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Slide1
Health Care Workflow Process Improvement
Quality Improvement Methods
Lecture b
This material (
Comp 10 Unit 8
) was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000024
. This material was updated by Normandale Community College, funded under Award Number 90WT0003.
This work is licensed under the Creative Commons Attribution-
NonCommercial
-
ShareAlike
4.0 International License. To view a copy of this license, visit
http://creativecommons.org/licenses/by-nc-sa/4.0/
Slide2Quality Improvement Methods
Learning ObjectivesDescribe strategies for quality improvement
Describe the role of Leadership in Quality Improvement Describe the local clinic improvement capabilities
Describe and recommend tools for quality improvement
Compare and contrast the quality improvement methodologies and tools and their appropriate uses in the health care setting
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Slide3Organizational Culture
Quality Improvement projects can be aided or impeded by the organizational culture
Organizational Culture factors to considerLeadership
Ability to adapt to change
Communication ability
Understanding of change or need for change
Factors needed for success (Ransom, 2004)
Making quality improvement part of the job
Leadership support is essential for quality improvement activities to succeed
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Slide4Leadership Support
Leaders can enable quality improvement in their health care settings by:
Creating and promoting a quality vision Increasing staff capacity to support quality improvement
Motivating staff to participate in QI projects
Establishing the QI teams
Demonstrating support of use of metrics to measure performance
Making sure that the
‘
voice’ of the patient is heard and acted on
Involving staff and patients
Including QI in the budget
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Slide5Exercise
Identify an area in your life that you would like to improve, such as:
Develop better study habitsGive up smokingEat healthier foods
Think through the challenges you will face, the factors that may influence your success, the steps that you might consider taking to assure success, how you will know if you succeed.
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Slide6Reflection
Reflect on these notes of the challenges you will face, the factors that may influence your success, the steps that you might consider taking to assure success as we review the quality improvement methods and tools.
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Slide7Quality Improvement Methods
Many methods Human-centered and supportive of the implementation of Health IT
Originally tailored for enterprises, not necessarily health care
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Slide8API Improvement Model
Developed by Tom Nolan and Lloyd ProvostSimple model for Process Improvement based on Deming’
s PDSA cycleThree fundamental questions form basis of improvement
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in improvement?
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Slide9Baldrige Criteria and Related Systems
Originally developed and applied to business1987 - Malcolm Baldrige National Quality Award created Public Law 100-107 (1987)
Health care specific criteria (1997)
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Slide10FOCUS-PDCA
1980s – Focus-PDCA modelFind an opportunity for improvement
Organize an effortClarify current understanding
Understand the process variations and capability
Select a strategy
PDCA cycle test the strategy
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Graham, 1995
Slide11PDSA Cycle
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Slide12ISO 9000
International Standards Organization
Components
Design and develop a QI program
S
ociocultural environment Reduce or avoid quality losses
Define QI responsibilities
Develop:
improvement planning processimprovement measurement processimprovement review process
Carry out QI projects
Analyze the facts before you decide to do QI
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Slide13Kaizen
KaizenJapanese for change for the better
Continuous ImprovementThe common English termConnotes ongoing improvement involving everyone
Assumes our way of life deserves to be constantly improved
Includes improvement practices
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Slide14Lean Thinking
Sometimes called the
“Toyota Production System”
Consists of five steps:
Identify which features create value
Identify the sequence of activities, called the value stream
Make the activities flow
Let the customer pull the product or service through the process
Perfect the process
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Slide15Lean Thinking - 2
Lean-thinking
People value the visual effect of flow,Waste is the main restriction to profitability,
Many small improvements in rapid succession are more beneficial than analytical study,
Process interaction effects will be resolved through value stream refinement,
People in operations appreciate this approach, and
Lean involves many people in the value stream.
Flow-thinking
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Slide16Six Sigma DMAIC
D.
Project goals and boundaries are set, and issues are identified that must be addressed to achieve improved quality
M.
Information about the current situation is gathered in order to obtain baseline data on current process performance and identify problem areas
A.
Root causes of quality problems are identified and confirmed with appropriate data analysis tools
I.
Solutions are implemented to address the root causes of problems identified during the analysis phase
C.
Improvements are elevated and monitored. Hold the gains.
http://
www.orielstat.com/lean-six-sigma/six-sigma-dmaic/overview
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Slide17Quality Improvement Tools
Quality Improvement ToolsFlowcharts,
Cause-and-effect diagrams,Statistical Process Control, Pareto charts,
Check lists
Ransom, et al, 2004
©
iStock
photo, used under
license
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Slide18Basic Tools – 1
RUN CHART
IHI, 2017
CONTROL CHART
ASQ, 2017
HISTOGRAM
Laerd
, 2017
SCATTER DIAGRAM
ASQ,
2017
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Slide19Basic Tools – 2
FLOWCHART
Penfield, 2016
CAUSE AND EFFECT DIAGRAM
CHECK SHEETS
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PARETO CHART
Slide20Basic Tools – 3
AFFINITY DIAGRAM
ASQ, 2017
CURRENT REALITY TREE
INTERRELATIONSHIP DIAGRAPH
PEI, 2017
20
Wikipedia, 2017
Slide21Basic Tools – 4
MATRIX DIAGRAM
(Society & Quality,
2017)
(Society & Quality,
n.d.
)
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TREE DIAGRAM
Slide22Basic Tools – 5
PROCESS DECISION PROGRAM CHART
(Society & Quality,
n.d
.
)
(Society & Quality, 2017)
(Society & Quality, 2017)
22
FAILURE MODE AND EFFECTS ANALYSIS
POKA-YOKE
Slide23Basic Tools – 6
CREATIVITY TOOLS
(“File:
MindMapGuidlines.svg
- Wikimedia commons,” 2011)
(Ali &
Bhaskar
, 2016)
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STATISTICAL
TOOLS
DESIGN
TOOLS
(ASQ, 2017)
Slide24Quality Improvement Mistakes
Mistakes in Purpose & Preparation
Error #1: Choosing a subject which is too difficult or which a collaborative is not appropriateError #2: Participants not defining their objectives and assessing their capacity to benefit from the collaborative
Error #3: Not defining roles or making clear what is expected of individuals taking part in the collaborative as faculty or participants
Error #4: Neglecting team building and preparation by teams for the collaborative
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Slide25Quality Improvement Mistakes
Mistakes in Planning and OperationsMistakes in fostering a learning community focused on improvement
Error #5: Teaching rather than enabling mutual learningError #6: Failing to motivate and empower team
Error #7: Not developing measurable and achievable targets.
Mistakes in transition and implementation
Error #8: Failing to learn and plan for sustaining.
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Slide26Quality Improvement Methods
Summary
Quality improvement strategiesQuality improvement tools
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Slide27Quality Improvement Methods
References – Lecture b
ReferencesDe Bono, E. (1985). Six Thinking Hats. Little Brown and Company .
Goldratt
, E. M. (1994). It’s not luck. Great Barrington, MA.: North River Press.
Graham, Nancy O (1995). Quality in health care : theory, application, and evolution. Aspen Publishers, Gaithersburg,
Md
Health Care Criteria for Performance Excellence. (
n.d.). Retrieved from The National Institute of Standards and Technology (NIST) website:
http://www.nist.gov/baldrige/publications/hc_criteria.cfm
ISO
9000. (
n.d.
). Retrieved from
http://www.iso.org/iso/iso_9000
Moen, R. D., & Norman, C. L. (2010, November). Circling Back. Retrieved February 22, 2017, from
ASQ Quality Progress Article entitled Circling Back
NIST, Baldrige Performance Excellence Program, The Malcolm Baldrige National Quality Improvement Act of 1987, Public Law 100-107. (1987, August 20). Retrieved from National Institute of Standards and Technology (NIST), U.S. Department of Commerce website:
http://www.nist.gov/baldrige/about/improvement_act.cfm
Øvretveit
, J, Quality and Safety in Health Care, 2002
Ransom, S. B., Joshi, M. S., & Nash, D. (Eds.). (2004). The Healthcare Quality Book: Vision, Strategy, and Tools (1
ed
). Chicago, IL: Health Administration Press.
Tague
, N. R. (2004). The Quality Toolbox (2nd ed.). Milwaukee, WI: ASQ Quality Press.
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Slide28Quality Improvement Methods
References – Lecture b – 2
Images Slide 16 – Six Sigma DMAIC [diagram]. Retrieved from:
Lean Six Sigma
Orienstat
website
Slide 17 – Measuring your
Success [image
]. Retrieved from: iStockPhoto
website
Slide 18 - Run Chart Tool. (
n.d.
). Retrieved February, 2017, from
IHI Resources Tools Website
Slide 18 - Control Chart. (
n.d.
). Retrieved February, 2017, from
ASQ Website
Slide 18 - Histograms. (
n.d.
). Retrieved February, 2017, from
Laerd
Statistical Guide Website
Slide
18 - Scatter Diagram. (
n.d.
). Retrieved February, 2017, from
ASQ Website
Slide
19:
Penfield, D. (2016). Own work. Retrieved February, 2017 from: Wikimedia websiteSlide 20: Affinity Diagram. (
n.d.
). Retrieved
February,
2017, from
ASQ Website
Slide
20: Current reality tree (theory of constraints). (
2017).
Retrieved
February,
2017, from
Wikipedia website
Slide 20: Province of Prince Edward Island, Canada. (
n.d
.
).
Retrieved
February,
2017, from
Prince Edward Island website
Slide
21:
Society, A., & Quality. (2017). Decision matrix. Retrieved
February,
2017, from
ASQ website
Slide 21: Society, A., & Quality. Tree diagram. Retrieved
February,
2017, from
ASQ website
Slide 22: Society, A., & Quality. Process decision program chart (PDPC). Retrieved
February,
2017, from
ASQ website
Slide 22:
Society, A., & Quality. (2017). Failure mode effects analysis (FMEA). Retrieved
February,
2017, from
ASQ Website
Slide
22:
Society, A., & Quality. (2017). Mistake Proofing. Retrieved
February,
2017, from
ASQ website
Slide 23:
File
:
MindMapGuidlines.svg
- Wikimedia commons. (2011, June 7). Retrieved
February, 2017
, from
Wikimedia
website
Slide 23: Ali, Z., &
Bhaskar
, S. B. (
2016).
Basic statistical tools in research and data analysis. Retrieved
February,
2017, from
NIH website
Slide 23: What is Quality Function Deployment (QFD)? (
n.d.
). Retrieved February, 2017, from
ASQ website
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Slide29Quality Improvement MethodsLecture b
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024. This material was updated by Normandale Community College, funded under Award Number 90WT0003.
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