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QI 100 for Health Care Clinicians
Unit 4:
Health Care Change Systems
Aligning Forces for Quality is supported by the Robert Wood Johnson Foundation, through a grant to the
Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning Forces for Quality is a joint project by the
Wisconsin Collaborative for Healthcare
Quality, the Wisconsin Hospital Association, and other organizations.
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QI
100
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of Engagement
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Please read carefully:
1. This powerpoint must be in “Slide Show” mode in order for all links to be active (see
the Slide Show menu at the top of your screen).
2. You must complete this unit in one sitting. You will not be able to exit and re-enter
from where you left off.
3. This unit has three exercises and a five question quiz at the end. You must complete
the quiz to get credit for Unit 4. You will be asked to enter your name.
4. CEU’s will be awarded after you have taken all five units and completed the
Capstone Quiz – a link to this quiz is given in Unit 5.
5. The content provided in this unit is for educational purposes only and is not to be
interpreted as an endorsement by WHA or any of it’s member or partner
organizations.
6. This learning series is supported by the Aligning Forces for Quality grant. Aligning
Forces for Quality is supported by the Robert Wood Johnson Foundation, through a
grant to the Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning
Forces for Quality is a joint project by the Wisconsin Collaborative for Healthcare
Quality, the Wisconsin Hospital Association, and other organizations.
7. If you have questions or problems please e-mail: ssobczak@wha.org
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Unit 1
• Why Quality Matters
Unit 2
• Participating in Improvement
Unit 3
• Holding the Gains
Unit 4
• Health Care Change Systems
Unit 5
• Capstone & Credit
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Introduction
to Unittitle
4 style
You are about to participate in the QI 100 Unit 4:
Health Care Change Systems
• Learn the difference between specific improvement and
system improvement
• Learn about the various systemic change approaches in health
care.
• Understand your role as a clinical staff person in systemic
approaches.
• Describe the relationship between systemic improvement
approaches and quality improvement efforts.
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Getting
Credit
Master
for Unit
title4 style
• When you see a light bulb icon, you can access a brief
exercise to reinforce the concept. Simply click on the
light bulb.
• When you see a screen icon, you should access a quiz
to test your knowledge. Simply click on the screen
icon.
• When you are done with an exercise simply close the
page by clicking the X or
at the top of the page.
• In order to officially participate in this unit, and receive
continuing education credit, you need to complete the
Unit 4 quiz.
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5
QI
vs. System
The Difference
Click
to editImprovements:
Master title style
What is a Health Care Change System, and how is it different
from improvement approaches such as PDSA or Lean?
Quality Improvement is a set of approaches and methods that
address a specific issue or a specific problem.
To influence the pace of change, health care organizations
sometimes engage in system-wide improvements to address
multiple opportunities for improvement at the same time.
To better illustrate the difference, let’s review the concept of
Systems Thinking.
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About
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Thinking
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What is Systems Thinking?
•
•
•
•
Systems thinking is the ability to see and analyze the many influences on an outcome.
It is an approach to problem solving by viewing "problems" as parts of an overall
system rather than reacting to present outcomes or events and implementing
solutions that potentially contribute to the undesired issue or problem.
Systems thinking requires an understanding of the linkages and interactions between
the elements, or parts, that make up the system.
Systems thinking acknowledges that an improvement in one area of a system can
adversely affect another area of the system, so it also promotes organizational
communication at all levels in order to avoid the silo effect.
Systems vs. Linear Thinking
Systems Thinking – all connected processes is the primary focus and the a single process is secondary.
vs.
Linear Thinking – one process or parts of a process are the primary focus and the whole is secondary .
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The
Difference:
vs. System
Improvements
Click
to editSpecific
Master
title style
Specific Improvements:
• One issue
• One or a few areas/depts.
• Weeks or Months
• Involves primarily
management & staff
• Internal recognition
• Effort of a few
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System Improvements:
• Many connected issues
• Whole organization
• Years
• Involves executives, the
board, management
& staff
• Public recognition
• Effort of many
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Click is
Why
tothis
editimportant?
Master title style
Many opportunities for improvement result from a
problem in the system of processes that produce the
result.
For example, let’s look at the issue of limited access to
primary care in one county:
A linear approach to the problem might look like this:
Poor access
Need more doctors
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Hire more doctors
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Click
A
Systems
to editView
Master title style
A systems view of
the same problem
would look like
this….
You can see how
acting on a linear
approach could
result in
unintended
negative effects.
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Specific
Systemic?
Click to or
edit
Master title style
Exercise #1 :
Try this brief exercise to reinforce the concept of
systemic improvement.
Are these improvements specific or systemic?
Just click on the light bulb 
Choose the answer from the pop up list.
When you are done, simply close out by clicking the X or
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at the top.
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Systemic
Change
Master
Approaches
title style
When an organization chooses to move forward
with a more comprehensive approach to
improvement, there are a number of health
care models to choose from.
Let’s review the most commonly chosen
models and how each might influence
a staff person’s role.
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Click to edit
Magnet
Recognition
Master title
® style
What is it?
The Magnet Recognition Program® was developed by the American Nurses
Credentialing Center (ANCC) to recognize health care organizations that
provide nursing excellence. The program also provides a vehicle for
disseminating successful nursing practices and strategies. The Magnet
Recognition Program is based on quality indicators and standards of
nursing practice.
Successfully implementing the Magnet criteria embodies a professional
environment guided by a strong visionary nursing leader who advocates
and supports development and excellence in nursing practice.
What does it mean for a staff person?
• More involvement in decisions about patient care practices.
• Opportunity to serve on a council.
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Malcolm
Baldrige
National
Quality
Award
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(MBNQA)
What is it?
The Baldrige Award is given by the President of the United States to businesses—
including health care – that apply and are judged to be outstanding in seven
areas: leadership; strategic planning; customer and market focus; measurement,
analysis, and knowledge management; workforce focus; process management;
and results.
Success is not based on meeting standards, but in achieving an demonstrating
excellent results for patients & families and the stakeholders in the business.
The U.S. Commerce Department’s National Institute of Standards and Technology
(NIST) manages the Baldrige National Quality Program.
What does it mean for a staff person?
• A comprehensive understanding of the whole organization and its processes.
• More involvement in planning and measurement.
• More emphasis on the patient as a customer of the organization.
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Transforming
Care
at
the
Bedside
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(TCAB)
What is it?
TCAB program is based on the original collaboration between the Robert
Wood Johnson Foundation (RWJF) and the Institute for Healthcare
Improvement (IHI), and coordinated with the American Organization of
Nurse Executives (AONE).
In 2003, through an initiative called Transforming Care at the Bedside
(TCAB), these organizations created a framework for change on
medical/surgical units built around improvements to the four main
themes of TCAB — Safe and Reliable Care, Vitality and Teamwork,
Patient-Centered Care, and Value-Added Care Processes.
What does it mean for a staff person?
• Involvement in multiple improvement pilots, sharing feedback about pilot results,
and assisting in the decision-making process.
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Click to Centered
Patient
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Medical
title style
Home
What is it?
The Patient-Centered Medical Home (PCMH) has been developed over several
years by the American College Physicians, American Academy of Family
Physicians, American Academy of Pediatrics and American Osteopathic
Association and other organizations.
The aim is to assess whether physician practices are functioning as a health care
setting which facilitates partnerships between individual patients, and their
personal physicians, and when appropriate, the patient’s family.
Building on the joint principles developed by the primary care specialty societies,
it is based on the use of systematic, patient-centered, coordinated care
management processes.
What does it mean for a staff person?
Increased attention to coordination of care and improvement.
• Use of technology to achieve consistency for all patients.
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Click to Governance
Shared
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What is it?
The Shared Governance model is an organizational structure in which clinical nurses
have a voice in determining nursing practices, standards and quality of care with a
focus on providing high quality and cost-effective nursing care, to establish and
monitor standards of clinical practice, and to promote excellence in professional
performance among the nursing staff .
Within the Shared Governance model, nurses have a defined way to communicate
concerns and work toward solutions through a series of councils.
Shared Governance is characterized by clear accountability for decisions. It is not
organized by any specific managing or professional organization.
What does it mean for a staff person?
• More involvement in clinical care planning, and decision-making about changes in
processes and practice in the clinical care areas by the direct patient care staff.
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informationhere…
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Click to Collaboratives
Clinical
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What is it?
Clinical Collaboratives are designed to enhance improvement efforts through shared
learning in a model where a variety of organizations work with each other to
rapidly test and implement changes that lead to lasting improvement.
A Collaborative is typically a short-term effort is designed to help organizations close
the gap between knowledge of effective practices and implementation of those
practices.
The Institute for Healthcare Improvement (IHI) is one national organization
promoting this model. States like Wisconsin have also used this model
successfully to implement standardized practices and clinical improvements. An
example of this is the effort to standardize wrist bands in Wisconsin.
What does it mean for a staff person?
• Staff may be involved in learning a new method, assisting with measurement or
tracking during the trial, and implementing changed practices while learning
alongside other health care organizations.
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Click to
More
About
edit Master
These Models
title style
Exercise #2:
Learn more about one of these programs by clicking
on the light bulb to the left.
ANCC Magnet Recognition
Malcolm Baldrige National Quality Award
Transforming Care at the Bedside
Shared Governance
The Medical Home
Clinical Collaboratives
When you are done, simply close out by clicking the X or
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Click to
What
about
edit Master
the Jointtitle
Commission?
style
The Joint Commission is an accrediting organization. Accreditation has been defined as
"A self-assessment and external peer assessment process used by health care
organizations to accurately assess their level of performance in relation to
established standards“.
In the first part of the 20th century, there was concern over how to best create an
appropriate environment in which clinicians work. Specific standards to better
control the hospital environment were generated, and these subsequently grew into
accreditation schemes with the overarching goal for hospitals to achieve a baseline
standard of care consistently present across facilities.
In contrast, systemic improvement approaches, such as those we have reviewed, are
not tied to reimbursement or other requirements. They are adopted as a voluntary
effort with aims such as achieving excellence in business, clinical excellence, being
an employer of choice, achieving national recognition, or other goals beyond
standards based performance.
(The Joint Commission recently adopted Lean as it’s internal improvement approach.)
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Click QI
How
to edit
relates
Master
to system
title style
change
One might ask, “Why would my organization participate in
Magnet or Baldrige, if we already use PDSA to improve?”
There may be a need or desire to improve beyond meeting state
regulatory requirements or achieving accreditation standards,
and specific methods to improve (such as Six Sigma) are
important components under any systemic change approach.
A facility can have a defined improvement method without a
systemic change approach, but a systemic change approach
would be much less effective without defined improvement
methods to go along with it.
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Click to
Most
importantly…
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A key takeaway is that you, and your
participation in improvement, is
important to make a difference for
everyone!
It’s easy to miss ‘the big picture’ in the
‘busyness’ of the day to day work, but you are
connected to the mission and vision of your
organization. Let’s review an example:
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Line
of Sight
– Connect
thestyle
“big picture”
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to edit
Master to
title
This is what an organization does …
Everyone has
a role in
“the big picture”.
Just look for
the connections!
 This
is you
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Click 4toSummary
Unit
edit Master
Quiz
title style
Congratulations!
You have completed Unit 4:
Health Care Change Systems
You can now test what you have learned by taking a short 5
question assessment.
Simply click on the screen icon 
**Please note: You must take the assessment to get full credit
for Unit 4
When you are done, simply close out by clicking the X or
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Click 4toResources
Unit
edit Master title style
Baldrige Framework http://www.baldrige21.com/Baldrige%20Criteria%202009.html
Using a Malcolm Baldrige framework to understand high performing clinical microsystems. Tina C Foster, Julie K
Johnson, et al. Qual Saf Health Care 2007;16:334–341.
http://www.thesystemsthinker.com/
http://sharedgovernance.org/
http://nursecredentialing.org/Magnet.aspx
http://www.ihi.org/IHI/Programs/StrategicInitiatives/TransformingCareAtTheBedside.htm
http://www.ihi.org/IHI/Programs/Collaboratives/
http://www.ncqa.org/tabid/631/Default.aspx
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