Quality Improvement, Methods and Tools

1. Quality Improvement
Principles
Methods & Tools

2. By
Dr. Maged Shaheen

3. Principles of Quality Improvement
“Quality is never an accident; it is always the result
of high intention, sincere effort, intelligent direction
and skillful execution; it represents the wise choice
of many alternatives.”
William Foster
(many variations attributed to others)

4. Performance Management

5. The Quality Environment
 Do you have an organization-wide commitment to
assessing and continuously improving quality over time?
 Do you use data to decide on improvement initiatives and
to know if the improvements are successful?
 Are your system decisions based
on data?
 Do you know if your Hospital is
achieving its goals?

6. Change vs. Improvement
 W. Edwards Deming stated “Of all changes I’ve
observed, about 5% were improvements, the rest,
at best, were illusions of progress.”
 We must learn how to improve rapidly
 We must learn to discern the difference
between improvement and illusions of progress
 We must become masters of improvement

7. Principles of Quality Management
1. Know your stakeholders and what they need
2. Focus on processes
3. Use data for making decisions
4. Understand variation in processes
5. Use teamwork to improve work
6. Make quality improvement continuous
7. Demonstrate leadership commitment

8. What questions do you have?

9. METHODOLOGY

10. 1. Proactive Method
FMEA

11. AIMS
- Promote patient safety by preventing errors from occurring
- Building quality into the process from the first place
- Proactive approach to promote patient safety and reduce
risk
WHEN TO USE
- Analyzing new or redesigned process
- Analyzing current process tat put you at risk before they
cause adverse events

12. F failure the condition or fact of not achieving the desired end
M failure mode different ways that a process fails to function i.e.
undesirable variation of the process
E effect the adverse consequences of failure mode that the patient
or other customers might experiences
A analysis i.e. find the causes, hazard, frequency of occurrence,
severity, detectability, critically index risk priority number, and
control measures

13. 2- Concurrent method
LEAN thinking approach
A look back and a look
forward

14. AIMS
- Eliminating and preventing waste
- Reducing process lead time
- Just in time efficient delivery of services
- Improving quality and reducing costs

15. L look for the value the customer wants.
All of actions required from start to finish in responding to a
customer need plus the information controlling this actions
that means entire flow and all of the steps and costs
E eliminate the unneeded steps
Strive continuously to reduce the number of steps to make
the flow value stream

16. A accelerate the process
Make the remaining process steps as rapid as possible
by reducing the amount of time , and amount of
information needed of each step to the necessary
N needs of the customer to be fulfilled
Meet the customer needs and expectations

17. 3-Reactive method
Improvement projects
(Problem Solving)

18. F = Find an opportunity for improvement.
- Select the process of interest.
- Define preliminary process boundaries.
- Decide if the selected process is the best one to improve.
O = Organize a team
- Identify the team leader/ process owner.
- Assign a facilitator/ coach who will guide the team.
- Select team members from appropriate levels.

19. C = Clarify the current process
- Flow chart the process.
- Make simple improvements to define the best process.
- Identify suppliers and customers.
U = Understand
- The sources of the problem and the process variation,
- Investigate special causes and seek to stabilize the process.
S = Select the improvement (a change)
- Identify improvement alternatives that will contribute the
most to improving the process.
- Reduce common cause variation

20. P = Plan the improvement
- Plan how the improvement identified in the "s" phase.
- An action plan is used to describe proposed improvement
efforts.
D = Do the improvement
- Implement the plan.
- Describe what was used to implement the plan.
- Collect data.

21. C = Ceck the results (is the change an improvement?)
- Analyze data to evaluate the improvement.
- Compare data with process capability and baseline data.
A = Act to hold the gain
- What steps will be taken next?
- The PDCA cycle can be repeated again and again,
attempting to refine the improvement.

22. STEPS

23. 1. Nominate the problems
2. Select the project
3. Verify the project
4. Problem statement
5. mission statement
6. flow chart
7. Project team
8. Operational definitions
9. Measure the symptoms

24. 10. Confirmed and modified mission statement
11. Brain storming
12. Affinity diagram
13. Cause – effect diagram
14. Weighted Multivoting
15. Remedies suggested
16. Evaluate the remedy
17. Action plan
18. Control spread sheet
19. Approval

25. SELECT THE
PROJECT

26. Baljurashi General Hospital
Proposed PROJECTS
1. Establishing a Recovery Room In OR theatre.
2. Conversion of Raw water to RO in hemodialysis.
3. Converting Hepatitis Positive (HDU) into Hepatitis negative.
4. Increasing or enhancing the HCW's awareness for Patient Safety from
20% to 40%.
5. Improving Digitalization of Medical Records.
6. Improving HCW's compliance/adherence in Medical Wastes
Segregation.
7. Facilitate the Discharge of Long Term Patients to Home 0% t0 25%.
8. Formulate and establish a well defined Patient & Family Education Plan.

27. ITEMS Recovery
room
HDM water Hep B Project 4
1- Low 5- Moderate 10- High
Chronic
Significant
Manageable size
Repetition
Potential impact
Urgency
1- High 5- Moderate 10- Low
Risk
Potential resistance to
change
TOTAL

28. ESTABLISH THE
PROJECT

29. Three activities to be done:
1. Prepare a MISSION statement.
2. Select a TEAM.
3. Verify the MISSION.

30. PREPARE A MISSION STATEMENT
The mission statement is the written
instruction to the team selected to
tackle a quality improvement project,
it describe:

31. PREPARE A MISSION STATEMENT
A. The problem to be resolved, that is what is
wrong.
B. b. The objective of the project, that is what is
wrong & the team, what they are going to do
about the problem.

32. CRITERIA FOR DESCRIBING THE PROBLEM
An effective problem description are :
1. Specific – it explain exactly what is wrong
and distinguishes the deficiency from similar
problem.
2. Observable – it describes visible evidence
of the problem.

33. CRITERIA FOR DESCRIBING THE PROBLEM
3. Measurable – it indicates the score of the problem
in quantifiable terms by answering
* How many?
* How often?
Measurement is important for 2 reasons :
* It helps to determine whether the problem
is large enough to justify attention.
* It provides criteria for evaluating the remedy.

34. CRITERIA FOR DESCRIBING THE PROBLEM
4. Manageable – that the problem can probably be
solved in six to twelve months.
Notice :
 If no measurement exist, they should be
developed by the quality improvement team.
 If a problem is too large, it should be broken
into several smaller, manageable projects.

35. DESCRIBING THE OBJECTIVE
 An effective mission statement also indicates the
objective of the project that is what the project
team is to do about the problem.
 The project team’s objective depends on what
the hospital wants to accomplish.

36. EXAMPLE :
 Our average length of stay for total hip
replacement surgery is 1.2 days larger than the
average for King Faisal Hospital at Riyadh.
SPECIFIC LOS
Observable Records
Measurable Days
Manageable Limited
Objective LOS

37. Too many X-rays are being retaken. 8 % of all
X-rays must be taken 2nd time.
Specific Measurable
Observable Manageable
Objective 1. No.
2. Cost
3. Exposure
EXAMPLE :

38. A mission statement should not :
 Imply a cause
 Suggest a remedy
 Assign blame

39. Our average LOS for total hip replacement
surgery is 1.2 days longer than average in King
Faisal Hospital in Riyadh, eliminate the
postponement of scheduled hip replacement
surgeries that leads to longer length of stay.
EXAMPLE

40. EXAMPLE
Our average LOS for total hip
replacement surgery is 1.2 days
longer than average in King Faisal
Hospital in Riyadh.

41. The surgeons must improve their procedure
technique in total hip replacement to reduce
LOS to be same as King Faisal Hospital in
Riyadh.
EXAMPLE

42. Patient transfer from Wards to Radiology
Department takes too long time up to 1
hour. We need to improve the scheduling
and assignment of transport personnel to
reduce transport time.
EXAMPLE

43. SELECT A PROJECT TEAM
Quality improving team for project should be
selected from :
 Where the problem is observed.
 Where sources or causes of the problem might be found.
 Among those with special knowledge, information or skills
in uncovering the root cause of the problem.
 In areas that can be helpful in implementing the remedy.

44. THE TEAM CHARACTER
a. The team is expected to apply the steps of the quality
improvement process throughout the project.
b. The team is authorized to collect relevant data, discuss
the problem with those involved within it.
c. The team members are asked to spend a specific
amount of time on the project each week (at least 4
hours).
d. The team has access to the resources it needs to carry
out the mission.

45. WE NEED TEAM TO :
 Exchange of experience
 To have all practical information about the problem.
 Complete understanding of each step and changes
needed.
 We ensure that the remedy shall be practical.

46. VERIFY THE MISSION
 It should be done once team meets
 It requires that the team: -

47. VERIFY THE MISSION
 Evaluate the problem description and mission
description to make sure they meet the criteria
for an effective mission statement.
 Verify that problem exists.
 Identify any aspects of the project that needs
clarification.

48. VERIFY THE MISSION
 Verify that team members represent the
appropriate departments.
 Obtain clarification and agreement from the
quality committee on any needed changes to
mission statement or team membership.

49. 10 Questions to be answered
1. Does the mission statement indicate what is
wrong?
2. What visible evidences of the problem does
the statement describe?
3. What measure is use to indicate the scope of
the problem?

50. 10 Questions to be answered
4. In your opinion, is the problem manageable?
5. Exactly what objective does the mission
statement indicate your team is to pursue?
6. Does the mission statement imply cause,
suggest a remedy or assign blame?

51. 10 Questions to be answered
7. How will your team verify that the problem
exists?
8. Are there any aspects of the project that
require clarification?
9. What changes in the mission statement
would you recommend?

52. 10 Questions to be answered
10.Does your team represent the appropriate
parts of the organization; what alterations in
team composition would you recommend?

53. What questions do you have?

54. THANK YOU!!!