Fast -Trekking through the Model for Improvement

Excellence through Quality Improvement Project (E-QIP)

May 2019

The Excellence through Quality Improvement Project (E-QIP)

E-QIP is a partnership initiative between Addictions & Mental Health Ontario, Canadian Mental Health Association, Ontario & Health Quality Ontario to promote and support quality improvement (QI) in the community mental health and addiction sector.

E-QIP is based on the sector’s existing commitment to providing high quality, person-centered care to individuals and families.

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Learning Objectives 1. Participants will engage in fast-track work stations to better understand how to identify root causes of common MHA problems including wait times and dropout rates.

2. Participants will rotate through the fast-track work stations to experience the key steps of a quality improvement process with “Model for Improvement”.

3. Participants will engage in a dialogue with their colleagues about the experience and their next steps to begin/continue QI in their home agency.

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Handout Orientation

⮚“Addiction Services of Winston” case example

⮚Trekking route and utility belt – All the tools you need for a successful trek!

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Setting Our Compass The Model for Improvement

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Working Together to Achieve a Culture of Quality

Efficient

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Dimension Client Meaning Provider Meaning

SafeI will not be harmed by the health system. The care my client receives does not cause

them to be harmed.

EffectiveI receive the right care, and it contributes to

improving my health.

The care I provide is based on best evidence

and produces the desired outcome.

Client CenteredMy goals and preferences are respected. My

family and I are treated with respect and

dignity.

Decisions about my client’s care reflect the

goals and preferences of the clients and family

or caregivers.

EfficientThe care I receive from all providers is well

coordinated and efforts are not duplicated.

I deliver care to my clients using available

human, physical, and financial resources

efficiently, with no waste to the system.

Timely

I know how long I have to wait to see a provider

or for assessments or care I need and why. I

am confident this wait time is safe and

appropriate.

My client can receive care within an

acceptable time after the need is identified.

Equitable

No matter who I am or where I live, I can

access services that benefit me. I am fairly

treated by the health care system.

Every individual has access to the services

they need, regardless of location, age, gender,

or socio- economic status

Adapted from Quality Matters: Realizing Excellent Care for All | Health Quality Ontario, Queens Printer for Ontario, 2015. http://www.hqontario.ca/Portals/0/documents/pr/realizing-excellent-care-for-all-en.pdf. Accessed 14.07.2016.

A good health system provides care that is…

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Quality Control vs. Quality ImprovementQuality Control Quality Improvement

MotivationMeasuring compliance

with standards

Continuously improving

process to meet standards

Means Inspection Prevention

Attitude Required, defensive Chosen, proactive

Focus Individuals Processes and Systems

Scope Care provider Client care

Responsibility Few All

* Adapted from the Health Resources & Services Administration website

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START

ROOT

CAUSESCHANGE IDEAS

FAMILY OF

MEASURES

PDSA CYCLES

RUN

CHARTS

SUSTAIN & SPREAD

(END)

FAST TRACKING THROUGH

THE MODEL FOR

IMPROVEMENT MAP

Lets Get Started! Planning our Route to Improvement

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Get to know your team and read the case AMHO CONFERENCE 2019 - FAST-TREKKING THROUGH THE

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QI TOOL: Problem/Opportunity Statements

A problem statement:

contains one or two sentences that identifies and summarizes a condition, problem, or issue

provides a clear expression of what a QI team is setting out to achieve

does not talk about solutions

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First step to creating problem/opportunity statements:

Answer the “5W2H” questions to get your

problem/opportunity statement:

» What is the problem/opportunity?

» Why is it a problem/opportunity?

» Where do we observe the problem/opportunity?

» Who is impacted?

» When did we first observe the problem/opportunity?

» How does it affect clients, families, caregivers, and

staff?

» How often does it occur?

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‘Winston’ Problem Statement

Since 2017 approx. 42% of clients do not attend their first case management appointment at the Addiction Service of Winston for reasons that are not known, resulting in clients not receiving the service they have been referred to and not having their substance use / addiction needs met.

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Symptom vs. causes of problems

Symptom

An indicator of a problem or quality issue – indicators make a problem known.

▪ Example: You have a very bad headache so take medication to help.

▪ Example: The car’s headlights are dim so you change the lightbulb.

Cause

The primary reason or reasons why there is a gap between the existing state and the desired state.

▪ Example: Your are actually very dehydrated and the headache is a symptom of this cause.

▪ Example: The car battery is low and causing headlights to be dim.

In other words, a symptom is a product of a problem. When we act on a symptom we get “band aid” or short term solutions. When we act on true causes to problems, we get improvement.

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QI TOOL: Fishbone Diagram

Helps groups brainstorm to identify potential root causes of a quality issue.

Identifies and predicts potential failures in a process or a system.

Distinguishes between forces that either help or hinder reaching the desired outcome.

Can use the “5 P’s” to categorize issues

PROBLEM STATEMENT

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QI TOOL: 5 WhysStart with a statement of the problem.

Ask why the problem is happening until you get to something you can actually take reasonable action on.

Always write your 5 Whys on a flip chart or white board where everyone can see, or incorporate into your fishbone diagram.

It is not always 5! May be 3 -7 whys.

If you have several possible responses to a why, avoid those that place blame, target individuals/ lead to HR issues or make assumptions. Go with process based, factual responses to get to a “fixable” root cause.

This is not as easy as it sounds! Data and other information are key in having the most fruitful answers.

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Work with your team to diagnose the causesAMHO CONFERENCE 2019 - FAST-TREKKING THROUGH THE

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Aim Statements: What are we trying to accomplish?

Aim: A good aim addresses an issue that is important to those involved; it is specific, measurable, and addresses these points:

• How much?• By when?• For whom (or for what system)?

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QI TOOL: Aim Statement

Specific

Measurable

Attainable/Actionable

Relevant/Realistic

Time-bound

24

“Some is not a number, soon is not a time.”

- Don Berwick

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Set an Aim Statement AMHO CONFERENCE 2019 - FAST-TREKKING THROUGH THE

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Outcomes Measures

• Where are we ultimately trying to go?

• Are your changes leading to improvement

• Measures of the customer or client

• Ex. 1: Average # of clients attending the clubhouse program each week

• Ex. 2: Reduction in avoidable hospital readmissions

Process Measures

• Are we doing the right things to get to the outcome?

• Measures of the workings of the system

• Are we doing the right steps – are our changes working?

• Ex 1: % of clients that reply to email indicating location change of clubhouse

• Ex 2: % of clients reporting physical needs are being met through OCAN

Balancing Measures

• Are the changes we are making to one part of the system causing problems in other parts of the system?

• Measures of other parts of the system

• Ex 1: % of clubhouse members report they are satisfied with new location of clubhouse program

• Ex 2: % of time staff are using to connect with home & community care services to address unmet physical needs

Family of Measures

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Select high leverage change ideas early on to facilitate sustainability

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TOOL 1: Random Word Exercise

Deliberate act to cut across established patterns

Words hold many concepts and are a convenient way to get a new starting point

Other ‘random’ stimuli can be used

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Tool 2: The Triz

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Generate some creative change ideas! AMHO CONFERENCE 2019 - FAST-TREKKING THROUGH THE

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Builds knowledge sequentially and increases ability to predict what will result▪ Test on a small scale

▪ Use multiple cycles incorporating a wide range of conditions (different shifts, days of week, different types of staff, different patient/client complexities)

Increases likelihood for implementation success▪ Allows you to determine when a change idea

won’t work and address those circumstances

▪ Allows people to be a part of the change

▪ Decreases likelihood for resistance

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Plan-Do-Study-Act

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• The ‘improvement evaporation effect’

⮚ lack of sustainability

• The ‘islands of improvement effect’

⮚ lack of spread

Typical Improvement Frustrations…

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START

ROOT

CAUSESCHANGE IDEAS

FAMILY OF

MEASURES

PDSA CYCLES

RUN

CHARTS

SUSTAIN & SPREAD

(END)

FAST TRACKING THROUGH

THE MODLE FOR

IMPROVEMENT MAP

Discussion

⮚Can you see yourself taking a “QI trek” with any problems that you encounter in your work?

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Questions?

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Resources Additional tools for your QI ‘Backpack’

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E-QIP’s Quick QI Webinars

E-QIP’s Quick QI webinar series now available online!

For those interested in understanding or refreshing their knowledge on the Model for Improvement, this webinar series is for you. E-QIP coaches have developed this series of 9 webinars which are twenty to thirty minutes each. These webinars are based on our coach’s first-hand experience and use a case study on reducing wait times to case management programs to demonstrate how to use QI tools. The webinar series can be viewed hereand supporting slide decks and resources for each webinar can be found here.

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E-QIP Webinar SeriesWebinar 1: Supporting a QI Culture

Webinar 2: The Use of OCAN in Quality Improvement

Webinar 3: Quality Improvement and the OPOC

Webinar 4: The Role of Data in the QI Process

Webinar 5: Change Management and Organizational Support

Webinar 6: Sustaining and Spreading Success

Webinar 7: Client and Family Member Engagement in QI (Part 1)

Webinar 8: Experience Based Design

Webinar 9: Primer on Governance and Leadership for QI

Webinar 10: QI Mythbusting Webinar

Webinar 11: PDSA Cycles and Data

Webinar 12: Client and Family Member Engagement in QI (Part 2)

Webinar 13: Trusting the Quality Improvement process

Webinar 14: Prioritizing Quality Improvement in community MH&A agencies

Webinar 15: Encore Webinar: Primer on Governance and Leadership for QI

Webinar 16: Enhancing Joy in work for professionals through healthcare improvement with Dr. Hayes

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E-QIP Newsletter

Join our mailing list to stay informed of

future webinars and training events:

http://eepurl.com/b1A5EX

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Resources:

▪ E-QIP’s webinar on sustainability and spread can be viewed here

and the “QI myth busting” webinar can be viewed here.

▪ The resource folder on E-QIP’s Community of Practice regarding

sustainability and spread can be viewed here.

▪ View E-QIP’s new “Quick QI Webinar” series to refresh yourself and

others on the coaching curriculum content and Model for

Improvement using a community MH&A example can be viewed here.

▪ Resource folder all of the coaching curriculum materials from training

sessions can be found here and a list of QI Projects and Team leads

can be found here from Cohort 2.

#EQIPON

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