Insert Date here
The Quality Improvement Guide
Presenter:
Insert name of presentation on Master Slide
The Quality Improvement Guide
•
•
•
•
Introduction
The Model for Improvement
Measurement & Reliability
Teamwork & Leadership
The Quality Improvement Guide
The Quality Improvement Guide
• Engaging your audience
• Summary
• Discussion time!
The Quality Improvement Guide
Introduction
The first question:
“How should we set about making this
improvement?”
The Quality Improvement Guide
Introduction
• Will – we must want to improve
• Ideas – we must know what to try
• Execution – we must know how to
change
The Quality Improvement Guide
Introduction - examples
1 ~ reducing risk in primary care
(Based on work done in the 1960s/70s)
2 ~ preventing deaths and injuries due
to road traffic (non-healthcare example)
3 ~ improving stroke care
The Quality Improvement Guide
The Model for Improvement
Based on three key questions:
1. What are we trying to accomplish?
2. How will we know that a change is an
improvement?
3. What change can we make that will result in
improvement?
The Quality Improvement Guide
The Model for Improvement
The Quality Improvement Guide
1 ~ What are we trying to accomplish?
The Quality Improvement Guide
2. How will we know that a
change is an improvement?
• desired outcome identified
• need to identify standard to measure the
outcome against
The Quality Improvement Guide
2. How will we know that a
change is an improvement?
Use a measure which is:
•
•
•
•
well defined
allows comparison between sites and over time
already in use, if possible
specific and sensitive enough to identify and monitor
outcomes
• can be applied to the whole community, population or
system
The Quality Improvement Guide
2. How will we know that a
change is an improvement?
Remember:
Improvement work can go ahead
WITHOUT there being a good outcome
measure, and BEFORE monitoring is
stable
The Quality Improvement Guide
The Quality Improvement Guide
3. What changes can be made
that will result in improvement?
Must link outcome measures to ‘interventions’ –
the systems and processes that achieve the
desired outcome
Two parts to this question –
• “What is wrong with the system now?”
• “What works?”
The Quality Improvement Guide
What is wrong with the system now?
• What will deliver the biggest benefit? What will affect the
things that are done most often or the area where most waste
is incurred.
• What do typical cases tell us about the system?
• Are demand and need understood properly? (How much
demand is repeat work or work caused by another part of the
service?)
The Quality Improvement Guide
What is wrong with the system now?
• What is the high-value part of the system (the part that delivers
real benefit)?
- Is it the same as the part which has the highest costs?
• What can simplify the process?
• How can we use the knowledge of service users and people in
other parts of the process?
The Quality Improvement Guide
What works?
• Need to gather evidence of how a good system
should work.
• Don’t need to go into too much detail.
• Successful change is most likely to be achieved using
simple steps
• Use evidence gathered to produce driver diagrams to
show desired outcomes and ways to achieve them
The Quality Improvement Guide
Driver Diagrams
First column – ‘Aim’ – shows desired outcome (the
simpler the better)
Second column – ‘Drivers’ – shows factors that affect
the outcome
Third column – ‘Interventions’ – shows actions that have
been shown to make a difference and bring about
improvements
The Quality Improvement Guide
Aim
Driver
Intervention
The Quality Improvement Guide
How do we introduce changes to
processes?
•
•
•
•
Plan
Do
Study
Act
The Quality Improvement Guide
PDSA - Plan
• Plan what you are going
to do differently
• Who
• What
• Where
• When
The Quality Improvement Guide
PDSA - Do
Carry out the plan and
collect information on
what worked well and
what issues need
tackling
The Quality Improvement Guide
PDSA - Study
What is the information
telling us?
What worked and what
didn’t?
What should be adopted,
adapted, or abandoned?
The Quality Improvement Guide
PDSA - Act
Use this new knowledge to
plan the next test. Agree
changes / amend outcome
measures if necessary
Continue testing, refining
the procedure or technique
The Quality Improvement Guide
Measurement & Reliability
Use a spreadsheet to count all critical parts
in the process.
Use “process mapping” to convert process
into visual, step-by-step diagram
The Quality Improvement Guide
The 7 Steps to Measurement
The Quality Improvement Guide
The 7 Steps to Measurement
Steps 4 to 6 form the ‘Collect-Analyse-Review’ cycle.
~ Collect information (step 4)
~ Analyse it and convert it into useful
information (step 5)
~ Review the information to see what
decisions need to be made (step 6)
The Collect-Analyse-Review cycle
then starts all over again (step 7)
The Quality Improvement Guide
Measurement best practice
• Use run charts to spot variation
• Frequent measures show reliability of
new processes
• Measure for improvement not judgement
The Quality Improvement Guide
Teamwork & Leadership
The 3 types of leadership you need
• Leadership at an organisational level
• Clinical or technical expertise
• Frontline leadership
The Quality Improvement Guide
Teamwork & Leadership
Attract and keep excellent team members by...
•
•
•
•
Using information to define and solve the problem,
Gathering ‘enthusiasts’
Appointing a local specialist or ‘process owner’
Setting up ‘sub-teams’ if there are several areas to be
covered or specific areas of expertise are needed
The Quality Improvement Guide
Teamwork & Leadership
Changing practice often requires a change
in the organisation’s culture (the beliefs
and assumptions people have about ‘the
way things are round here’).
The Quality Improvement Guide
Teamwork & Leadership
The tasks of leaders
• Setting clear improvement aims
• Monitoring and communicating progress
• Generating and spreading new ideas – encouraging
front line teams to come up with ideas and share them
• Encouragement, praise, celebrating success
The Quality Improvement Guide
Engaging your audience
• Develop language which wins ‘hearts and minds’
• Communicate the improvements and the involvement of those
delivering them
• Develop tools which allow frontline staff and leaders to
understand what needs to be done
• Report on involvement and success
• Maintain momentum to make sure new ways of working are
spread throughout and across organisations.
The Quality Improvement Guide
Engaging your audience – how!
• Identify your audiences and their perspectives
• Craft a key message to convey the work in a short, memorable
statement
• Focus on frontline staff – their views, their success stories – to
encourage more people to get involved
• Develop a ‘brand’ beyond just a logo – consider the ‘tone’ and
emotional impact
• Provide resources for others to spread the message
The Quality Improvement Guide
Summary
• The Model for Improvement provides a
framework for change
• Consult evidence to select the best
interventions to achieve your aims
• Measurements will help you understand
the problem and see whether your
solution is having an effect
The Quality Improvement Guide
Summary
• Teamwork and leadership are both vital
• The commitment to change often requires
a change in culture
• An emphasis on engaging people with a
coherent and urgent key message will
enable change to happen
The Quality Improvement Guide
More information
The Quality
Improvement
Guide
Available to download at
www.1000livesplus.wales.nhs.uk
The Quality Improvement Guide