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How do quality improvement (QI) tools and methods contribute to healthcare improvement?
 

How do quality improvement (QI) tools and methods contribute to healthcare improvement?

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2013 Canadian Knowledge Mobilization Forum

2013 Canadian Knowledge Mobilization Forum
Cathy Howe
NIHR CLAHRC for Northwest London

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How do quality improvement (QI) tools and methods contribute to healthcare improvement? How do quality improvement (QI) tools and methods contribute to healthcare improvement? Presentation Transcript

  • How do quality improvement(QI) tools and methodscontribute to healthcareimprovement?Cathy Howe, Julie Reed, Derek BellNIHR CLAHRC for Northwest London
  • CLAHRC NWL ApproachQualityImprovementQuality Improvement MethodsPatient and PublicInvolvementEngaging Patients and StaffResearchRigorous Design and Use ofDataEducationTraining, Support andCollaborationA collision of different worlds…NIHR CLAHRCFor Northwest LondonHealth OutcomesPatient ExperienceImprove health outcomes and patient experience through delivery ofclinically effective care.Primary aim:4 Rounds: 21 Projectsover 55 Sites engagingover 500 NHS staffsystematic approach
  • CLAHRC NWL AchievementsBeneficial impacts on care quality, outcomes, experience and costs• COPD discharge care bundle:– Improved compliance with „best care‟ (from 0% baseline - 70%)– reduced length of stay (e.g. by 2.5 days)– costs savings (e.g. estimated at £123,410/year)• Medicines Management:– ADR identification (e.g. 70% potential ADR)– medication reduction (e.g. 52% meds)– cost avoidance (e.g. estimated net £145,000/yr)– co-designed “My Medication Passport” (paper & app, c.9,000 copies)• Diabetes Improvement through Peer Led Education (DIMPLE):– Built capacity: 31 “community champions‟, 6 peer educators and 9 peer mentors– engaged over 9,182 people through 352 events inc BME groups,– Social return on investment estimated at £11 for every £1 invested.Demonstrated Patient & Public Engagement & Involvement benefitsInclude (3 examples):
  • Conceptual Frameworkfor delivering improvement in healthcareAct scientificallyandpragmaticallyEngage andempowerEmbraceComplexitySupport for longterm successUnderstand and utilise existing knowledgeIterative DevelopmentCapture and produce new knowledgeActive engagementFacilitate dialogueFreedom to act and willingness to learnUnderstand services and processesUnderstand variationIdentify and act on systemic issuesProvide headroom and resourcesPolitical and Strategic AlignmentInvest in continual improvementValuesPrinciples
  • Contribution of QI tools and methods : The CLAHRC NWL approachResources/ Funding£100k or £50k to develop or ‘roll-out’ projects matched funded byNHS and/or industry partners..Model for ImprovementThree questions and rapid-cycle smalltests of change.Measurement for ImprovementA ‘few key weekly measures’ to show progress using run charts and automated SPC charts.Representative Team (Centre)Clinical lead, project manager, information lead andexecutive sponsor, plus others including patients.Process MappingRepresentation of activities andbranching points in a care ordata process.Patient & Public InvolvementPatient advisors, digital stories, focus groups…Action Effect MethodA facilitated approach torepresent the ‘theory of change’including a patient-focusedaim, contributing factors, andideas for interventions.Outcome MeasurementOne or two measures to show impact ofthe work on outcomes, qualitative orquantitative.ReviewsTwo-way formative 6 monthreviews exploring how teamsuse and engage with QI tools.Sustainability ModelNHS III Sustainability Model toidentify and address factorsthat affect sustainability.Stakeholder MappingTwo-by-two matrix to identify keystakeholders interest and influenceplus management plan.
  • Act Scientifically & Pragmatically: Utilise existing knowledge.Model forImprovementProcessMappingAction EffectMethod
  • Act Scientifically & Pragmatically: Iterative Development.Model forImprovementMeasurement for ImprovementRepresentative Team(Centre)
  • Act Scientifically & Pragmatically: Capture & produce new knowledge.Model forImprovementMeasurement for ImprovementRepresentative Team(Centre)ProcessMappingPPE/IAction EffectMethodOutcomeMeasurementReviewsSustainabilityModelStakeholderMapping
  • Contribution of QI tools : Act Scientifically & Pragmatically.Model forImprovementMeasurement for ImprovementRepresentative Team(Centre)ProcessMappingPPE/IAction EffectMethodOutcomeMeasurementReviewsSustainabilityModelStakeholderMapping
  • Contribution of QI tools : Engage & Empower.Model forImprovementMeasurement for ImprovementRepresentative Team(Centre)ProcessMappingPPE/IAction EffectMethodOutcomeMeasurementReviewsSustainabilityModelStakeholderMappingFinancial Support
  • Contribution of QI tools : Embrace Complexity.Model forImprovementMeasurement for ImprovementRepresentative Team(Centre)ProcessMappingPPE/IAction EffectMethodOutcomeMeasurementReviewsSustainabilityModelStakeholderMapping
  • Contribution of QI tools : Support Long Term Success.Model forImprovementMeasurement for ImprovementRepresentative Team(Centre)ProcessMappingPPE/IAction EffectMethodOutcomeMeasurementReviewsSustainabilityModelFinancial Support
  • QI tools contribution• All tools make social and technicalcontributions• All tools contribute to two or more values• Most tools contribute to most values• Tools contribute differently to all values –but exactly how, is still to be explained• No ‘super-tool’ or subset of ‘super-tools’
  • QI tools in practiceModel for Improvement Sustainability Model Driver Diagram Measuring for Improvement Process Mapping Stakeholder Engagement PPI Dissemination of Learning Project MedianRound 11 1 1 2 3 1 2 2 5 22 3 2 2 3 1 2 5 5 2.53 1 1 2 2 0 2 0 6 1.54 5 1 2 2 1 2 5 6 25 5 1 2 2 6 5 2 6 3.56 3 1 2 6 6 2 2 6 2.5Median 3.0 1.0 2.0 2.5 1.0 2.0 2.0 6.0Round 21 5 1 5 3 5 6 5 5 52 5 6 5 3 6 3 6 5 53 5 2 2 4 3 5 3 2 34 3 2 2 2 2 2 2 5 25 1 2 2 2 5 3 2 2 26 5 2 2 3 6 2 2 5 2.57 3 2 2 3 5 3 2 5 38 3 2 2 1 0 2 3 5 29 1 1 2 0 0 1 2 6 110 2 2 2 1 0 1 2 1 1.511 2 1 2 1 0 2 3 6 212 5 3 2 0 0 3 2 5 2.513 3 1 2 2 0 2 2 5 214 5 1 2 5 3 3 2 6 315 3 1 5 5 3 3 5 5 416 5 0 2 5 0 2 2 6 217 3 1 2 0 0 1 2 5 1.5Median 3.0 2.0 2.0 2.0 2.0 2.0 2.0 5.0Round 31 6 5 6 6 6 5 5 5 5.52 5 0 6 0 6 2 2 5 3.53 1 3 5 1 6 2 5 5 44 3 3 5 1 6 2 6 5 45 1 3 5 0 6 2 5 5 46 4 3 5 5 5 5 2 2 4.57 1 0 1 2 0 2 2 5 1.58 3 1 2 2 3 5 2 0 29 5 0 5 5 6 5 5 5 510 5 3 5 5 6 2 2 5 511 6 0 2 0 6 5 2 5 3.512 5 3 6 5 6 4 5 5 513 3 0 5 3 6 6 5 2 414 5 0 5 6 1 6 6 5 515 5 3 5 5 6 6 6 5 516 5 2 6 5 4 2 2 6 4.517 5 3 5 3 6 2 2 5 418 3 3 5 5 6 5 2 3 419 4 0 5 3 6 5 5 2 4.520 4 3 5 5 4 6 5 5 5Median 4.5 3.0 5.0 4.0 6.0 5.0 5.0 5.0• The degree of engagement with each of the QI tools andmethods varied within and across projects.• More projects engaged with more methods in each round.
  • NIHR CLAHRCfor Northwest LondonFind us at…W: www.clahrc-northwestlondon.nihr.ac.uk/homeE: clahrc.nwl@imperial.ac.ukT: @CLAHRC_NWLFind me at…W: www.cathyhowe.netE: c.howe@imperial.ac.ukT: @cathgreenhalgh