patient safety and improvement Flashcards
what is quality improvement?
it is committing to act upon mistakes and learning and reflecting on them - it is a commitment to continuously improving the quality of healthcare, focusing on the preferences and needs of people who use the services
what does QI incorporate?
it addresses the gap between the service being delivered and what should be delivered - it involves changing at least one of the quality characteristics - service, environment, product and making a sustainable difference
what does QI encompass?
a set of values and a set of methods
what is the set of values in QI?
commitment to self reflection, shared learning, use of theory, partnership working, leadership and an understanding of context
what is the set of methods in QI?
measurement, understanding variation, cyclical change, benchmarking and a set of tool and techniques
what are the basic principles of QI?
eliminate inappropriate variation and document any change
what does all improvement require?
change
what does the triangle model of suggested improvement skills show?
that there are experts on the outskirts for analysis and prioritisation, and then frontline staff to set goals and measure, clinical leaders for implementation and spread, operational leaders for managing spread, executives for setting direction and bug goals
how can QI protect patients and improve care?
place patients needs at centre, deal effectively with uncertainty, understanding the framework of system you work in, promote and monitor health, understand improvement, respond appropriately, demonstrate awareness and understand importance
what should every aim be?
SMART specific measurable achievable realistic/relevant time limited
what are the key improvement themes?
involving staff, users carers and public, process and systems thinking, personal and organisational development and making it a habit - initiating, sustaining and spreading
what is incorporated in process and systems thinking?
understanding the work processes and systems and how they link and looking for ways to increase capacity and reduce demand and waste
what is the aim, method, bias and sample size of improvement?
aim - improvement of care
method - observable
sample size - just large enough - small sequential samples
bias - accepting consistent bias
what is the flexibility of hypothesis, testing strategy, determining if the change is improvement and confidentiality of data in improvement?
flexibility - hypothesis is flexible and changes as learning occurs
testing strategy - sequential test
determining improvement - run charts or shewart control charts
confidentiality - data only used by those involved
what is the aim, method, bias and sample size of accountability?
aim - comparison, choice, reassurance, spur for change
method - not test just evaluating current performance
sample size - 100% of current data
bias - measure and adjust to reduce
what is the flexibility of hypothesis, testing strategy, determining if the change is improvement and confidentiality of data in accountability?
no hypothesis
no tests
no change focus
publicly available for review
what is the aim, method, bias and sample size of research?
new knowledge
test blinded or controlled
designed to eliminate bias
just in case data
what is the flexibility of hypothesis, testing strategy, determining if the change is improvement and confidentiality of data in research?
fixed hypothesis
one large tests
p values, hypothesis and statistical tests
research subjects identities’ are protected
why do we need to test changes before we implement?
do not always determine the difference between change and improvement - need objective ways of measuring change impact
what are the QI methods?
clinical audit - measuring against a predefined standard where the biggest challenge is completing the cycle of audit
PDSA - clinical audit a stage further - focusing on development testing and implementation and repeated rapid small scale tests of change
what is the QI methodology beneficial for in clinical audit?
happens in a real time dynamic way with little or often measurement - focuses on change and making a visible, timely difference to patient care but making the process more robust
what is PDSA?
plan do study act - test ideas before implementing changes, change ideas, measurements and aims incorporated
what is beneficial about PDSA?
overall saves time as can see what is working effectively
how would you measure improvement?
collect baseline data, define clearly define what you are collecting, clear and open transparent measurement and continuous measurement
what are outcome measures?
they are measurements of achieving an endpoint
what are balance and process measures?
balance - checking change hasnt caused another problem
process - measures of the throughput
what is the aim of statistical process control?
display data to make the performance visible, show if has resulted in improvement compared to baseline data, determine if there are gains
what is the clinical audit cycle?
identifying the problem or the topic, setting the criteria and agree standards, collect data, analysing the data, identifying why it did not work, implementing changes and monitoring progress
how is QI achieved?
through changing provider behaviour and organisation through using a systematic change method and strategies
QI day to day: what is the process?
aim, change, measure, predicted improvement and anticipated problems
what is the most effective way to start QI?
small changes focuses on the team’s needs - rapid cycles of change measure review
what are effective changes?
they are quick and immediately evident
what is beneficial about ideas that don’t work?
they direct learning and can encourage enthusiasm - can later support a larger scale change
