A crash course in Quality Improvement Methods

Jane Runnacles Consultant Paediatrician, Royal Free London Co-lead for QI Education, RCPCH

DATE PATRON HRH The Princess Royal

What is Quality?

Timely

Effective

Equitable

is the service accessible?

are we giving the same treatment every time?

Are the service and outcome equal for all ?

Efficient

Safe

do we get value?

are we harming children?

Experience Is the service child friendly and patient centred?

The Berwick report A promise to learn- a commitment to act

Fostering whole-heartedly the growth and development of all staff, including their ability and support to improve the processes in which they work.

The Model for Improvement

Plan-Do-Study-Act

Small tests of change • October sky movie • What lessons can you apply to your QI projects?

Improvement

Small tests of change

Hunches theories ideas

A P

Changes that result in improvement

S D

A

P

S

D

Start small

Time

QI Tools

• • • • •

Driver diagrams SMART aims Process mapping Run charts Stakeholder mapping

Your Aim

• • • • •

Specific Measurable Attainable Relevant Time Specific

Understanding the process • Data will not explain why the problem exists! • Process mapping reveals: – – – –

Unnecessary delays Waste/duplication of effort Things that don’t make sense Bottlenecks

Data for Improvement

Understand types of measurement Aspect

Improvement

Research

Improvement of care

New knowledge

Test observable

Test blinded or controlled

Accept consistent bias

Design to eliminate bias

• Sample Size

“Just enough” data, small sequential samples

“Just in case” data

• Flexibility of Hypothesis

Hypothesis flexible, changes as learning takes place

Fixed hypothesis

• Testing Strategy

Sequential tests

One large test

• Determining if a Change is an Improvement

Run charts or Shewhart control charts

Hypothesis, statistical tests (t-test, F-test, chi square), p-vlaues

• Confidentiality of the Data

Data used only by those involved with improvement

Research subjects’ identities protected

Aim Methods: • Test Observability • Bias

Solberg, L.I., G. Mosser, and S. McDonald. The three faces of performance measurement: Improvement, accountability and research. The Joint Commission Journal on Quality Improvement. 23:135–147, 1997

Dynamic View

UCL

Static View

time

LCL

Static View Standard Deviation

90% of the tools available for NHS change agents are designed for the “action” stage The reality of our change situation • It’s hard to engage people in change • It’s hard to get people to make the changes we want them to make • People get irritated, defensive, irrational • We feel powerless in our ability to lead or facilitate the change

"There’s only one corner of the universe you can be certain of improving, and that’s your own self." Aldous Huxley

Framing Is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action Snow D A and Benford R D (1992)

If we want people to take action, we have to connect with their emotions through values values

emotion

action

Source: Marshall Ganz

What do we need to do?

1. 2. 3. 4.

Tell a story Make it personal Be authentic Create a sense of “us” (and be clear who the “us” is) 5. Build in a call for urgent action

Outwitted He drew a circle that shut me out Heretic, rebel, a thing to flout. But Love and I had the wit to win: We drew a circle that took him in.

Edward Markham

RCPCH QI Education Programme Introduction to QI & Patient Safety • • • • •

London Portsmouth Birmingham Manchester East of England

Leading and Supporting QI • London • Wessex • Belfast Faculty Training Day • London 23rd October

Resources

• • • • • •

Equipped papers in Archives Ed&Practice Health Foundation The King’s Fund NHS Institute for Innovation and Improvement IHI (www.ihi.org) Running Horse Group