Point of Care Quality Improvement WHO Collaborating Center
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care Steps in QI Step 1: Identifying a problem, forming a team and writing an aim statement Step 2: Analyzing the problem and measuring quality of care Step 3: Developing and testing changes Step 4: Sustaining improvement www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care Step 2 Learning objectives You will learn Ø Tools for understanding processes and systems of healthcare and how to use them Ø How these tools can help identify possible solutions to reach your aim Ø How to choose indicators for process and outcome Ø How to use indicators to track progress and improvement www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care Quality Improvement “Business of Management” in Medicine www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care SEVEN QUALITY TOOLS • • Cause and Effect Diagrams Flow Charts Checksheets Histograms Pareto Charts Control Charts Scatter Diagrams www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care Step 2: Analyzing and measuring quality of care Cause & effect Why might a problem be happening? Get to the root cause of the quality issue (4 P’s) People Places Procedures (practices) Policies anything else www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care Thank you www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care 1. Fishbone Get to the root cause of the quality issue(4 P’s) People Policy Major influence Minor influence Problem v PPPP Major influence Minor influence Procedure Place www. pocqi. org
Establishing Skin to Skin Contact after delivery Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care 5 Whys • Curiosity killed the cat? • You could be a child again ! When the “Why s” give you the “What” (. . needs to be done? ) www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care Tree Diagram-Graphic display of the 5 whys www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care 2. “Five whys” Mothers are not breastfeeding – Why? They feel uncomfortable taking their gown off – Why? The gown opens at back, so they have to take entire gown off to breast feed, so they feel exposed. Why they have this type gown? That is what store keeper orders. Why doesn’t the store keeper order better gowns appropriate for breast feeding? Because no one has requested him to do that www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care 3. Pareto charts www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care PARETO CHARTS www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care When to Use a Pareto Chart? • When there are numerous causes to a problem • When you want to analyze the frequency of the causes behind a problem • When you want to categorize the problems having a potential to contribute to improving the problem you are addressing www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care Example: Medication error Inadequate dilution Shortage of staff Wrong patient Expired medicine Weight of the patient Improperly filled Wrong label on vial Misread handwriting Inadequate supply/storage Doctor error /prescription v 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care Example: Medication error 100 90 80 70 60 50 40 30 20 10 0 tio n lu Di ff sh or ta ge pt St a W m d pi re Ex ro ng ed t w Pt fil le rly op e pr ro n W d ab el g in Ha nd w rit ag or gl Im Su pp l y/ Do st ce rro e r 80% of problems due to 30% of v causes % Cum % www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care 4. Process flow chart How to develop a process flow chart 1. Decide the beginning and end points of the process to be flow charted 2. Identify the steps of the process as these are practiced at present 3. Link the steps with arrows showing direction 4. Review the chart to see whether the steps are in their logical order to achieve the end point efficiently: Is the order wrong, are some steps unnecessary? www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care How to create a process Flow chart One flow line out of step Step Two flow lines out of steps that lead to different options One flow line out of cloud steps No that are not clear Start/stop Ye s Optio n Cloud step www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care www. pocqi. org
Point of Care Quality Improvement WHO Collaborating Center for Training and Research in Newborn Care Key tips Analysis helps to find out the root cause of problems Try to find few barriers that account for most of the problem Help the teams think about how re-organization can help with fixing the problem Video on Pareto chart www. pocqi. org
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