A crash course in Quality Improvement Methods
Jane Runnacles Consultant Paediatrician, Royal Free London Co-lead for QI Education, RCPCH
DATE PATRON...
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.
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