Health Care Workflow Process Improvement Quality Improvement Methods

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 IU 24 OC 000024. This material was updated by Normandale Community College, funded under Award Number 90 WT 0003. This work is licensed under the Creative Commons Attribution-Non. Commercial-Share. Alike 4. 0 International License. To view a copy of this license, visit http: //creativecommons. org/licenses/by-nc-sa/4. 0/

Quality Improvement Methods Learning Objectives • Describe 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 2

Organizational Culture • Quality Improvement projects can be aided or impeded by the organizational culture • Organizational Culture factors to consider – Leadership – 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 3

Leadership 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 4

Exercise • Identify an area in your life that you would like to improve, such as: – Develop better study habits – Give up smoking – Eat 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. 5

Reflection • 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. 6

Quality Improvement Methods • Many methods • Human-centered and supportive of the implementation of Health IT • Originally tailored for enterprises, not necessarily health care 7

API Improvement Model • Developed by Tom Nolan and Lloyd Provost • Simple model for Process Improvement based on Deming’s PDSA cycle • Three 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? 8

Baldrige Criteria and Related Systems • Originally developed and applied to business • 1987 - Malcolm Baldrige National Quality Award created Public Law 100 -107 (1987) • Health care specific criteria (1997) 9

FOCUS-PDCA • 1980 s – Focus-PDCA model – Find an opportunity for improvement – Organize an effort – Clarify current understanding – Understand the process variations and capability – Select a strategy – PDCA cycle test the strategy Graham, 1995 10

PDSA Cycle 11

ISO 9000 • International Standards Organization • Components – Design and develop a QI program – Sociocultural environment – Reduce or avoid quality losses – Define QI responsibilities – Develop: improvement planning process o improvement measurement process o improvement review process o – Carry out QI projects – Analyze the facts before you decide to do QI 12

Kaizen • Kaizen – Japanese for change for the better • Continuous Improvement – The common English term – Connotes ongoing improvement involving everyone – Assumes our way of life deserves to be constantly improved – Includes improvement practices 13

Lean Thinking • Sometimes called the “Toyota Production System” • Consists of five steps: 1. 2. 3. 4. 5. 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 14

Lean 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 15

Six 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 http: //www. orielstat. com/lean-six-sigma/sixmonitored. Hold the gains. sigma-dmaic/overview 16

Quality Improvement Tools – Flowcharts, – Cause-and-effect diagrams, – Statistical Process Control, – Pareto charts, – Check lists Ransom, et al, 2004 © i. Stock photo, used under license 17

Basic Tools – 1 RUN CHART HISTOGRAM IHI, 2017 Laerd, 2017 CONTROL CHART SCATTER DIAGRAM ASQ, 2017 18

Basic Tools – 2 FLOWCHART CAUSE AND EFFECT DIAGRAM PARETO CHART CHECK SHEETS Penfield, 2016 19

Basic Tools – 3 AFFINITY DIAGRAM CURRENT REALITY TREE Wikipedia, 2017 INTERRELATIONSHIP DIAGRAPH ASQ, 2017 20 PEI, 2017

Basic Tools – 4 MATRIX DIAGRAM TREE DIAGRAM (Society & Quality, n. d. ) (Society & Quality, 2017) 21

Basic Tools – 5 PROCESS DECISION PROGRAM CHART POKA-YOKE (Society & Quality, n. d. ) FAILURE MODE AND EFFECTS ANALYSIS (Society & Quality, 2017) 22

Basic Tools – 6 CREATIVITY TOOLS STATISTICAL TOOLS (Ali & Bhaskar, 2016) DESIGN TOOLS (“File: Mind. Map. Guidlines. svg - Wikimedia commons, ” 2011) (ASQ, 2017) 23

Quality Improvement Mistakes in Purpose & Preparation • Error #1: Choosing a subject which is too difficult or which a collaborative is not appropriate • Error #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 24

Quality Improvement Mistakes • Mistakes in Planning and Operations – Mistakes in fostering a learning community focused on improvement Error #5: Teaching rather than enabling mutual learning o Error #6: Failing to motivate and empower team o Error #7: Not developing measurable and achievable targets. o – Mistakes in transition and implementation o Error #8: Failing to learn and plan for sustaining. 25

Quality Improvement Methods Summary • Quality improvement strategies • Quality improvement tools 26

Quality Improvement Methods References – Lecture b References De 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_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 (2 nd ed. ). Milwaukee, WI: ASQ Quality Press. 27

Quality 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: i. Stock. Photo 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 website Slide 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: Mind. Map. Guidlines. 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 28

Quality Improvement Methods Lecture 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 IU 24 OC 000024. This material was updated by Normandale Community College, funded under Award Number 90 WT 0003. 29