Quality Improvement PDSA Model and You What is

Quality Improvement, “PDSA Model”, and You! • • • What is QI? What does it means for me the employee? What are the 10 steps to a PDSA Model? Where can I find more QI and PDSA model assistance? How do I enter and track my QI project to assure I get credit? Lorilie A. Hardy, MEd, RRT, Ginger Schelp, MHA. RRT, & Karen Cox, Ph. D, RN Performance Improvement Professionals Office of Clinical Effectiveness hardyla@health. missouri. edu

What is Quality Improvement? “The combined and unceasing efforts of everyone: – – – Patients and their families Healthcare Professionals Healthcare Researchers Healthcare Payers Healthcare Planners/Coordinators Healthcare Educators to make the changes that will lead to: • better patient outcomes (health) • better system performance (care), and • better professional development (learning). ” http: //qualitysafety. bmj. com/content/16/1/2. extract

What this means for you… 1. MU Health Care employees (≥ 50% FTE) are required to participate and complete a minimum of 2 QI (aka PDSA) projects (2 projects / 2 aim statements) per year either individual or group. (<50% FTE employees are highly encouraged to participate in QI projects) 2015 QI (PDSA) Requirements for credit: • Two competed QI projects: – 2 aim statements= two projects – PDSA EDUCATION NO longer counts as a project • “Project Categories and Metrics” completed for each • Both projects completed and in QI Tracker by June 30, 2015 2. Use the “PDSA” model for each quality improvement project. 3. Use the MUHC QI Tracker to track your 2 QI Projects (aka PDSAs). • MUHC QI Tracker is open from Aug 15 - June 30 annually.

What QI projects should you participate in? Create a new QI regarding a proven problem: - OR - S g t n re i t am s e r lin e t EXCITING e In y c n e i c i f f E Passiona te Choose an existing QI team/committee: – Hospital-wide • • Fall Prevention CAUTI VAE Patient Satisfaction – Unit specific: • Staff Morale • Cerner Documentation • Through-put s s e n e v i t Effec Your participation is vital, as YOU know BEST how to improve the care you give your patients!

The “PDSA” Model for Quality Improvement “Plan-Do-Study-Act” 1. What proven problem do we have to improve? Pre-data 2. What change can we implement that will result in improvement? Aim Statement 3. How will we know that a change is an improvement? Post-data (Metric = the measurement of data to compare before and after the change)

10 Steps to PDSA Model PLAN-DO-STUDY-ACT PLAN: WHAT ARE WE TRYING TO ACCOMPLISH? 1. Choose a problem that aligns with UH strategic goals: People, Growth, Financial, Quality, Patient Experience, Work Environment, Information Technology 2. Identify a leader (you or a peer) and executive sponsor (SLS, Manager, or PIP) 3. Assemble the improvement team (just yourself or you, other co-workers and resources) 4. Study baseline (current state) pre-data – MUST have proof this needs improvement! 5. Outline how the “current state” process works 6. Find out how others have tried to solve this or a similar challenge: research literature for evidence based best practices, brainstorm, etc. 7. Determine potential solutions: prioritize solutions and use one solution per cycle

PLAN-DO-STUDY-ACT (10 -step model) 8. “DO”: Implement or Trial the “CHANGE/SOLUTION” that may RESULT in IMPROVEMENT for the designated timeframe. 9. STUDY: HOW is it KNOWN that the CHANGE is an IMPROVEMENT? *Measure the impact of the solution with objective data Use graphs or charts * 10. ACT: IMPLEMENT or REVISE AND REPEAT THE PLANDO-STUDY-ACT CYCLE(S) UNTIL the GOAL is ACHIEVED: *Try different solutions one at a time until the goal is achieved *Each solution is a new cycle

Where can I find QI / PDSA model assistance? & How do I enter and track my QI project to assure I get credit?

Helpful PDSA Tools can be located in “My Apps”→”QI Resources→”QI/PI” 2 3 1

Where to enter your PDSA project information

QI Tracker Basics 1 b- educational informative 4 minute video. 2 b Add new project 8 questions: (Title, Aim Statement, Type [MUHC, SOM, etc), Aim of Project [Met/In Progress/ Not Met], Status [active/Complete/Discontinued], Second Editor, Start and End dates) free text and drop down menus and submit 3 b. Add persons INCULDING YOURSELF and assure you have a manager, SLS, or PIP as your “SPONSOR”, a staff members will be the “team lead or team member”, any UH employee can be a Facilitator/Coach/Advisor 4 b. Three drop down menus: major category [select the UH strategic goal that aligns with your project], subcategory [select most appropriate] , and Metric [select most appropriate or “other” and free text your metric]). Repeat to add multiple categories as indicated by the project.

“PDSA” Template (located on QI Tracker)

“How to” Template for a Final “Single Cycle” of a Project

Plan-Do-Study-Act Cycles • Repeated measurement and subsequent adjustment in “cycles or interventions” until the goal is met. Hunches Theories Ideas P D S A 1. Revise Policy P D S A 2. Educate Staff P D S A 3. change printers P D S A Changes that result in improvement 4. positive Pt ID prior to blood draw

Sample “How To” Template for a Final “Multi-Cycle” Project

Resources for Planning a QI Project Brainstorming Cause Mapping Direct Observation Time Motion Studies Check Sheets Affinity Diagram Medical Journals Evidence Based Standard Practices……… Practices

SAMPLE PDSA Planning:

Use Graphs and Charts

“PDSA” is a Model for Improvement Aim Statement = Details of the change to be made to result in improvement Metrics: The measurement that will prove the change is an improvement ACT PLAN STUDY DO

“Aim Statement” requirements: ü Focus on: ü Safe ü Timely ü Effective ü Efficient ü Equitable ü Patient Centered ü Include a specific patient population ü Include numerical goals ü Include a timeframe ü State the aim Clearly: Specific and Concise ü Keep it simple to not expand- stay focused

Examples: Aim Statement, Metric, and Plan • By January 1, 2015, 100% of admitted ED patients will be transferred out of the ED to an in-patient bed within 1 hour of decision to admit. – by comparing Cerner time stamps of ED physician admission orders (decision to admit) and time of nursing floor or ICU admission documentation 3 months prior to and after the initiation of ASCOM phones – Use of ASCOM phones for timely communication to determine and correct throughput issues • Reduce the number of ED patient falls by 75% by January 1, 2015 – Number of falls reported in PSN 3 months prior to and 3 months post the initiation of verbal/brochure education. – the use of verbally communicating to the patient and handing the patient an educational brochure discussing fall prevention while in the hospital (see exhibit a). • Improve ED patient satisfaction with healthcare communication, education, and reconciliation of home medications upon discharge by 75% in 3 months beginning October 1, 2014 – NRC Key Driver scores regarding pt satisfaction with medication education 3 months prior and 3 months after the initiation of nurse and provider education – Educate Nurses and physicians on having the patient repeat his/her understanding of medications.

Helpful Hints using the PDSA Model Take time to: – PLAN the details – Write a sound AIM STATEMENT – Use Quantitative or Qualitative Numeric Metrics – Keep each “cycle” simple to prove success or not, repeat as needed until successful, give recommendations regarding the result of each cycle – Include graphics or charts to show results

Next Service Line Newsletter/E-mail will have a link to: “Quality Improvement, PDSA Model, and You!” Powerpoint on a Service Line Website for future reference.

Got Questions? ? “Without change there is no innovation, creativity, or incentive for improvement. Those who initiate change will have a better opportunity to manage the change that is inevitable. ” Lorilie Hardy -William Pollard ED & Surgical Services Performance Improvement Professional hardyla@health. missouri. edu 884 -1755