Silverman Symposium Process Improvement Project Summary Workshop
Kathy Murray, Director, Process Improvement, HCQ Jason Laviolette, Project Manager, HCQ Margaret Bernier, Project Manager, HCQ
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Workshop Objectives • • • •
Be more familiar and confident with the Process Improvement Project Summary Template Have a better understanding of the Project Summary content guidelines Prepare an initial draft of your Project Summary Identify Quality resources available for follow-up support
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Why a Project Summary Template? • • •
Provides a structured outline Helps to focus on the key data, actions and results You only need to write one page!
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Using the Template •
Download the template from the portal at
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Make sure you are viewing the poster in the Print Layout mode (Top Menu Bar “View”, “Print Layout”)
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Enter the Poster Title in the header area by double clicking in the header area.
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Identify a Primary Contact for the project team, and enter that individual’s name and brief credentials, and e-mail address in the space provided at the footer.
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Enter the content of your project into each of the sections. Templates are temperamental. Often, it is best to write the content out and wordsmith in a separate document, then “cut and paste” into the Project Summary template.
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Don’t change the font or line spacing—write as concisely as possible to fit into the space.
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Remember to save your work and rename the file with your project’s name.
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HCQ resources can help if needed.
http://home.caregroup.org/templatesnew/links/cat_out.asp?pageid=8423
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In addition to the PI Project Summary Template, you will find Guidelines and Instructions. http://home.caregroup.org/templatesnew/departments/BID/HCQ/uploaded_documents/PI%20Pro ject%20Summary%20Template.dot
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The Template
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The Problem or Opportunity Statement •
Describe the problem to be fixed or improvement opportunity that initiated the project effort in clear, concise and measurable terms.
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A good problem or opportunity statement will be brief and include: –
How the team recognized the problem—A metric or measure that indicated that less than ideal performance was occurring;
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What new information (a best practice) or regulatory requirement suggested an improvement opportunity;
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The Scope of the project effort—work units or processes to be impacted.
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How the problem or opportunity impacts patients and/or internal customers; and
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Linkage to one of the Institute of Medicine Dimensions of Quality Care: Effectiveness, Efficiency, Timeliness, Equitability, Safety (patients, visitors, and employees), and/or Patient Centeredness
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Problem/Opportunity Statement Examples Although inhaled corticosteroids have long been accepted as first-line controller medications for asthma patients, in the Ambulatory Pulmonary Clinic we found that only 76% of patients with asthma had an active prescription for inhaled corticosteroids. From “Prescription of Inhaled Corticosteroids for Patients with Asthma “ Silverman Symposium 2009 Poster Ventilator Associated Pneumonia (VAP) occurs in 10-20% of patients ventilated 2 days or longer and doubles a patient’s risk of death. The Institute for Healthcare Improvement (IHI) recommends implementation of a VAP bundle and following oral care bestpractices to reduce the incidence of VAP cases. From “Reducing Ventilator Associated Pneumonia One Step at a Time “ Silverman Symposium 2009 Poster The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) identified BIDMC as a high-outlier for surgical site infections in the most recent risk-adjusted data report. SSI can lead to prolonged hospital stay, increased cost, and additional post-operative complications including sepsis and death. From “Surgical Site Infection Task Force “ Silverman Symposium 2009 Poster
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Aim/Goal/Target •
Describe the outcome of the improvement effort in specific and measurable terms Use data collected at the start of the project or recommended external performance benchmarks. State the time period for achieving (and sustaining) goal performance
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The Team • • ¾ ¾ ¾
A bulleted listing of improvement team members/departments involved to demonstrate the interdisciplinary nature of the PI project. Provide First name, Last name, Brief credentials (e.g. MD, RN, MA, BSN), and primary Department/Division affiliation. Jane Doakes, MD, Health Care Associates Mary Knot, CPA, Finance John Doe, RN, Health Care Quality 7
Aim/Goal Target Examples To ensure that all appropriate patients with asthma seen in the Ambulatory Pulmonary Clinic have an active prescription of inhaled corticosteroids. From “Prescription of Inhaled Corticosteroids for Patients with Asthma “ Silverman Symposium 2009 Poster By following best-practices and dedicating resources to VAP prevention we aim to reduce the number of VAP cases that occur at BIDMC. From “Reducing Ventilator Associated Pneumonia One Step at a Time “ Silverman Symposium 2009 Poster The goal within ACS NSQIP is to reduce SSI incidence by approximately 20% to change BIDMC from high-outlier status to low-outlier status. The Institute for Healthcare Improvement (IHI) has deemed 40-60% of SSIs preventable and this reduction will align us with our goal of eliminating all preventable harm at BIDMC by 2012. From “Surgical Site Infection Task Force “ Silverman Symposium 2009 Poster
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The Interventions / Countermeasures Provide a bulleted list of specific actions taken by the team during the project. These actions and activities could include the Project Team’s approach to: ¾ ¾ ¾ ¾ ¾
gathering current performance data or other metrics about the problem or opportunity statement; developing or identify potential solutions to the problem, including software development or enhancements; soliciting input from patients, colleagues, and testing potential solutions; implementing a new process/protocol, including staff training and internal communications; and on-going performance measurement and monitoring after a solution has been implemented.
Frequently, this list of activities is presented as a time table, to illustrate the actual length of time required to complete the improvement effort.
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Interventions/Countermeasures Examples
Set a goal of 100% compliance in prescribing inhaled corticosteroids for patients with asthma seen in the Ambulatory Pulmonary Clinic. Reviewed electronic medical records: a sample of 50 visits, out of approximately 250 visits, is reviewed on a quarterly basis. Designed a database and an electronic dashboard for data collection; and presentation on this as well as other Pulmonary QI measures. Used Individual score cards to report clinicians’ performance. Provided quarterly feedback to physicians on their individual performance compared to the performance of the group. From “Prescription of Inhaled Corticosteroids for Patients with Asthma “ Silverman Symposium 2009 Poster
Organize the clean supply rooms on general medicine/surgical units: Reduce searching for items Increase pick efficiency by co-locating similar items & creating functional carts Labeled items with common clinical terms Adjust par levels based on usage to: Reduced cost of overstocked items Reduce likelihood of items expiring Used color-coded, right-sized bins to insure correct par levels Create a culture of continuous improvement on inpatient units and spread Lean thinking by having staff from each unit mentor the next From “Lean Clean Supply Rooms – Spread “ Silverman Symposium 2009 Poster
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The Results / Progress to Date •
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Present a graphic illustration of the improvement effort. ¾ Often this is numeric data that demonstrates measurable improvement in the improvement project Goal metric over time. (e.g., an Excel graph of the number of errors each month / quarter for several months or quarters.) For some improvement efforts, it may be a picture that illustrates improvement ¾ Consider a ”before and after” process maps or photographs of a reorganized storage, work area, or cart. The image makes the results tangible and real. Not all improvement efforts consistently show improvement—some efforts may show worse performance. ¾ This does not mean the project failed, but rather the improvement effort may be more complex that initially believed, or a different solution may be required. In any event, the learning (what works and what doesn’t) is important!
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Run Chart
Bar Chart
“Prescription of Inhaled Corticosteroids for Patients with Asthma “Reducing Ventilator Associated Pneumonia One Step at a Time
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From “Lean Clean Supply Rooms – Spread “
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More On Graphical Display of Data What Kind of Chart? •
Bar charts are graphical comparisons of two or more quantities, such as days, dollars, units, where the length of the horizontal or height of vertical bars represents the relative magnitude of the values.
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Run charts are a type of line graph that shows how a characteristic varies over periods of time. It shows the variability in a measurement or a count of items. Run Charts can help identify trends and patterns in data over time.
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Pie charts are a common approach to portraying outcomes or results graphically, showing the relationship among three or more quantities. While they can be used to compare outcomes at two points in time (before and after) to show the shift among outcomes or attributes
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A Few Words About Labels No matter what kind of graphical display of data chosen, all graphs and images must be labeled with: ¾
Title: what is being measured or displayed
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Time period: the data displayed represents what time period (month/year, quarter/year, day of week, time of day, etc.
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Legend or data labels that clearly identify what was measured.
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Interpretation Guidance: Higher (or Lower) Score is Better. Trend line or arrow indicating improved performance
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Sample size, and statistical measures (R2, p, Std Dev values, etc) if appropriate
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If a photo image, a caption describing the image
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Lessons Learned •
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During a project, unexpected opportunities and challenges arise that positively or negatively impact an improvement effort. Often unexpected challenges arise from omissions in planning or involving other groups. In this section described the most important lessons learned about the improvement effort, with the aim to share these ideas with others so that everyone benefits from your team’s experiences.
Next Steps / What Should Happen Next Describe the actions that the Team will be taking going forward: • How will the team implement or sustain the improvement? • How “spread” will occur? • What additional analysis or opportunities exist? • How will the team overcome challenges that may have impeded successful achievement of the improvement goals?. 12
Example – Lessons Learned The SSI bundle demonstrated that overall compliance needs improvement. The specific areas of concern are peri-op glucose management and the need for more vigilant glucose monitoring and antibiotic selection documentation to comply with bundle and SCIP protocol. The aseptic audit drill down told us the most glaring issues centered on skin prep and proper hand hygiene. It is necessary to consistently apply evidence-based tools to lower incidence of SSI. From “Surgical Site Infection Task Force “ Silverman Symposium 2009 Poster •Unit staff are subject experts, and they should make the decisions for better designs •Relationships developed between nursing and distribution are key for sustainment •Peer leads are ideal teachers & mentors and have made improvement on their unit •Small changes = big gains From “Lean Clean Supply Rooms – Spread “ Silverman Symposium 2009 Poster Examples – Next Steps The 2009 initiatives include implementing pre-operative antimicrobial showers, standardization of skin prep practices, and management of MRSA. In addition, new forms have been created to improve antibiotic documentation and re-education efforts are underway regarding glucose management and antibiotic protocols. Lastly, efforts are on-going developing the BC/BS contract with a focus on SSI reduction in high-risk populations. From “Surgical Site Infection Task Force “ Silverman Symposium 2009 Poster
•Continuous partnership: Unit, Distribution & Lean Program •Understand Lean principles, not improvements •“Do 1, Teach 1” model = RNs and PCTs participate in an event then lead one •Spread beyond Medical/Surgical units From “Lean Clean Supply Rooms – Spread “ Silverman Symposium 2009 Poster
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Additional Resources •
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For many excellent examples of completed PI Project Summaries, view the entire collection of Silverman Symposium Posters at ¾ http://bidmc.org/QualityandSafety/QualityandSafetyImprovementsatW ork/2009CelebratingQualityandSafetyatWork.aspx ¾ http://bidmc.org/QualityandSafety/QualityandSafetyImprovementsatW ork/CelebratingQualityandSafetyatWork.aspx PI Project Summary Template, Guidelines and Instructions for completing the Template, and Workshop Handouts may be found on the Portal at ¾ http://home.caregroup.org/templatesnew/departments/BID/HCQ/uplo aded_documents/PI%20Project%20Summary%20Template.dot Contact HCQ directly with your questions at
[email protected]
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“Cut and paste” the BIDMC Portal page address into your browser to view 1. The Silverman Symposium Poster collections and 2. The PI Project Summary Template
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Wrap-up & Workshop Evaluation •
Did we meet your needs and expectations? ¾ ¾ ¾ ¾
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Practical Value Clarity of content and understandability of materials Meeting your expectations and making real progress Increase your confidence in using the template and completing the project summary
Please complete our course evaluation and we welcome your additional comments and suggestions!
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