QI theories relevant to PPE compliancePresentation Transcript
PDSA and Peer Review Theories
Plan, Do, Study, Act Used for continuous improvement As it is a cycle it requires constant changes to the ongoing processDiagram taken fromhttp://www.iso9001consultant.com.au/PDCA.html
Plan: Recognize the need for change and plan it. Do: Test the change initiative by carrying out a small-scale study. Study: Review the study, the results and identify what you have found. Act. Take action based on the above: If it was not successful, redo the cycle focusing on a different area. If it was successful, incorporate what you learned to plan new improvements, and begin the cycle again.Adapted from the American Society for Quality’s Project Planning and Implementing Tools paper.
“Plan-do-study-act cycles as an instrument for improvement of compliance with infection control measures in care of patients after cardiothoracic surgery” Van Tiela, F.H., Elenbaasb, T.W.O., Voskuilenc, B.M.A. M., Herczega, J., Verheggend, F.W., Mochtarb, B., & Stobberingh, E.E. (2006). Journal of Hospital Infection, 62,(1).
Plan: 1. Identify potentially modifiable risk factors for wound infections in patients after cardiothoracic surgery. 2. Develop a pragmatic strategy to modify or prevent the occurrence of these risk factors. Do: 1. Collect baseline data, e.g. rates of compliance regarding the chosen indices of correct procedure (baseline measurement). 2. Carry out the planned intervention strategy. 3. Collect basic data, e.g. rates of compliance regarding the chosen indices of correct procedure (follow-up measurement). Study: 1. Analyse data. 2. Summarize the results. 3. Identify problems in the implementation of the designed intervention. Act: 1. Determine the overall success or failure of the intervention. 2. Identify potential modifications to improve the intervention strategy. 3. Update the intervention with solutions for the identified problems. 4. Prepare for the next PDSA cycle.
Theshort answer is “Yes”, although continuous monitoring would need to be implemented, possibly through peer reviews, and further education. Clipart taken from: http://www.istockphoto.com/stock- illustration-6514236-clipboard-list.php
Failing to complete the STUDY and ACT step Failing to complete the whole cycle Completing the plan but not implementing it.
Peer review is synonymous with, but not limited to, retrospective medical record review. Among other methods, cases are identified through generic screens for adverse events. Peer review is conducted in committees.
Medical Peer Review: negligence and misconduct issues >Nursing peer review
“The Health Care Quality Improvement Act of 1986 is, ostensibly, meant to protect the public from incompetent physicians by allowing those physicians on peer review committees to communicate in an open and honest environment and thus weed out incompetent physicians, without the specter of a retaliatory lawsuit by the reviewed physician. However, the consequences of the Act have instead helped promote an environment that protects those physicians on a peer review committee when they distort the review process for their own gain, by maliciously disciplining those physicians that may be in political or economic competition.” Hall, B.J. (2011). The Health Care Quality Improvement Act of 1986 and Physician Peer Reviews: Success or Failure? Retrieved from: http://www.usd.edu/elderlaw/student_papers_f2003/health_care_quality_improvement _act.htm
No supervision “reasonable belief” standard No effective oversight of hospital peer review proceedings to protect the physician and ensure that peer review decisions are evidence based. Possible inappropriate personal motives
According to Kinney, E.D. (2009). Rigorous adherence to established principles of procedural due process in the design of peer review proceedings that are eligible for HCQIA immunity. Establish higher standards for the evidence that must be demonstrated to meet the “reasonable belief” standard. Ensure that hospitals’ conduct of inappropriate peer review proceedings are subject to consequences that are effective deterrents to the abuse of peer review. Provide more effective oversight of hospital peer review proceedings to ensure more accountability from the hospital and participating physicians that peer review proceedings are fair and accurate.
Committees would need to be set up Greater accountability needs to be taken by the hospital and the committee External committees Further trainings Non-compliance issues dealt with