Quality Improvement: Essential Leadership Improvement: Essential Leadership Anne Matlow, September...

The International Conference on Residency Education | La Conférence internationale sur la formation des résidents

Quality Improvement: Essential Leadership

Anne Matlow,

September 30, 2016

Je n’ai aucune affiliation (financière ou autre)

avec une entreprise pharmaceutique, un fabricant

d’appareils médicaux ou un cabinet de communication.

I do not have an affiliation (financial or otherwise)

with a pharmaceutical, medical device or

communications organization.

Anne Matlow,

September 30, 2016

INTRODUCTIONS

Learning objectives

• Discuss the importance of Quality improvement to everyday practice

• Identify an area needing process

improvement • Describe the 5 steps of developing a

quality improvement project • Apply 2 tools for process analysis • Understand the role of leadership in

effecting change

WHAT IS QUALITY?

BACKGROUND

Doing the right thing at the right time

in the right way for the right person.

The International Conference on Residency Education | La Conférence internationale sur la formation des résidents 6

Quality is personal….

ITEM SCORE

My desk is always clean.

I am caught up on my work.

I exercise daily.

I see my friends regularly.

I get enough exercise.

I am satisfied with my work-life

balance.

? QUALITY HEALTHCARE ?

WHAT IS QUALITY?

Safe, effective, efficient, equitable,

patient-centred, timely IOM 2001

Commonwealth Fund Study 2013

Quality of care: a global view

The Mission: Quality Health Care

FISHBONE (Cause and Effect) DIAGRAM

Leadership and QI

West M et al. Leadership in health care: a summary of the evidence base. Faculty of Medical Leadership and Management and King’s Fund. 2015.

“ There is clear evidence of the link

between leadership and a range of

important outcomes within health

services, including patient satisfaction,

patient mortality, organisational financial

performance, staff wellbeing,

engagement, turnover and absenteeism,

and overall quality of care.”

What are you going to do about it, Mr PM?

OK,I want to make things better.

Hall Barber. Academic Medicine October 2015

http://www.hqontario.ca/portals/0/documents/qi/qi-quality-improve-guide-2012-en.pdf

Personal Improvement Project

My desk is never clean.

I gotta get

this under

control!

What would

‘in control’

look like?

OK: Get started. My

precise goal:

What? by how much?

Where?

By when?

Papers and

books, pens

and empty

coffee cups

TOOLS OF QI

5 why’s

Graph it out

Fishbone diagram

Walk it out

Process flow

Match solution

to problem,

small tests of

change Set SMART*

Measurement

• SMART aims: specific, measurable, achievable, realistic, time-based

• Eg: By Nov 30, 2016 all papers on my desk will be filed by the end of each day

5 why’s

Graph it out

Fishbone diagram

Walk it out

Process flow

Match solution

to problem,

small tests of

change

Assemble

Set SMART*

Measurement

• SMART aims: specific, measurable, achievable, realistic, time-based

QI is a team sport

Outpatient Calls to a Tertiary Oncology Service

• The Quality Problem: Patients

experiencing a medical issue can wait long

periods of time for a callback from the on

call MD.

Slides courtesy of

Dr.Chris Willis, McMaster U

Who should be on the team?

• Provide input to the process

• Perform one or more of the process steps

• Receive output from the process

The Team

Chief Resident (Team Lead)

Program Director

Lead MD – Oncology

Hospital Paging

Answering Service

ER Resident

Outpatient RN

• Defining the problem

• Understanding the system

Process flow map

Patient

Provider

Answering

Service

Paging

Spaghetti diagram

IT’S YOUR TURN

Small group activity

The Change Opportunity

You are a PGY3 who has just completed a two month elective in

internal medicine at Elsewhere General Hospital. You were

impressed by the way the weekly Morbidity and Mortality

Rounds (MMRs) were conducted at Elsewhere General Hospital;

the philosophy behind MMRs there was one of continuous

learning and improvement, and not one of shame and blame.

Now back home after your elective, you are struck by how

much finger-pointing actually goes on during MMRs at your own

organization, and by the reluctance of trainees to speak up lest

they get blamed and/ or accused of making a stupid or

irrelevant comment. At the last evaluation, 50% of trainees

said they did not find MMRs useful. You would like to see the

approach to MMRs improved to more closely resemble those at

Elsewhere General Hospital, and are prepared to work with

others to improve the process using the Model for

Improvement Framework.

1. Complete the project charter for this project.

2. Present your SMART aim statement.

3. Using the “Model for Improvement” describe

how you will approach improving the MMRs

at your hospital.

• What will you try to achieve with your first two PDSA cycles?

4. Discuss with your group leadership strategies

that will help you to implement change ideas

for MMRs.

In your groups

• There are lots of opportunities to improve the delivery of health care (TIP: if you don’t know where to start, count something)

• There is a 5 step framework for doing QI

• Medical leadership is essential

Conclusions

BACK-UP SLIDES

LEADERSHIP

The main ingredient for successful QI

From January 2005 and

March 2009, 400-1,200

patients died as a result

of poor care.

Public inquiry:

- neglect

- pain relief late or not

at all.

- patients unwashed

- etc…… https://www.gov.uk/government/uploads/system/

uploads/attachment_data/file/226703/Berwick_Report.pdf

When things go wrong:

STAFFORD HOSPITAL

Exerpted from http://www.theguardian.com/society/2013/feb/06/mid-staffs-hospital-scandal-guide

When things go very well…..

Educational activities

1. formal curricula that teach concepts or

methods intended to facilitate trainees’

participation in QI activities;

2. educational activities that impart specific

related skills (i.e. disclosure of medical errors),

3. QI initiatives that involve trainees as active or

passive participants.

Med Educ. 2012 Jan;46(1):107-19.

Academic Medicine October 2015

EVALUATING YOURSELF

My dictated notes don’t

reach the GP soon enough!!!

WE gotta

get this

control!

What would

‘in control’

look like?

OK: Get started.

OUR precise goal:

What? by how much?

Where?

by when?

Leadership styles

QI IN RESIDENCY

Culture + Persistence

http://www.hqontario.ca/portals/0/documents/qi/qi-quality-improve-guide-2012-en.pdf

SETTING AIMS

Quality Improvement: Essential Leadership Improvement: Essential Leadership Anne Matlow, September...

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