Using the Template This template will help you

Using the Template } This template will help you and your team develop a solid presentation for RITE graduation day. } By the end of the presentation, your audience should be able to state the following points: − I know what the problem is − I know what you did to solve it − I know the results − I know how to replicate this in my institution } You will have 7 minutes to present and then 5 minutes for questions. The template includes 12 slides. Strive to keep your presentation close to that number of slides. Below is better. } Delete the prompted questions and statements in the presentation and replace them with your project’s information. You should also delete the gray boxes. They are just place holders. } Don’t layer too many charts or graphs on one slide. Any given slide should have no more than 1 -2 charts or graphs. } Many of the slides include questions for you to consider in presenting that slide. Do not write down the answers to the questions on the slide, but be prepared to share that information and any other information you deem pertinent. } Less is more when creating slides. This slide is a horrific slide. 1

RITE Cohort 1 PROJECT TITLE Tell a story, share a picture or graphic, describe your “case for change”? Recommendation is less than 2 minutes

RITE Cohort 1 IMPROVING THE QUALITY OF MAMMOGRAPHIC POSITIONING TO DETECT BREAST CANCER

Team Members } Institution − Department } Leaders(s) − Leader 1 − Leader 2 Insert team pictures or individual pictures } Participants − Participant 1 − Participant 2 } Sponsor(s) − Sponsor 1 − Sponsor 2 4

Team Members } Stanford Hospital − Breast Imaging Department } Leaders − Sunita Pal, MD − Audrey Strain } Participants − Robert Jesinger, MD − Danielle Botelho − Sandra Fromholz − Christina Chen } Sponsors − Deb Ikeda, MD − Claudia Cooper 5

Target State: SMART Goal State your SMART goal here } How did you determine this was the best goal for your project? } Have other institutions achieved this? } Define any acronyms or numbers if needed 6

Target State: SMART Goal Our goal is to increase the percent of mammograms that meet all ACR positioning criteria from a mean of 33% to 90% by April 2015. 7 ACR is the American College of Radiology

Baseline Display run chart or control chart including data before interventions and target state, no intervention data. Annotations included on run chart if needed. } What is your metric? } How are you measuring it? } At what frequency? 8

Baseline Mammograms meeting ACR criteria Desired Direction 9

Analysis Here you can display a fishbone diagram, Pareto chart, process map, brainstorming, etc. Include the tool(s) you used to understand the root causes of your problem. } Based on your analysis, what are the root causes of your problem? } Who did you involve in performing your analysis? } Which causes did you focus on for your project? Why? 10

Analysis 11

Key Drivers } How do your key drivers relate to your fishbone and/or Pareto chart? } Did they change as you progressed through your project? Display your 4 -6 Key Drivers that came from your analysis } Did you remove any that were once there in the beginning? (Things that must happen consistently to reach your goal) } Which drivers did you focus on for this project? 12

Key Drivers Agreement on what meets criteria Key focus areas from fishbone 1. No agreement on what meets criteria 2. Patient limitations and difficulties 3. Lack of communication between tech and rad Standard work for acquiring and reading images Clear communication between tech and rad Measurement system to track performance Coaching on technologist skills, tips and tricks, and techniques

Interventions Display your Key Driver diagram with full list of interventions. Include reliability level and maturity bars. (Don’t have to include dates or red and green circles) } How do your interventions relate to your key drivers? 14

Interventions Key Drivers Agreement on what meets criteria Standard work for acquiring and reading images Clear communication between tech and rad Measurement system to track performance Coaching on technologist skills, tips and tricks, and techniques Interventions / Countermeasures Create learning module using 30 sample images, use for new radiologists and technologists (1) Alexis Create standard work for radiologist in performing technical recall, 2 rads sign off before recall is performed (2) Sunita When performing a difficult exam, tech will document the reason why criteria was missed on patient history form for radiologist (2) Audrey Implement question box for technologists to submit questions and feedback for next in-service. Notes should include exam label for reference (1) Audrey Radiologist audits images every week and report findings to Jake, Jake will compile into report, Audrey will share with techs in huddles (1) Robert Technologist performs mammogram audit, Robert and Sunita training Danielle, Danielle to train other techs (1) Audrey Report individual positioning results to technologists (1) Jake Implement partner Fridays during tumor boards to allow techs to learn from each other and share techniques (2) Audrey 15

Run Chart and Interventions This is your power slide. Display your run chart or control chart with annotations showing how and when interventions impacted your metric. } Can you explain the hills and valleys in your chart data? } Which intervention positively impacted your metric, which did not? 16

Run Chart and Interventions Mammograms meeting ACR positioning criteria 3 2 1 Impactful Interventions 1. 7/14: Mammogram audit done weekly, shared with technologists 2. 9/2: Tech documents reason why criteria was missed for radiologist 3. 9/22: Report individual results to technologists quarterly 17 Desired Direction

(Optional) Additional Results Related Material } On this slide you can summarize any additional results. Any other wins or benefits not illustrated by your run chart? For example, how your project impacted: − Patient Safety − Clinical Outcomes Insert pictures, diagrams, charts that depict your results − Patient Satisfaction − Efficiency/Productivity 18

Sustain Plan } What structures are embedded in the management system to ensure that your improvements will be continued in perpetuity? } Who owns your new improvements? Are they aware of their duties? } Are new roles and responsibilities properly defined? Insert your sustain plan here (format should match one below) Activity to sustain Owner Sustain method and frequency Report to Reliability Level (): (1) Individuals: Feedback, checklists, training, basic standards (2) Procedures: Embedded standard work, reminders, constraints (3) Systems/culture: Process redesign, built-in quality, automated systems, fail safes, physical structure, social norms, “mindfulness” 19

Sustain Plan Activity to sustain Owner Sustain method and frequency Report to Technologist performs audit, Technologist take turns auditing 3 images Tech Radiology results shared to team at daily (15 minutes). Results shared to team Supervisor Director least bi-weekly (1) in daily huddle. Partner Fridays where technologists work together and share tip and tricks on good positioning (2) Tech Partner Fridays happen whenever there is Radiology Supervisor tumor board. Director 2 radiologists have to agree before a technical recall is performed (2) Any recalls that are not signed by 2 radiologists are sent to radiologist who Tech performed recall by tech supervisor. Supervisor Radiologist then provides reason why recall was performed Mammography Section Chief Reliability Level (): (1) Individuals: Feedback, checklists, training, basic standards (2) Procedures: Embedded standard work, reminders, constraints (3) Systems/culture: Process redesign, built-in quality, automated systems, fail safes, physical structure, social norms, “mindfulness” 20

Key Learning Points } List overall learning points with the project 1. Learning 2. Learning 3. Learning 21

(Optional) Next Steps } What are your next steps in leading continuous improvement in your area? For example: − Next steps in finishing your project? − Expanding improvements to other departments? − Creating a culture of continuous improvement? − Empowering others to use the QI tools and methods? 22