Flex Flashcards
Compare and contrast Research, Program Evaluation, and Quality Improvement
Research: Expands knowledge in a field by attempting to answer questions that are generalizable to other context, and publish results in a peer reviewed journal.
Requires REB.
Program evaluation: Assesses the merit of an existing program, with the primary goal to inform decision-making about whether the program is effective or should continue.
No REB.
Quality improvement: Focuses on improving some aspect of how a program performs, when existing evidence is available to support the program or practice, and the expectation is that the program will continue.
No REB.
Provide a current example of physician opportunity to take a leadership role in QI.
Doctors of BC Physician Quality Improvement initiative.
A hospital wants to implement a new recommended protocol for sepsis.
Research, Program Evaluation, or QI?
QI
A clinic is deciding whether to extend its exercise initiative for another year?
Research, Program Evaluation, or QI?
Program Evaluation
A medical student thinks that there is a better way to organize a waiting room.
Research, Program Evaluation, or QI?
QI
A hospital needs to justify funding for its heart health program.
Research, Program Evaluation, or QI?
Program Evaluation.
A doctor wants to find out if a new blood pressure med has side effects.
Research, Program Evaluation, or QI?
Research
A clinic wants to increase patient compliance for medication management.
Research, Program Evaluation, or QI?
QI.
Quality Improvement is best understood as…?
An approach involving systematic, data guided activities designed to bring about immediate improvement in a health care setting.
Continuous Quality Improvement
The ongoing process to evaluate how an organization works and ways to improve processes.
Benefits of Continuous Quality Improvement
Reduce waste
Increase efficiency
Improve outcomes
Prevent mistakes
Improve satisfaction
3 elements for QI as identified by the Institute for Healthcare Improvement.
Ideas
Will
Execution
2 important and interrelated components of the Model of Improvement.
The 3 questions.
Plan-Do-Study-Act (PDSA) cycle.
What are the 3 questions in the Model for Improvement?
What are we trying to accomplish?
How will we know that a change is an improvement?
What change can we make that will result in improvement?
5 steps of the Model for Improvement
- Set an aim.
- Establish measures.
- Identify changes.
- Test changes (PDSA cycle)
- Implement changes.
What are appropriate sources of ideas during quality improvement initiatives?
Critical thinking about the current state.
Consulting Choosing Wisely guidelines.
Comparing yourself to other organizations.
Asking the front lines.
Reading academic journals.
2 methods used to “get at the root” of a problem.
The 5 Whys.
Driver Diagrams.
Symptoms vs Root causes
Symptoms: Easy to see, Result, Short-term fix.
Root causes: Less obvious, Source, Long-term fix.
Symptom or Root cause:
The source of the problem
Root cause
Symptom or Root cause:
Less obvious
Root cause
Symptom or Root cause:
Easy to see
Symptom
Symptom or Root cause:
Addressing it is a long-term fix
Root cause
Symptom or Root cause:
A result of the problem
Symptom
Symptom or Root cause:
Addressing it is a short-term fix.
Symptom
Discuss the 5 Whys method of root cause analysis.
You ask “why?” 5 times to uncover the root cause of your problem.
Discuss the use of a Driver Diagram in root cause analysis.
Visual diagram that shows connections between the overall aim you are trying to achieve, the primary drivers that contribute directly to achieving the aim, the secondary drivers that are key mediators or influencers of the primary drivers, and specific ideas to test for each driver.
What is a critical step which saves time and energy when planning QI interventions?
Identifying the root cause
List person-based interventions from least effective to most effective.
Rules and policies.
Education and information.
Reminders, checklists, and double checks.
List system-based interventions from least effective to most effective.
Simplification and standardization.
Automation or computerization.
Forcing functions and constraints (removes of a produce from use)
What do person-based interventions focus on?
Changing knowledge, attitudes, or behaviours of individuals.
What do system-based interventions focus on?
Changes in policy, process, or infrastructure at an organizational level.
Which type of interventions are more likely to improve outcomes?
High-leverage, system-based interventions addressing key drivers.
Agree II tool function
Guides the critical appraisal of clinical practice guidelines.
6 domains of the Agree II tool.
- Scope and purpose.
- Partner Involvement
- Rigour of development.
- Clarity of presentation.
- Applicability.
- Editorial independence.
What are two tools that can help identify and support interventions?
Hierarchy of evidence.
High quality, appraised, clinical practice guidelines.
Which type of interventions does the hierarchy of evidence describe as least effective, most feasible?
Person-based.
Which type of interventions does the hierarchy of evidence describe as most effective, least feasible?
System-based.
What is vital to employ in order to identify team members and engage individuals who will benefit from, or be affected by, the improvement?
Equity lens.
Who should be included on a QI project team?
People with experience in the system.
Day-to-day leader or process owner.
Experience with improvement methods.
Technical/clinical/subject matter expert.
Project sponsor/system leader.
Organizational Culture
The values, beliefs, and goals that impact how people behave in an organization.
Ethics
A set of moral standards that help us determine what’s right and wrong.
6 questions to help identify and address ethical issues.
- How will the knowledge gained in this project be useful?
- How will the methods used in the project generate the desired results?
- How will you ensure that the participant (or data) selection process is fair and appropriate?
- How will you maximize benefits and minimize or mitigate the ethical risks associated with the project?
- How will the rights of individuals, communities, and populations be respected?
- will informed consent be needed for this project?
FIPPA
Freedom of Information and Protection of Privacy Act.
Under control of health authorities; collections, use, and sharing of personal information.
Health authorities are required to advise patients what their data may be used for.
Knowledge Translation
A dynamic and interactive process that includes the synthesis, dissemination, exchange, and ethically sound application of knowledge to improve health, provide more effective services and products, and strengthen the health care system.
Valley 1
The limited capacity to translate the results of discoveries generated by basic biomedical research in the lab to the clinical landscape.
Valley 2
The limited capacity to synthesize, disseminate and integrate clinical research results more broadly into clinical practice and healthcare decision making.
What is the benefit in sytemizing concepts
We can more readily talk about and use them
2 types of knowledge translation
End of grant/Project KT:
the researcher develops and implements a plan for making knowledge users aware of the knowledge gained in the project.
Integrated KT:
stakeholders or potential research knowledge users are engaged in the entire research process. Researchers and research user work together to shape the research process.
Examples of End of Grant/Project KT activities
Conference presentations and publications in peer-reviewed journals
Summary briefings to stakeholders, interactive educational sessions with patients, practioners, or policy-makers.
Media engagement, use of knowledge brokers.
Commercialization of scientific discoveries.
Examples of Integrated KT activities
Collaborating to determine the research questions.
Deciding on the methodology, being involved in data collection and tools development.
Interpreting the findings and helping disseminate the research results.
What is a benefit of Integrated KT?
Produces research findings that are more likely to be relevant to and used by the end users.
Implementation Science
Continual refinement and improvement of KT strategies, and the study of methods to better promote and enact KT.
Includes systemic approaches to studying barriers and facilitators to adopting new evidence-based interventions in real-world settings.
What are the benefits of using a model to guide KT?
Strengthens planning.
Increases the effectiveness of translating knowledge into practice.
Provides an evidence-based, reproducible, and clear articulation of the assumptions and mechanisms that drive the KT activity.
CIHR’s Knowledge to Action Cycle
End of Grant/Project completion
Create knowledge
Apply knowledge
SMART Framework
Integrated KT
Offers an approach modelling how all stakeholders can actively contribute to all aspects of the research process.
Ways of Creating Knowledge
Derive knowledge from primary studies (Knowledge Inquiries).
Synthesize primary studies to form secondary knowledge.
Generate knowledge tools or products.
Ways of applying knowledge
Identify the problem.
Adapting knowledge to local context.
Assessing barriers and facilitators.
Selecting, tailoring, and implementing an intervention.
Monitoring knowledge use.
Evaluating the outcome of knowledge use.
Develop mechanisms to sustain knowledge use.
