Academic Pediatric Association
QUALITY
IMPROVEMENT
TRAINING:
Module #3
This work is supported by a grant from
The Centers for Disease Control & Prevention.
Initiating a QI project
National Partnership for
Adolescent Immunization
PI: Peter Szilagyi
Coordinators: Christina Albertin, Nui Dhepyasuwan
FACULTY & CONSULTANTS
 Donna D'Alessandro
 William Atkinson
 Ed Marcuse
(communication expert)
 Paul Darden
 Cindy Rand
 Sharon Humiston
 Jan Schriefer (QI expert)
(moderator)
 Keith Mann (QI expert)
 Stanley Schaffer
 Janet Serwint
 William Stratbucker
This is part of the APA series on Quality
Improvement. The examples focus on
adolescent immunization, but the principles
are widely applicable. The series includes:
1. Overview: The Model for Improvement and
2.
3.
4.
5.
6.
Deming’s System of Profound Knowledge
Improvement cycles and the psychology of change
Initiating a QI project
More tools to better understand the system
How will we know that a change is an
improvement? An introduction to QI measurement
Changes we can make that will result in
improvement
Module 3 Objectives
After viewing this segment, you will be
able to:
1. Identify roles and responsibilities of
QI team members
2. Draft an Aim Statement (Describe
your problem, timeline, scope, and
target population)
3. Complete a charter
4. Build a driver diagram
1. Identify roles &
responsibilities of
QI team members
“Including the right people on a process improvement team is critical to
a successful improvement effort.”
Institute for Health Improvement
When putting together a QI team…
 How to choose team members:
 Review the general mission 
What system will be affected by the
improvement efforts?
 Invite members familiar with different
parts of the process
 Size: 5-7 people at most
 Executive sponsor: takes responsibility for
the success of the project
Possible Team Members & Their Roles
 Project sponsor/champion – oversee QI project
(e.g., goal setting, data collection & analysis),
advocate for & find resources to get project done
 Clinical technical expert -- knows the subject
intimately, understands the processes of care
 Day to day leader – plan & deliver all training
needed to implement the project; managing the
implementation and testing the change
 System leader -- advocate
 Other team members – “voice of experience”
 Outsider?
 QI expert if available
Some characteristics that
make a good team member:
 Good knowledge of process, product, and
customer
 Access to data about the process or product
 Willingness to work cooperatively with
other team members
 Ability to devote 3-4 hours/week to data
collection and team meetings
 Ability to challenge the status quo
From The Six Sigma Way: Team Fieldbook
PS Pande, RP Neuman, RR Cavanagh
QUESTION #1
True or False?
When developing your QI team, the
project champion should emphasize that
the project will take almost no time in order
to attract important (i.e., busy) team
members.
QUESTION #1
(Answer)
False!
When developing your QI team, the project
champion should acknowledge that QI
takes time in order to attract team
members prepared for the commitment.
2. Draft an
Aim Statement
AIM Statement
 What are we striving to accomplish
(measurable goal(s))?
 When will this occur? (what is the timeline)?
 How much? What is the specific, numeric
improvement we wish to achieve?
 For whom? Who is the target population?
 Why is it important?
See Jean Meeks on “Developing Clear Aim Statements” at
http://positive-eye.com/2008/12/developing-clear-aim-statements/
QUESTION #2: Name at least 1 component (What,
When, How much, For Whom, Why) that is missing
from each of the following first draft AIM statements.
A. Within the next 12 months we will increase our
first dose HPV vaccination rates by 50%.
B. We will strive to achieve 100% HPV vaccination of
all adolescent patients in our clinic.
C. Between January 1 - June 30, 2014 we will
improve HPV vaccination coverage among our
patients (both males and females) who are 11 or
12 years of age as of January 1, 2014.
QUESTION #2: Name at least 1 component (What,
When, How much, For Whom, Why) that is missing
from each of the following first draft AIM statements.
A. Within the next 12 months we will increase our
first dose HPV vaccination rates by 50%.
Missing: For whom?
B. We will strive to achieve 100% HPV vaccination of
all adolescent patients in our clinic.
Missing: When?
C. Between January 1 - June 30, 2014 we will
improve HPV vaccination coverage among our
patients (both males and females) who are 11 or
12 years of age as of January 1, 2014.
Missing: How much?
A Sample AIM Statement for
HPV Vaccination
How high should we set our goals?
Not so high that it paralyzes people because they
know they can’t succeed
But it shouldn’t be so low that it just barely
exceeds the status quo
“The measure of goodness is as much
improvement as you can possibly accomplish.”
From http://tipqc.org/qi/jit/methods/developing-an-aim-statement/
3.Complete a
charter for the
project
committee
What is in a project charter?
(see template based on http://quality.wisc.edu/project-management-charter.htm)
 AIM Statement (includes goal and timeline)
 Members and their responsibilities
 Meetings
--Timing (e.g., every Tuesday 12:00-12:50,
expectation to start & end on time)
--Who will take notes, document decisions?
Why use a project charter?
 Defines the project and organizes critical
pieces of info about a project in one place
 Emphasizes approval by leadership
 Builds understanding, consensus, and clarity
 Is a living document that evolves using a
structured approach
4. Build a
driver diagram
Driver Diagram
 The system can be described through a
graph called a driver diagram.
 Purpose: to show the factors that
cause an outcome
 The outcome we are interested in is our
Aim, so let’s start there.
Desired Outcome
(Aim)
Improve HPV
immunization rate
from 30% to 80%
in 12 months
Desired Outcome
(Aim)
Primary Drivers
System: The providers have to
remember to order the HPV
vaccine
Improve HPV
immunization rate
from 30% to 80%
in 12 months
Variation: The providers all use
different HPV vaccination
schedules and the nurses
can’t keep them straight
Knowledge: Physicians
don’t know how they are doing
and tend to assume the best
Psychology: A lot of the team
members believe that it’s
better to give HPV vaccine
right before college
(“when sex is more likely”)
Desired Outcome
(Aim)
Improve HPV
immunization rate
from 30% to 80%
in 12 months
Primary Drivers
2ndary Drivers
Desired Outcome
(Aim)
Primary Drivers
Interventions
Use standing orders
Providers forget to order it
Add vaccination to check
list
Use EMR prompt
Improve HPV
immunization from
30% to 80% in 12
months
Nurses can’t remember/guess
who will order
what, when
Agree on standard
schedule
Post standard in clinic
“I’m sure I vaccinate
80% of my patients.”
“Let’s wait.”
Monthly data reviews
Education
Desired Outcome
(Aim)
Primary Drivers
Interventions
Use standing orders
Providers forget to order it
Add vaccination to check
list
Use EMR prompt
Improve HPV
immunization from
30% to 80% in 12
months
Nurses can’t
remember/guess who
will order
what, when
“I’m sure I vaccinate
80% of my patients.”
“Let’s wait.”
Agree on
standard
schedule
Post standard in clinic
Monthly data reviews
Education
QUESTION #3: Match the term on the
left with the phrase on the right.
Graphic display of a system with
the outcome of interest and the
Aim statement major influences on the outcome
An AIM Statement, the team’s
Project charter members and their responsibilities,
expectations for the meetings
Driver diagram A careful description of a desired
outcome with respect to its
importance, the desired
measurable goal(s), the timeline,
the target population
QUESTION #3 (Answer)
A. Driver diagram – Graphic display of a
system with the outcome of interest and
the major influences on the outcome
B. Project charter – An AIM Statement, the
team’s members and their responsibilities,
expectations for the meetings
C. Aim statement – A careful description of a
desired outcome with respect to its
importance, the desired measurable
goal(s), the timeline, the target population
Summary
 QI teams should include 5-6 people familiar with
different parts of the problem plus an executive
sponsor.
 An Aim Statement should explicate the measurable
goal, the timeline, the numeric improvement you
plan to achieve, the target population and why the
issue is important.
 Your team charter should include the AIM
Statement, team members and their
responsibilities, and details of meetings such as
timing and note taking.
 A driver diagram depicts the problem, the primary
drivers, possibly the secondary drivers, and potential
interventions to address the drivers.
The End
of Module #3
IHI. Science of Improvement: How to Improve
http://www.ihi.org/knowledge/Pages/HowtoImprove/
ScienceofImprovementHowtoImprove.aspx