Quality Improvement Series Session 7- System Redesign Windy Stevenson [email protected]
16
1 Quality Improvement Series Session 7- System Redesign Windy Stevenson [email protected] Cindy Ferrell
description
Quality Improvement Series Session 7- System Redesign Windy Stevenson [email protected] Cindy Ferrell. Today’s Agenda. Recap. Problem: The DCH ambulatory clinic problem lists are incomplete and inaccurate. Patients with BMI>85%ile do not have obesity listed on their problem lists. - PowerPoint PPT Presentation
Transcript of Quality Improvement Series Session 7- System Redesign Windy Stevenson [email protected]
2
Today’s Agenda
3
RecapProblem: The DCH ambulatory clinic problem lists are incomplete and inaccurate.
Patients with BMI>85%ile do not have obesity listed on their problem lists.
Drivers:1. Improve patient care- facilitate decision support2. Improve provider efficiency (reduce chart review)
Lessons Learned:• We have to narrow our scope• Just saying we fix the system is woefully inadequate• Everything is more complex than we expect• Random audits of an ill defined product are not helpful• We are still limited by our access to data
4
5
Changing behaviorBy changing motivation By making the right thing
the easy thing
Culture change
Convince every provider that this is important so that he/she REMEMBERS to change behavior
Systems change leading to eventual culture change
Reconfigure the system so it doesn’t matter in the beginning if it is important to providers
This works in a system with immediate feedback
(treats or shock collar)
This works when there is no natural consequence
(fence)
Let’s say your dog keeps running into the street
6
Two Real-life examples
7
Two Real-life examples
8
The Science of Reliability
Reliability Level Reliability Expression
Reliability Rate Failure Rate
Level 1 10‾¹ 80-90% reliable 1-2 failures in 10 opportunities
Level 2 10‾² 95% reliable <5 failures in 100 opportunities
Level 3 10‾³ 99% reliable <5 failures in 1000 opportunities
Level 6(Six Sigma)
10‾6 <5 failures in 1,000,000 opportunities
9
How do we get from CHAOS to Level 1?
Work harder next time Feedback on compliance Increase awareness and vigilance
– Also known as work harder
10
How do we get from Level 1 to Level 2?
– Real time identification of failures– “forced function” check lists– Redundancy– Make the right thing the easy thing– Provide decision aids
11
So, what’s our first AIM?
Specific we are intentional and focusedMeasurable we can prove we’ve had an impactActionable there are no known insurmountable barriersRealistic it’s within our scopeTimely we’ll do it within a time frame
12
Our First AIM:
____ % of patients of ____ age seen by _______ in the ________ clinic(s) with a BMI > ____ %ile will have _______ listed on their problem list by ______ (date)
13
Let’s envision our ideal state
Process Mapping
14
How do we get there?
15
Obesity and Meaningful Use- more opportunity
The percentage of patients 2‐17 years of age who had an outpatient visit with a PCP and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year.
16
Take Home Points (review)
Real (sustainable) change comes from changing systems, not changing within systems
Be specific about what you want to accomplish, and why; be intentional
Focus on patients
Start before you think you are ready; don’t get paralyzed
