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INTRODUCTION TO QUALITY
IMPROVEMENT
Learning Objectives
By the end of this session, participants will be able to:
Be
Define quality;
Define
Define the science of quality improvement;
Define
Describe common quality improvement approaches;
Describe
Develop Develop a problem statement
OUTLINE
Conceptualizing Quality
Defining Quality Improvement
Common QI Principles and Processes
Problem Statement
DEFINING QUALITY (AHCRQ)
Doing the
right thing
At the right
time
In the right
way
To achieve the
best possible
results
The gap between
what we can do
and what we
actually do
THE “KNOW –
DO GAP”
WHAT WE KNOW VS. WHAT WE DO
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14
What We Do
Know–Do Gap
What We Know
WHERE WE ARE VS. WHERE WE SHOULD BE
Quality Gap
Where we should be
DEFINING QUALITY IMPROVEMENT
QI is a systems approach that applies the scientific
method to the analysis of performance and
systematic efforts to improve it
DEFINING QUALITY IMPROVEMENT CONT…..
It requires a systematic,
ongoing process that uses
performance data to
measure quality changes.
“THE SCIENCE OF IMPROVEMENT”
Is grounded in testing and learning cycles
It’s pragmatic and based on experience
It combines psychology and logic
Requires the use of operational definitions
Understands process variation
10
- Adapted from Perla et al., 2013
The CQUIN Project
• Client Focus
• Team Approach
• Leadership Commitment
• Focus on Processes
• Systems Thinking
• Data Driven
• Continual Improvement
COMMON PRINCIPLES OF QI
The CQUIN Project
• Establish a QI team
• Define the problem
• Set overall improvement priority
• Define measures and collect data
• Develop and test changes
• Measure change
• Continuous cycles
COMMON QI PROJECT STEPS
Rich Picture, Five Whys, Process Map, Fishbone Diagram,
Baseline Data
Driver Diagram, Focusing Matrix/ Pareto Diagrams
Family of Indicators, Run Charts, Control Charts
Quality Improvement Tools
Under-
Standing the
problem
Prioritizing
solutions
Testing
change
ideas
Measure Change:
Family of Indicators
QI
TOOL BOX
APPROACH
Understand
Complexity of Quality
Challenge:
Rich Picture
Develop
Change Ideas:
Driver Diagram
Prioritize Problems
and Solutions:
Focusing Matrix
Pareto Charts
Find Root Causes:
RCA
Fishbone Diagram
Process Map
Translate Data into
Information:
Run Charts
THE MODEL FOR IMPROVEMENT
AIM
What are we trying
to accomplish?
MEASUREMENT
How will we know if
a change is an
improvement?
CHANGE
What changes can
we make to result in
improvement?
Act Plan
Do
Study
- Langley G, Nolan T, Norman C, Provost L (1996) The Improvement Guide
Performance Improvement Framework vs
Plan-Do-Study-Act Cycle
Plan Do
Study & Act
REPEATED USE OF PDSA CYCLE
Changes
that
lead
to
improvement
Wider-scale
tests of change
PLAN
DO
STUDY
ACT
PLAN
DO
STUDY
ACT
Small-scale
tests of
change
PLAN
DO
STUDY
ACT
PLAN
DO
STUDY
ACT
Implementation
at scale
End Goal
National, Regional or
International
Accreditation Body
THE STEPWISE APPROACH
55-64%
65-74%
75-84%
85-94%
≥95%
Zero
Stars
One
Star
Two
Stars
Three
Stars
Four
Stars
Five Stars
Problem Statement Definition
• A clear and concise statement that describes the symptoms of a
problem to be addressed
• Describes the scope and impact of a problem
• Generally, includes a brief description of the problem as well as
supporting data on:
 Where the problem is occurring
 Time frame
 Size of the problem
 Topic
The CQUIN Project
The Problem Statement
Effective problem solving begins
with a good problem statement
Describes the problem, its scope
and impact
Problem Statement Purpose
• Creates a sense of ownership for teams
• Serves as both an internal and external communication
tool for QI teams
• Describes the “symptoms” in measurable terms
• Drives the Root Cause Analysis (RCA) process
Key Questions in Developing Problem Statement:
Problem, Scope, and Impact
 Size/scope of the problem?
 Where is it happening?
 What is the time frame?
 What is the impact?
22
Problem Statement
• Does NOT include the causes
• Does NOT include the actions or corrections required
• Does NOT assign blame
• Does NOT address more than one problem
Do these include the key elements of a
strong problem statement?
• Partner X does not meet their targets
• Waiting times are too long
• There are many errors in our data
• Partner Y’s reports are always late and incomplete
because there is a lot of turn over in their staff
24
Example 1: High School
Dropout
• “The high school dropout rate in our community has risen by 20%
over the past two years, negatively impacting our future workforce”.
• Does this include the key elements of a strong problem statement?
Example 2: Low CTX Coverage
• “Over the past 2 years, only 50% of HIV- exposed infants at the 22
health facilities supported by implementing partner X were
prescribed CTX by the time they were 6 weeks- old, leading to
avoidable morbidity and mortality.”
Does this include the key elements of a strong problem
statement?
The CQUIN Project
QUESTIONS?

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Introduction to Quality Improvement Essentials

  • 2. Learning Objectives By the end of this session, participants will be able to: Be Define quality; Define Define the science of quality improvement; Define Describe common quality improvement approaches; Describe Develop Develop a problem statement
  • 3. OUTLINE Conceptualizing Quality Defining Quality Improvement Common QI Principles and Processes Problem Statement
  • 4. DEFINING QUALITY (AHCRQ) Doing the right thing At the right time In the right way To achieve the best possible results
  • 5. The gap between what we can do and what we actually do THE “KNOW – DO GAP”
  • 6. WHAT WE KNOW VS. WHAT WE DO 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 What We Do Know–Do Gap What We Know
  • 7. WHERE WE ARE VS. WHERE WE SHOULD BE Quality Gap Where we should be
  • 8. DEFINING QUALITY IMPROVEMENT QI is a systems approach that applies the scientific method to the analysis of performance and systematic efforts to improve it
  • 9. DEFINING QUALITY IMPROVEMENT CONT….. It requires a systematic, ongoing process that uses performance data to measure quality changes.
  • 10. “THE SCIENCE OF IMPROVEMENT” Is grounded in testing and learning cycles It’s pragmatic and based on experience It combines psychology and logic Requires the use of operational definitions Understands process variation 10 - Adapted from Perla et al., 2013
  • 11. The CQUIN Project • Client Focus • Team Approach • Leadership Commitment • Focus on Processes • Systems Thinking • Data Driven • Continual Improvement COMMON PRINCIPLES OF QI
  • 12. The CQUIN Project • Establish a QI team • Define the problem • Set overall improvement priority • Define measures and collect data • Develop and test changes • Measure change • Continuous cycles COMMON QI PROJECT STEPS
  • 13. Rich Picture, Five Whys, Process Map, Fishbone Diagram, Baseline Data Driver Diagram, Focusing Matrix/ Pareto Diagrams Family of Indicators, Run Charts, Control Charts Quality Improvement Tools Under- Standing the problem Prioritizing solutions Testing change ideas
  • 14. Measure Change: Family of Indicators QI TOOL BOX APPROACH Understand Complexity of Quality Challenge: Rich Picture Develop Change Ideas: Driver Diagram Prioritize Problems and Solutions: Focusing Matrix Pareto Charts Find Root Causes: RCA Fishbone Diagram Process Map Translate Data into Information: Run Charts
  • 15. THE MODEL FOR IMPROVEMENT AIM What are we trying to accomplish? MEASUREMENT How will we know if a change is an improvement? CHANGE What changes can we make to result in improvement? Act Plan Do Study - Langley G, Nolan T, Norman C, Provost L (1996) The Improvement Guide
  • 16. Performance Improvement Framework vs Plan-Do-Study-Act Cycle Plan Do Study & Act
  • 17. REPEATED USE OF PDSA CYCLE Changes that lead to improvement Wider-scale tests of change PLAN DO STUDY ACT PLAN DO STUDY ACT Small-scale tests of change PLAN DO STUDY ACT PLAN DO STUDY ACT Implementation at scale
  • 18. End Goal National, Regional or International Accreditation Body THE STEPWISE APPROACH 55-64% 65-74% 75-84% 85-94% ≥95% Zero Stars One Star Two Stars Three Stars Four Stars Five Stars
  • 19. Problem Statement Definition • A clear and concise statement that describes the symptoms of a problem to be addressed • Describes the scope and impact of a problem • Generally, includes a brief description of the problem as well as supporting data on:  Where the problem is occurring  Time frame  Size of the problem  Topic
  • 20. The CQUIN Project The Problem Statement Effective problem solving begins with a good problem statement Describes the problem, its scope and impact
  • 21. Problem Statement Purpose • Creates a sense of ownership for teams • Serves as both an internal and external communication tool for QI teams • Describes the “symptoms” in measurable terms • Drives the Root Cause Analysis (RCA) process
  • 22. Key Questions in Developing Problem Statement: Problem, Scope, and Impact  Size/scope of the problem?  Where is it happening?  What is the time frame?  What is the impact? 22
  • 23. Problem Statement • Does NOT include the causes • Does NOT include the actions or corrections required • Does NOT assign blame • Does NOT address more than one problem
  • 24. Do these include the key elements of a strong problem statement? • Partner X does not meet their targets • Waiting times are too long • There are many errors in our data • Partner Y’s reports are always late and incomplete because there is a lot of turn over in their staff 24
  • 25. Example 1: High School Dropout • “The high school dropout rate in our community has risen by 20% over the past two years, negatively impacting our future workforce”. • Does this include the key elements of a strong problem statement?
  • 26. Example 2: Low CTX Coverage • “Over the past 2 years, only 50% of HIV- exposed infants at the 22 health facilities supported by implementing partner X were prescribed CTX by the time they were 6 weeks- old, leading to avoidable morbidity and mortality.” Does this include the key elements of a strong problem statement?