsf.edu