Quality Improvement Flashcards
What is quality improvement?
Scientific approach to tackling the challenge of ensuring quality and safety in healthcare provision
What does QI method include?
Systematic analysis of performance and interventions to improve it
What is Quality Assurance?
Corporate management strategy that involves retrospective evaluation triggered in reaction to or avoid expected negative events.
What does QA focus on?
Where the system fails
Aims to replace failed components
Aims of QI
Improve current practice
Avoids blame
Create systems to prevent rather than rectify errors
Generalisability of QI projects
Not generalisable
Interventions in QI project?
Within established standards of care
Common QI approaches?
PDSA FADE Six sigma Lean RCA FMEA
What can be used to measure predicted change?
Statistical process control charts (SPC)
Pareto chart
Benefit realisation plan
Stakeholder analysis
Another name for SPC?
Run charts
What do SPC allow?
Helps to assess the system for predictability of outcome when change is implemented
Rules employed in SPC to identify a variation
Does outcome measure go beyond limits of expectation?
Does outcome lie consistently (7) on one side of expected central value?
Does out come show progressive, regressive or cyclical trend?
Does outcome stay out of middle third of expected range of values?
Importance of variations
Opportunity to study outside factors that influence the system
What is a pareto chart?
Bar chart - bars organised to show categories with most frequent events on left
What does pareto chart help with?
Visualise high-yield events which when focused on, give maximum improvement
What is a benefit realisation plan?
Table used to ensure that the intended benefits originally planned in a QI are actually delivered to stakeholders in a timely fashion.
What is stakeholder analysis?
Identifying everyone with interest who needs to be involved in a QIP, categorising them based on importance and influence and explicitly making a plan to engage with them.
Types of stakeholders
High power, low impact
High power, high impact
Low power, low impact
Low power, high impact
What to do with high power, low impact stakeholders?
Keep satisfied
What to do with high power, high impact stakeholders?
Manage closely
What to do with low power, low impact stakeholders?
Monitor
What to do with low power, high impact stakeholders?
Keep informed
Name the 9 stakeholders
Commissioners Customers Collaborators Contributors Channels Commentators Consumers Champions Competitors
What are commissioners?
Those that pay the organisation to do things
What are customers?
Those that acquire and use organisations products
What are collaborators?
Those with whom the organisation works to develop and deliver products
What are contributors?
Those from whom the organisation acquires content for products
What are channels?
Those who provide the organisation with a route to a market or customer
What are commentators?
Those whose opinions of the organisation are heard by customers and others
What are consumers?
Those who are served i.e. patients
What are champions?
Those who believe in and will actively promote the project
What happens during Plan in PDSA?
Identify and describe change to be tested or implemented
What happens in Do during PDSA?
Carry out change
What happens in Study during PDSA?
Examine/reflect on success of change using data before and after
What happens in Act during PDSA?
Plan next change cycle before full implementation
Who started PDSA?
Shewhart and Deming
What is PDCA?
Plan do check act
What is PDCA used for?
Context of error correction or fault detection
Crucial ingredients for PDSA
Small-scale interventions
Iterative approach to test interventions
Rapid assessment of effect of change
Flexibility to adapt change according to feedback
Why are small-scale tests important?
Provide users with freedom to act and learn
Minimise risk to patients and organisation
Minimise resource requirement while giving opportunity to build evidence
Engage stakeholders
What does focus stand for?
Finding a process to improve Organising a team Clarifying current knowledge Understanding cause of variation Selecting process improvement procedures
Who developed the FADE model?
Organisational Dynamics Institute, Wakefield, Massachusetts
What does FADE stand for?
Focus
Analyse
Develop
Executive
What happens during Focus of FADE?
Identify and sharply define process to e improved
What happens during Analyze of FADE?
Systemically collect data to establish current state and identify root causes
What happens during Develop of FADE?
Based on data analysis, develop action plans for improvement
What happens during Execute of FADE?
Implement action plans on smaller scale
What is fifth step of FADE?
Evaluate - install ongoing measuring/monitoring system for success
What is Lean thinking?
A management philosophy
Features of Lean thinking?
- Preserve value by identifying value stream
- reduce resource consumption by enabling process and value flow
- Reduce waste and develop pull systems
- Improve user satisfaction by pursuing perfection
What is sigma in statistics?
Standard deviation - measure of dispersion
What is the theory behind six sigma model?
Sigma = SD
In a normally distributed and therefore efficient system, 6 sigma = 3.4 outliers per million
Aim of six sigma model is to reduce inefficiency to this level
What does six sigma model focus on?
Regular measurements to improve performance and reduce problems
Types of six sigma models
DMAIC
DMADV
What does DMAIC stand for?
Define Measure Analyze Improve Control
Aim for DMAIC?
Improving existing processes that fall below specification.
Aimed at incremental improvement.
What does DMADV stand for?
Define Measure Analyze Design Verify
What is DMADV used for?
To develop new processor products at superior performance levels
What is MFI?
Extension of PDSA - needs to occur before PDSA
Questions in MFI
What are we trying to accomplish?
How will we know if change is an improvement?
What change can we make that will result in improvement?
What does root cause analysis (RCA) involve?
Retrospective investigation that occurs after an adverse event
Aim of root cause analysis?
Identify causal factors and explain variation in performance that resulted in the event
What does RCA focus on?
Individual events
Problems with RCA
Hindsight bias
Cannot be generalised
What is failure modes and effects analysis (FMEA) used for?
Assess risk of patient injury/adverse event by prospectively identifying potential system failures.
What question does FMEA address?
How could the system fail?
What question does RCA address?
Why did the system fail?
Five steps of FMEA
- Team selection for focus group of multidisciplinary experts
- Process identification wherein group meets regularly to identify system risks
- Generating process flow diagram
- Failure mode identification and prioritising risk
- Action planning
What is a failure mode?
Weak link in a system that can break down and adversely affect outcomes
What is SQUIRE statement?
Standards for Quality Improvement Reporting Excellence
What does SQUIRE consist of?
19 items checklist recommended when reporting formal studies of healthcare quality improvement
What features need to be evaluated in a QIP
Definition of change and explicit prediction of direction of change Use of multiple iterations Small-scale testing Understanding of temporal variation Documentation
What does understanding of temporal variation mean?
Key feature of QIPs is building evaluation systems that account for complex but inherent variations that occur over time
Why is documentation relevant for QIPs?
Essential for linking future cycles and transferring knowledge to others
