Quality Improvement Methodology

Beth Hickerson

Quality Improvement Advisor

September 18, 2017

WHAT IS QUALITY IMPROVEMENT?

What is Quality Improvement?

3Value Driven. Health Care. Solutions.

Quality Improvement is systematic and continuous

action that lead to measurable improvement in:

Outcomes Cost

Efficiency Experience

What Quality Improvement is NOT

4Value Driven. Health Care. Solutions.

Quality Improvement is NOT Quality Control

Quality Improvement Quality Control

Better Perfect

“What could we do?” “What should we do?”

Real, messy world Controlled environment

How does it relate to GLPTN?

Milestone 19 PCP/ 14 SPEC of the PAT

“Practice uses an organized approach (e.g. use of PDSAs,

Model for Improvement, LEAN, Six Sigma) to identify and

act on improvement opportunities.”

Phase 2 – The practice is beginning to incorporate regular

improvement methodology to execute change ideas but the

methodology has not been implemented in all areas.

Phase 4 – The practice fully incorporates regular

improvement methodology to execute change ideas.

5Value Driven. Health Care. Solutions.

How does it relate to GLPTN?

Milestone 20 PCP/ 15 SPEC of the PAT

“Practice builds QI capability in the practice and empowers

staff to innovate and improve.”

Phase 2 – Practice is actively building QI capability within the

practice through approaches such as including QI skills in

orientation for all new staff and ensures that all staff participate in

QI training.

Phase 3 – Practice has developed QI capability within the

practice and empowers staff/providers to participate by allocating

time for QI activities, including QI within defined job duties,

recognizing and rewarding innovation and improvement.

6Value Driven. Health Care. Solutions.

WHY IS QUALITY IMPROVEMENT

METHODOLOGY IMPORTANT?

Quality Improvement gone wrong

8Value Driven. Health Care. Solutions.

QUALITY IMPROVEMENT PRINCIPLES

The Building Blocks

10Value Driven. Health Care. Solutions.

“Where there’s a WILL there’s a way.”

11Value Driven. Health Care. Solutions.

No will = the hard way

Resistance to Change is Human

The greatest reason for resisting change is the human

need for certainty.

Change brings uncertainty, which leads to anxiety.

Anxiety suggests that my existing paradigm is in

danger.

Our paradigms create our reality and we feel safe

there.

Source: www.derekhendrikz.com

12Value Driven. Health Care. Solutions.

Building (Good) Will

Start with leadership (aka YOU!)

Explain what – problem and vision

Explain why – make the status quo uncomfortable and

the possible attractive

Identify and acknowledge objections

Share WIIFM

Clarify expectations

Avoid punishment

Acknowledge effort

Reward innovation

Share achievements

13Value Driven. Health Care. Solutions.

The QI Secret

14Value Driven. Health Care. Solutions.

“IDEAS come from curiosity.” –Walt Disney

Ideas

Thoughtful conversation

Most powerful tool in QI

15Value Driven. Health Care. Solutions.

=

16Value Driven. Health Care. Solutions.

Why you need a QI Team

Create good will and ownership with team members

Team members become “buy-in” ambassadors

“No decisions about me without me.” (not just for

patients!)

Many minds are better than one

“Out of the box” ideas usually come from outsiders

Good leaders know when to delegate

Engage your “changers”

Minimize discomfort on your “maintainers”

Minimize and spread the work of execution

“EXECUTION is everything.” –Jeff Bridges

17Value Driven. Health Care. Solutions.

Step I – What needs improvement?

18Value Driven. Health Care. Solutions.

Step II – How can we improve it?

19Value Driven. Health Care. Solutions.

Small Tests of Change Framework

20Value Driven. Health Care. Solutions.

Adopt, Adapt or Abandon

21Value Driven. Health Care. Solutions.

Repeat as Needed

22Value Driven. Health Care. Solutions.

Smaller is Better

Small test change cycles are short:

• A single patient encounter

• An hour

• A day

• A week

Small tests of change increase the speed and impact

of improvement work

• People are less resistant to “testing” than “changing”

• Fewer logistics and people to manage

• Problems can be corrected earlier and easier

23Value Driven. Health Care. Solutions.

Record your Progress

24Value Driven. Health Care. Solutions.

SUMMARY – IMPROVE THE WAY YOU IMPROVE

Change is hard…when it’s done wrong

OLD WAY NEW WAY

Rush to solve Question the problem

Leadership decides on solution Team discusses issue

Run with first logical solution Gather ideas and analyze options

Throw $ at the problem Invest time in a solution

Spend as little $ as possible Research pros and cons

Rollout full (theoretical) solution Run small tests of change

Course-correct immediately Pause and learn from failure

Throw baby out with bathwater Run, pause, learn, repeat

Revert to original state Implement new solution

26Value Driven. Health Care. Solutions.

Final Thoughts

Improvement can be a game rather than a burden

• Promotes communication, collaboration, problem-solving

Blame processes, not people

• Every system is perfectly designed to achieve the results

it achieves

Always better, never perfect

• “Perfection is the enemy of progress” – Winston

Commit to the process, not the outcome

• Avoid the tyranny of the urgent

Improvement is a journey, not a destination

• You can rest, but you can’t stop

27Value Driven. Health Care. Solutions.

QUESTIONS? COMMENTS?

Contacts

Beth Hickerson, Quality Improvement Advisor

• bhickerson@medadvgrp.com

29Value Driven. Health Care. Solutions.

NEXT MONTH

Creating Joy in the Workplace

October 17, 2017 at 11:30 a.m. at Soin Hospital, Kumar Conference Center