Quality improvement - 1

Question 1

What is the definition of quality improvement (from the health foundation)?

Answer 1

Combination of CHANGE with a METHOD to attain a SUPERIOR OUTCOME

Question 2

What are the components of quality of care?

Answer 2

• safe
• effective
• patient centered
• timely
• efficient (resource management)
• equitable

Question 3

What are the 2 types of knowledge needed for QI?

Answer 3

1. subject matter knowledge - understanding medicine

2. profound knowledge - understanding systems and psychology (also known as improvement science)

Question 4

What are the four components of improvement science?

Answer 4

1. PDSA cycles and run charts
2. Appreciation of a system
3. Variation
4. Psychology

Question 5

What is a system?

Answer 5

A COLLECTION OF PROCESSES working together to produce a defined output

(think of a transport system and all the interconnected processes that need to get people from A to B - ie the outcome)

Question 6

What is a process?

Answer 6

A set of connected STEPS that are done to produce an outcome

Question 7

What is appreciation of a system in QI?

Answer 7

We have improved our outcomes over time with QI, but the complexity of the system has increased

Question 8

What does variation mean in the context of QI?

Answer 8

we have to work in different ways which makes it difficult to plan

Question 9

What are the two types of variation?

Answer 9

1. common cause variation

2. special cause variation

Question 10

What does common cause variation mean?

Answer 10

CHANCE cause of variation eh driving to work never takes the same amount of time
RANDOM
due to MULTIPLE FACTORS within the system

Question 11

What does special cause variation mean?

Answer 11

ASSIGNABLE CAUSE
STATISTICALLY SIGNIFICANT
something we can change and do something about

Question 12

What does psychology mean in the context of QI?

Answer 12

negative view of change in culture

Question 13

What does team coaching achieve in QI?

Answer 13

discuss ways to improve care

Question 14

Describe PDSA cycles

Answer 14

this is a model used to rapidly test improvement ideas - these ideas should be something the team thinks will help progress them towards their improvement aim and should be able to test this idea.

Subsequent PDSA cycles are carried out until the improvement aim is met

Question 15

What steps do you need to go through first before running a PDSA cycle?

Answer 15

1. set your aims - what are you trying to accomplish

2. plan for measurement - how will we know that a change is improvement

Question 16

Give an example of an aim

Answer 16

Should be measurable with targets attached to it

We aim to reduce the time our patients wait in clinic by 20% by 1st January

Question 17

What is SDSA?

Answer 17

Standardise, do study, act
When the improvement aim has been met with subsequent PDSA cycles and you now need to standardise the process to make it part of normal working practice
(this is not the end or progress as the team should be alert to new developments that would lead to a need for improvement and then going from SDSA back to PDSA)

Question 18

What is the plan stage of the PDSA?

Answer 18

• what ‘hunch’ is being tested
• when the test will take place
• who will undertake which role
• what data should be collected to know whether
  the test has led to an improvement
• what the predicted impact of the change they make is

Question 19

What is the do stage of the PDSA?

Answer 19

• when the test is performed as set out in the plan phase
• helpful to record any details of problems occurred in a log
• gather feedback about how it is going from others in the team

Question 20

What is the study stage of the PDSA?

Answer 20

• data collected during the do phase is analysed

- compare what actually happened to what they predicted would happen

Question 21

What is the act stage of the PDSA?

Answer 21

• decide whether the change idea that is under test should be adapted or abandoned, based on the results obtained
• refine the plan if needed and retest
• if successful, adopt on a larger scale and retest