Practice and Process Improvement Flashcards
Research process
Identify the problem Review of literature Identify conceptual framework Define concepts and variables Select design Identify population and sample Determine measurement methods Plan data collection and analysis Implement: collect, analyse, interpret Disseminate findings (most important)
Qualitative inquiry
Subjective (words)
Inductive
Broad focus
Meaning/discovery
Quantitative inquiry
Single, measureable reality Objective (numbers and statistics) Deductive Narrow focus Cause and Effect
Research study critique
Introduction: is problem identified
Problem statement: is it clear
Purpose statement: clearly stated goal or objective?
Review of literature: is the review comprehensive
Theory and conceptual framework; Clearly identified and discussed
REsearch question: clearly stated? Further delineates the problem area of study?
Design/methodology: is the design appropriate to test the study
Ethics: appropriate IRB approval
Data: were collection methods clearly described? Statistics clearly discussed? Demographics?
Findings: are findings presented clearly and objectively? Is each hypothesis addressed separately?
Limitations: any that may have influenced findings?
Implications: suggestions for nursing practice, education or further nursing research
Evidence-based Practice steps
Formulate a burning question using PICOT:
Population or patient; interest or intervention; comparison; outcomes; time (optional) it takes to achieve outcome
Search best evidence
Review evidence
Integrate evidence with clinical expertise and patient preferences/values in making practice change
Evaluate effectiveness is of change meeting desired outcomes
Disseminate findings
Rapid critical appraisal
Validity: was research study conducted in a rigorous manner
reliability: can others realistically expect to achieve the same results
Applicability: does the study apply to my patients/learners?
Levels of evidence
Systematic review or meta-analysis RCT Controlled trial without randomization Case control or cohort study Systematic review of qualitative or descriptive studies Qualitative or descriptive study Expert opinion or consensus
Evaluating the evidence: 3 important question
Is the evidence strong enough to implement the findings into practice?
Is the evidence so weak that a research study needs to be conducted?
Should we return to the literature and do a more complete search, widening the sources used?
Principles of quality management
Customer focus
Leadership
Involvement of people at all levels of the organization
Process approach
System approach to management of interrelated processes
Continual improvement
Factual approach to decision making
Mutually beneficial supplier relationships
6 measures of quality
Safe; timely; effective; efficient; equitable; patient-centered
QSEN versus IOM Measures of healthcare quality
QSEN : IOM
Pt centered care : delivering pt centered care
Teamwork and collaboration : working as part of an interdisciplinary team
EBP : Practicing EBP
QI : focusing on QI
Informatics : using information technology
Safety
FOCUSPDCA
Find a problem Organize a team Clarify the problem Understand a problem Select an intervention Plan Do Check the results Act
Six Sigma Improvement
Near-elimination of defects from every product, process or service; minimizing variances;
Approaches: DMADV, DMAIC
six sigma approaches
DMADV (define, measure, analyze, design and verify) :developing a new process
DMAIC (define, measure, analyze, improve and control) improving an existing process
Lean thinking
Provide perfect value to the customer through zero waste (time waste, supplies where they need to be, improves efficiency)
Rapid cycle improvement
Small, concrete changes that can be implemented and piloted quickly Set the aim Define the measures Make the change Test changes using PDSA Repeat cycle if changes or did not work.
FMEA. Failure mode and effect analysis
Looking in a future way where is there a potential for errors to occur and the likelihood for that to happen, goal is error prevention, may be used to evaluate new or existing processes
Steps in FMEA
Select a process
Select a team
Describe the process
Identify what could go wrong at each step of process
Work on eliminating the problems chosen
Design and implement changes to reduce or prevent problems
Measure the success of the process changes
Dashboards
Internal formative assessment of performance and quality care
PICOT
P - population or patient - most important characteristics
I - interest or intervention - Issue or intervention to be studied, measure, improve, or affected
C - comparison - Describe the main alternatives
O - outcomes - Describe what is to be accomplished
T - Time it takes for intervention to achieve outcome - describe the timeframe
3 components of EBP
Best evidence
Clinician (NPD) Expertise
Patient (learner) values/preferences
Quality improvement skills
Using systematic processes and tools to define problems (flowchart, cause effect diagrams)
Recognizing potential causes of problems (RCA)
Planning and implementing change
Using tools and data to measure quality, performance and variation (control chart, run chart)
Selecting appropriate methods for testing possible solutions (PDCA)
Evaluating effects of change to improve care and practice
Flowchart
Flow of work through a process including activities, decisions, and measurement points. Oval – beginning and end, rectangle Dash steps in the process, diamond – decision making point
Line graph or run chart
Shows data trends over time Y axis shows the time delay, defects or cost and X axis shows the time
Pareto chart
Bar graph showing frequency of measures in descending order, focuses on the improvement effort by identifying the 20% of the contributors that create 80% of the time delay, defects, or cost in any process
Cause-effect diagram or Fishbone diagram
Begins with major causes and work backward to read causes, five whys; Problem statement and brainstorm to identify potential issues related to specific categories – people, process, materials, management, environment, policy, etc.
Control chart
Helps analyze, sustain, and monitor the current levels of process stability and identify key issues for problem-solving or root cause analysis. Looks for variation over time.
Histogram
Bar graph showing frequency and pattern of distribution of one variable - numeric data
Bar graph
Compares multiple variables – categorical data
Matrix
Compares two or more groups of ideas, determines relationships among the elements, and makes decisions. It helps prioritize tasks or issues to a decision making and shows linkages between large groups of characteristics, functions, and tasks.
Tree diagram
Systematically links ideas, target, objectives, goals, or activities in greater and greater detail it shows key goals, some goals, measures, and tasks required to accomplish an objective.
Scatter diagram
Plotting data on a graph to look for correlations between variables (positive, negative, or no correlation)
FADE Methodology
Focus, analyze, develop, execute/evaluate
CIPP Model
Model of program evaluation: Context, Input, Process, Product; evaluating to aid in decision making and improve process
Context - goals, needs assessment; Input - planning, Process - action/implementation, Product - evaluate outcomes
provides formative and summative evaluation
