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Psp mpc topic-07
 

Psp mpc topic-07

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    Psp mpc topic-07 Psp mpc topic-07 Presentation Transcript

    • Topic 7 Using quality-improvement methods to improve care Patient Safety Curriculum Guide 1
    • Learning objectives  The objectives of this topic are to: • • Describe the basic principles of quality improvement Introduce students to the methods and tools for improving the quality of health care Patient Safety Curriculum Guide 2
    • Knowledge requirements  The science of improvement  Change concepts  Improvement principles  Role of measurement in improvement Patient Safety Curriculum Guide 3
    • Performance requirement  Identify the opportunities for using safety science to analyse errors  Appreciate the range of improvement methods available for reducing harm to patients  Apply at least one improvement tool in a particular clinical context  Participate in an improvement activity (if possible) Patient Safety Curriculum Guide 4
    • The science of improvement  Appreciation of a system  Understanding of variation  Theory of knowledge  Psychology Source: Langley GL Patient Safety Curriculum Guide 5
    • Change concepts … … are general ideas, with proven merit and sound scientific or logical foundation that can stimulate specific ideas for changes that lead to improvement. Source: Nolan TW, 1996 Patient Safety Curriculum Guide 6
    • The model for improvement What are we trying to accomplish? How we will know that a change is an improvement? What change can we make that will result in an improvement? ACT STUDY PLAN DO Source: Langley GL, Nolan, KM, Nolan, TW, Norman, CL & Provost, LP 1999 Patient Safety Curriculum Guide 7
    • The quality improvement model: the PDSA cycle  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? Patient Safety Curriculum Guide 8
    • The PDSA cycle Determines what changes are to be made ACT STUDY Summarizes what was learned Change or test PLAN DO Carry out the plan Source: Langley GL, Nolan, KM, Nolan, TW, Norman, CL & Provost, LP 1999 Patient Safety Curriculum Guide 9
    • The Institute for Healthcare Improvement (IHI): different measures Measurement for research Measurement for learning and process improvement Purpose To discover new knowledge To bring new knowledge into daily practice Tests One large "blind" test Many sequential, observable tests Biases Control for as many biases as possible Stabilize the biases from test to test Data Gather as much data as possible, "just in case" Gather "just enough" data to learn and complete another cycle Duration Can take long periods of time to obtain results "Small tests of significant changes" accelerate the rate of improvement Patient Safety Curriculum Guide 10
    • Three types of measures  Outcome measures  Process measures  Balancing measures Patient Safety Curriculum Guide 11
    • Three examples of improvement methods  Clinical Practice Improvement methodology (CPI)  Root Cause Analysis ( RCA)  Failure Mode Effect Analysis ( FMEA) Patient Safety Curriculum Guide 12
    • The improvement process Project mission Project team Ongoing monitoring Outcome Future plans Project phase Sustaining improvement phase 1 5 1 month Annotated run chart SPC charts Impact phase 4 3 S 2 months 2 Diagnostic phase Conceptual flow of process Customer grid Data -fishbone -Pareto chart -run charts -SPC charts A D Intervention phase P S A D P S A D P S A D D S P A P 2 months Plan a change Do it in a small test Study its effects Act on the result Source: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement (www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf) SPC – statistical process control Patient Safety Curriculum Guide 13
    • Interventions phase Identify appropriate interventions Implement changes identified in the diagnostic phase Undertake one or more PDSA cycles Interventions phase Decide on interventions Undertake one or more PDSA cycles Source: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement (www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf) Patient Safety Curriculum Guide 14
    • How to use the PDSA Cycle  Use 'plan-do-study-act' cycles to conduct small-scale tests of change • Plan a change • Do it in a small test • Study its effects • Act on what learned  Team uses and links small PDSA cycles for broader implementation NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement (www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf) Patient Safety Curriculum Guide 15
    • PDSA cycle - single test PDSA Cycles – single test D S A A P S S D P A S P A Changes that result in improvement P D D Hunches, theories and ideas Source: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement (www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf) Patient Safety Curriculum Guide 16
    • PDSA cycle – multiple tests NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement (www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf) Patient Safety Curriculum Guide 17
    • Impact and implementation phase 1. 2. 3. 4. Measure impact of changes/interventions Record the results Revise the interventions Monitor impact Impact and implementation phase Measure impact • Annotated run chart • SPC charts • Other graphs Implement the changes NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement (www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf) Patient Safety Curriculum Guide 18
    • Sustaining and improvement phase   Once an intervention has been introduced, the intervention and any improvements need to be sustained Sustaining improvement phase This may involve: • • • • Standardization of existing systems and processes Documentation of policies, procedures, protocols and guidelines Measurement and review of interventions to ensure that change becomes past of “standard” practice Training and education of staff Sustain the gains •Standardization •Documentation •Measurement •Training NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement (www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf) Patient Safety Curriculum Guide 19
    • Flowchart of process Example of a flow chart for a project titled: Accelerated Recovery Colectomy Surgery (ARCS) North Coast Area Health Service Australia Something amiss Visit to general practitioner Investigations Referral to surgeon Referral to hospital Hospital admission Return to life Post-anaesthetic care Operating theatre Surgical ward Allied health Surgical team Pain team Pre-op ward Admitted to hospital Discharge planner Community health/ Peripheral hospital Preoperative clinic Admissions office Home Patient Safety Curriculum Guide 20
    • Cause and effect diagram Social issues Staff attitudes home support Complications length of stay poor pain control wound complications mobility of patient pain control little family support nutrition Adequate nutrition of patient mobilization nil by mouth surgery pain control Procedure weak/malnourished infection Prolonged Length of Stay expect longer stay poor understanding of procedure little knowledge of support services locus of control Patient perception general practitioner community health family colon-care nurse Post discharge support Accelerated Recovery Colectomy Surgery (ARCS), North Coast Area Health Service, Australia Patient Safety Curriculum Guide 21
    • Pareto chart Source: Langley GJ, Nolan KM, Norman CL, Provost LP, Nolan TW. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 1996 Patient Safety Curriculum Guide 22
    • Run chart Average Length of Stay (days) per month 60 50 Made change here days 40 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 m onth Patient Safety Curriculum Guide 23
    • Strategies for sustaining improvement        Document and report each patient Length of Stay ( LOS) Measure and calculate monthly average LOS Place run chart in operating theatre, update run chart monthly Bimonthly team meetings to report positives and negatives Continuously refine the clinical pathways Report outcomes to clinical governance unit Spread - all surgeons - left hemicolectomy - all colectomy surgery - throughout North Coast Area Health Service Patient Safety Curriculum Guide 24