How to Design a Quality
Improvement Project
Kendiss Olafson MD FRCPC MPH
Assistant Professor
Section of Critical Care
University of Manitoba
What is Quality Improvement?
• Quality improvement is a formal approach to
the analysis of performance and systematic
approach to improving it.
Institute of Medicine
To Err is Human (1999)
• Brought issue of patient safety and medical
errors to for front
• 2% of all deaths are due to preventable
medical errors
Crossing the Quality Chasm (2001)
• Urgently calls for changes to health care
processes to improve quality of care
• Sets up framework for healthcare quality
improvement
• Brings importance of patient and family
centered healthcare to frontline
Quality Improvement versus Research
Traditional Research
Quality Improvement
• Goal is to attain new
generalizable
knowledge
• Trial new methods
• Data for publishing
• Goal to improve care
• Based in established
knowledge and applying
this to local site
• Data internal use
(usually but not always)
How to Design a Quality Improvement
Project
1) Identify Gap in Care
Quality of Care Indicators (STEEPS)
SAFE
• Hospital Acquired Infections
C. Dificle, CLI, Post-op Infection)
• Medication Errors
TIMELY
• Waiting times (See specialist, start chemo)
EFFECTIVE
• Patient Mortality
• Organ Donation rates
• ASA use post MI
EFFICIENT
• Hospital LOS
• Health care Costs
• Patient/Family Satisfaction
PATIENT-CENTERED
(FAMILY CENTERED)
STAFF WORKLOAD
• Staff turnover and burn out
(VAP,
How to Design a Quality Improvement
Project
1) Identify Gap in Care
2) Review Literature – Identify
Evidence based practices
Use Pre-existing Bundles and
Toolboxes
How to Design a Quality Improvement
Project
1) Identify Gap in Care
2) Review Literature – Identify
Evidence based practices
3) Quality Improvement Tools
Quality Improvement Strategies
•
•
•
•
Continuous Improvement (PDSA)
Total Quality Management
Six Sigma
Lean
Quality Improvement Tools
•
•
•
•
Process map
Cause-Effect Diagram
Pareto Chart
Control Charts
• Scatter Diagram
• Fishbone Diagram
• Decision Matrix
Strategies and tools to help organize, analyze and impact
change within a process
Develop protocols
and Bundles of Care
Educate
and
Engage
Reminders
and
Forced
Function
• Antibiotic Auto-stop
• Automatic orders
• Surgical Checklists
Address
Infrastructure
Audit
and
Feedback
• Workplace Design
• Equipment
• Human Resources
How to Design a Quality Improvement
Project
1) Identify Gap in Care
2) Review Literature – Identify
Evidence based practices
3) Quality Improvement Tools
4) Measuring Impact
Quality Improvement Studies
Challenges to Measuring Impact
• Involves Healthcare Systems and Health Care
Delivery Not just single intervention
– Randomized Controlled trials of Health care
systems
• Multiple interventions are tested over time
– Empiric Research with repeated measurements
over time
Traditional Medical Research
Time Consuming
Expensive
Intervention
Measure
Outcome
Data collection
Time
Only One intervention tested
Measure
Outcome
Data collection
Measure
Differences
in
Outcomes
Measure
Difference
Intervention
Measure
Difference
Intervention
Intervention
HOW ?Model
Quality Improvement
Data collection and Measuring Outcomes
Time
Measure
Difference
Statistical Process Control
Manufacturing
Process required to
make a nut and bolt
Healthcare
Process required to
make a sick person well
• Statistical Process Control measures the variation
associated with the outcome of a process
Statistical Process Control
Type of Illness
Health Care Workers
Severity of Illness
Resources
Co-morbidities
Treatment given
Demographics
Complications occurring
Variation in
Outcomes
Process required to
make a sick person well
• Differentiate common cause variation from extraordinary
variation
Goal is to optimize outcomes:
• Identify extraordinary variation early and act on it
• Limiting variation associated with a process
Creating a Quality Improvement Project
1) Identify Gap in Care
2) Review Literature –
Identify Evidence based
practices
3) Quality Improvement
Tools
4) Measuring Impact