Mod. 3 Performance and Process Improvement Flashcards
What does structure include?
All factors affecting context in which healthcare is delivered
What are some examples of structure?
- Physical facility
- Equipment
- Human Resources
- Training
- Payment methods
What does process include?
Sum of all the actions that make up healthcare
What are some examples of process?
- Diagnosis
- Treatment
- Patient education
- Actions taken by patients/families
Process is nearly equivalent to measure of quality. True or False?
True
What are outcomes?
All effects of healthcare on patients or populations
What are some examples of outcome?
- changes to health status
- changes to behavior
- changes to knowledge
- patient satisfaction
- health-related quality of life
Why are outcomes sometimes seen as the most important indicators of quality?
because improving patient health status is the primary goal of healthcare
Why is it difficult to measure outcomes that can be attributed exclusively to healthcare?
Drawing connections between process and outcomes often requires large sample populations, adjustments by case mix and long-term follow ups
How do you define value?
(Quality of service + outcome)/ cost
How are most quality indicators useful?
Indicators of potential problems, not definitive measures of quality
To gain a clear picture of quality care, multiple________ need to be integrated
measures of quality
When should you use a prioritization matrix?
- issues identified and options must be narrowed down
- When options have strong interrelationships
- When options all need to be done, but prioritization and sequencing is needed
Why would you use a prioritization matrix?
Organize tasks, issues and actions
How do you create a prioritization matrix?
1) Create L shaped matrix
2) prioritize and assign weights to list of criteria
3) Prioritize list of options based on each criterion
4) Prioritize and select the item(s) across all criteria
With a prioritization matrix, usually a higher number indicates ___________ importance
highest
What three things should each action plan/project clearly delineate?
- goals, objectives, structure and design
- roles and responsibilities
- methodology and evaluation
The conscientious, explicit and judicious use of current best evidence to make patient care decisions.
Evidence-Based Medicine (EBM)
The integration of clinical expertise, patient values and the best research evidence into the decision-making process for patient care
Evidence-Based Practice (EBP)
How does Evidence-Based Practice (EBP) compliment principles of performance and process improvement
Outcomes evaluation at the individual and aggregate levels is an essential step in evaluating the influence of EBP
How do you make collaboratives (between two healthcare systems, a healthcare system and external system (CDC, CMS)) successful?
Identify champions
What four things are required for effective performance and process improvement?
- involvement of top leadership
- value of every associate
- continuous improvement
- customer focus (patient experience)
Why is a team-based organization an important structural element for performance and process improvement?
empowers employees to take ownership and responsibility
What are some scenarios where teams will usually out perform individuals?
- task is complex
- creativity is needed
- path forward is unclear
- more efficient use of resources is needed
- fast learning is necessary
- high commitment is available
- implementation requires commitment of others
- task or process is cross-functional
A steering committee/Quality council is responsible for these things
- Oversight
- Developing and improving Quality program and plan
- Lending legitimacy to quality efforts
- Maintaining organizational focus
- Providing resources
Who makes up a natural team?
People who work regularly together
Who makes up a cross-functional team
People from various departments or areas who have a common interest
What elements should team charters include?
- clearly defined scope
- Description of team’s tasks (why and who)
- People or department represented
- Timeline for meetings and resources available
- Structure of leadership
- Expected communication of progress and results
- Ground rules for how the team works together
What are the four stages that most teams progress through?
- Forming
- Storming
- Norming
- Performing
What is the forming stage?
Team members get to know each other
What is the team leader’s role in the forming stage?
Provide role clarification
What is the storming stage?
Members express individuality
What is the team leader’s role in the storming stage?
Manage conflict
What is the norming stage?
Develop close ties
What is the team leader’s role in the norming stage?
Challenge the team to grow
What is the performing stage?
Works harmoniously
What is the team leader’s role in the performing stage?
Share leadership responsibilities
Not all teams progress through these stages and, if they do, they move back and forth (e.g., if new members join). T or F?
true
What are the four key traits that can predict a team’s success?
- Cohesiveness
- Communication
- Clear goals
- Clear roles
An interdisciplinary team is looking at a better process for checking in patients. At the last meeting everyone suggested ideas and there was criticism or almost every solution. One person dominated the conversation. What stage is this team in?
Storming
A team was formed to look at increasing responses to patient satisfaction surveys. They have studied the problem, recommended and implemented solutions and measured results. The team members work well together and continue meeting, but your supervisor asked you to end the team. What stage is this team in?
Performing
An ongoing Quality Council has just had 6 out of 18 members replaced. There is pressure on the Council to quickly establish strategic direction for the coming year. You are worried that some of the new members may feel intimidated and reluctant to share. What stage is this team in?
Forming
The Pediatric Group is a tight knit group that works well together. They like to work on every problem as a large team but this is slowing them down. You also notice there is some reluctance to disagree once a solution is proposed. What stage is this team in?
Norming
An ongoing Quality Council has just had 6 out of 18 members replaced. There is pressure on the Council to quickly establish strategic direction for the coming year. You are worried that some of the newer members may feel intimidated. What actions should be taken?
- structure what is to be shared and be sure to seek everyone’s input
- Review team charter and roles
- outline the goals and objectives of the current task
An interdisciplinary team is looking at a better process for checking in patients. At the last meeting everyone suggested ideas and there was criticism or almost every solution. One person dominated the conversation. What actions should be taken?
- Create ground rules
- Speak to those who are causing problems outside the meeting
- Assign specific tasks to people with similar roles/ideas
The Pediatric Group is a tight knit group that works well together. They like to work on every problem as a large team but this is slowing them down. You also notice there is some reluctance to disagree once a solution is proposed. What actions should be taken?
- Assign a devil’s advocate
- Assign small groups to work on a portion of the project
On a team, who is the formal leader of performance and process improvement, responsible for overall project and is not a team member?
Sponsor
On a team, who moves the team along, is not a team member/vested in the outcome and keeps the team on track?
Facilitator
On a team, who is vested in outcome of improvement efforts and involved in meeting content/improvement?
Leader
On a team, who are opinion leaders who provided project credibility and are often respected clinicians or staff with influence?
Champions
On a team, who is vested in outcome and shares knowledge/expertise
Member
Why is it important to conduct evaluations through a team’s process?
Assess:
- productivity
- satisfaction of team members
- individual growth
What areas should be assessed in a formalized team evaluation?
- organizational alignment
- goal clarity
- clear leadership, roles and norms
- team participation
What does PDCA/PDSA stand for?
Plan-Do-Check or Study-Act
What is done during the Plan part of the PDCA/PDSA cycle?
Question the capacity or capability of a process. Pose theories on how to improve and predict measurable outcomes
What is done during the Do part of the PDCA/PDSA cycle?
Make changes on an experimental, pilot basis
What is done during the Check/Study part of the PDCA/PDSA cycle?
Measure outcomes compared to predicted outcomes
What is done during the Act part of the PDCA/PDSA cycle?
Implement changes on broad scale
What are the steps in Plan of PDCA/PDSA?
- identify customer needs/expectations
- Describe current process
- Measure and analyze data
- Identify improvement opportunities
- Identify root causes of problems
What are the steps in Do of PDCA/PDSA?
- Generate and choose solutions
7. Plan and implement a pilot of solutions
What are the steps in Check of PDCA/PDSA?
- Evaluate results of pilot
9. Draw conclusions
What are the steps in Act of PDCA/PDSA?
- Standardize Change
11. Monitor the change and hold gains
What are the three questions to ask before a cycle?
- What are we trying to accomplish (setting aims)
- How will we know that a change is an improvement (establishing measures)
- What changes can we make that will result in improvement (selecting changes)
What is an Aim statement?
Explicit description of team’s desired outcomes expressed in a measurable and time-specific way (like a SMART goal)
Why should you plan for multiple cycles in advance of PDCA/PDSA cycle?
To support rapid-cycle movement
What is an example of not waiting for technology to make a change?
Using wait time white boards/rounding instead of electronic board
Which quality improvement model uses statistical analysis to measure and improve performance?
Six Sigma
What is the improvement model aligned with six sigma?
DMAIC
What does DMAIC stand for?
Define-Measure-Analyze-Improve-Control
Which quality improvement model emphasizes reducing waste and focusing on activities that add value for the customer?
LEAN
Which quality model identifies and prioritizes aims for improvement, moving quickly through the process?
Rapid Cycle Improvement (RCI)
What are Six Sigma’s four components for breakthrough strategy?
- Identification: recognize and define key business issues
- Characterization: Measure and analyze
- Optimization: Improve and control
- Institutionalize: Standardize and integrate
What does “poke-yoke” refer to in LEAN?
mistake or error proofing
Which quality improvement model uses Kaizen (continuous improvement)?
LEAN
What are the 8 sources of waste in LEAN?
- Transportation
- Inventory
- Motion
- Unused creativity
- Waiting Time
- Over-processing
- Over-production
- Defects/rework
What are strategies to eliminate transportation waste?
one-piece flow, avoid batching
What are strategies to eliminate inventory waste?
Standard work, 5-S tool
What are strategies to eliminate motion waste?
Quick change over, work cell, standardized work
What are strategies to eliminate waiting waste?
Quick change over, one-piece low, avoid batching
What are strategies to eliminate over production waste?
Standard work, one-piece flow, avoid batching
What are strategies to eliminate overprocessing/defect waste?
Mistake-proofing (poke-yoke), standard work
What does 5-S stand for?
- Sort (keep only necessary)
- Set in order (arrange and label only necessary items)
- Shine (keep everything clean)
- Standardize (maintain first 3 pillars)
- Sustain (make a habit)
When should you use SIPOC in LEAN? What does it look like?
To identify internal and external customer needs in a process and to use with other lean tools for improvement.
Shown in table with multiple rows under each column (like design blueprint)
What does SIPOC stand for?
- Supplier name
- Process Input
- Process step
- Process output
- Customer name
What is “system” in systems thinking?
Regularly interacting or interdependent group of items forming a unified whole
Why is systems thinking useful?
Helps see interrelationships and benefits
What are the critical factors to assess for change readiness?
- limits of human performance and inability to respond to change
- system’s actual capacity to handle change
An organization’s ability to handle frequent change is dependent on _____________
individuals, including leaders whose role is to establish culture of change and role model flexibility
Successful transformation is ______% leadership and ______% management
70-90
10-30
What is first order change?
Small, requires minimal effort (new form, obtaining same product)
What is second order change?
Complex, requires significant change in behavior (new computer system or clinical guidelines)
What are some ways you can build and sustain resilience (which is key to make changes quickly and rebound from one change to another)
- Make connections
- Avoid seeing rises as insurmountable
- Accept change as part of living
- Keep things in perspective (what’s the worst that could happen?)
What is the quality professional’s role in change management?
Change agent, improvement advisor and facilitator
What are the 7 categories to assessing change readiness?
- Leading change
- Creating shared need
- Shaping a vision
- Mobilizing commitment
- Monitoring progress
- Finishing the job
- anchoring the change
What are the seven categories of assessing change readiness?
- Leading change
- Creating shared need
- Shaping a vision
- Mobilizing commitment
- Monitoring progress
- Finishing the job
- Anchoring the change
What are the 6 stages of changing behavior?
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Termination
What are Kotter’s 8 Change Accelerators?
1) Create a sense of urgency around a Big opportunity
2) Build and evolve a guiding coalition
3) Form a change vision and strategic initiatives
4) Enlist a volunteer army
5) Enable action by removing barriers
6) Generate and celebrate short term wins
7) Sustain acceleration
8) Institute change
When should you use the Force Field Analysis Change Model?
Tool to be used to analyze a situation or process to be changed
What does the Force Field Analysis Change model look like?
Diagram of two columns developed to analyzing opposing forces related to a specific change
What are the two forces shown in a Force Field Analysis Change model?
Driving and restraining
What is an example of a driving and restraining force in a Force Field Analysis Change Model diagram of a proposed change to allow families 24-hour visiting hours in ICU
Driving: Families provide comfort to patients
Restraining: Nursing staff finds open visiting hours disruptive to getting work done
What is the Diffusion of Innovation Model?
Five stages of adopting an innovation
When is a Diffusion of Innovation Model used?
Wide implementation/communication of new ideas, products and/or technologies
What are the five stages in the Diffusion of Innovation Model?
- Knowledge
- Persuasion
- Decision
- Implementation
- Confirmation
What is the knowledge stage in the Diffusion of Innovation Model?
Socioeconomic characteristics/personality variables/communication behavior
What is the persuasion stage in the Diffusion of Innovation Model?
Attending to perceived characteristics of innovation
What is the decision stage in the Diffusion of Innovation Model?
Adoption or rejection
What is the implementation stage in the Diffusion of Innovation Model?
Direct application, reinvention
What is the confirmation stage in the Diffusion of Innovation Model?
Evaluation of effectiveness
What are the categories of adopters (or not) of innovation and their percentage?
- Innovators (25%)
- Early adopters (13.5%)
- Early majority (34%)
- Late majority (34%)
- Laggards (16%)
What are the two categories of adopters you can target to usually create sufficient support and motivate other groups to follow?
Innovators and early adopters
If someone is resisting change and not willing to make it, what is the best strategy? What if they continue resisting?
Setting goals, measuring performance, providing coaching and rewarding/recognizing positive efforts. If they continue, corrective action may be needed.
If someone is resisting and not able to perform change, what is the best strategy?
Providing education and training, using various management techniques. Managers may want to pair them with someone more confident for a short period and progress should be monitored.
If someone is resisting change and lacks knowledge about what is required, what is the best stragety?
Communicating the why, what, when, how and who, present positive outlook and have clear focus/goals. Also be adaptable, use structured approaches to manage ambiguity and use proactive rather than reactive approaches
What are the 6 factors in successful/accelerated change?
- Organizational learning is valued
- Human resources practices support culture
- Employees are involved
- Focus is on improving employee knowledge
- Social responsibility is integral
- Systems perspective is valued
