Quality Improvement

Question 1

What are tools that you can use to do a root cause analysis and understand your process?

Answer 1

1. Process mapping (flowchart of all steps in the process to identify problems)
2. Fishbone diagram (explore and display main causes and sub cases contributing to an effect/outcome to ID areas for improvement ex. provider, policies, patients, place, procedures)
3. Five why’s
4. Check sheets
5. Pareto chart (bar chart that shows various contributing factors to problem ordered from largest to smallest contribution to identify vital few that warrant improvement efforts)

Question 2

What are the steps to a QI project?

Answer 2

1. Assemble a team (leader, multidisciplinary, QI experience)
2. Identify problem
3. Develop “aim statement” using SMART framework and measures (outcome, process and balancing)
4. Define the changes (change ideas and change concepts)
5. Brainstorm what might be causing the problem (process map, fishbone diagram, 5 why’s, Pareto)
6. Implement rapid cycle improvements (PDSA cycles)
7. Measure outcome (sampling)
8. Analyze data (run chart)

Question 3

What are the two parts of the Model for Improvement?

Answer 3

Part 1
1. Aim - what are you trying to accomplish?
2. Measure - how will you know if a change is an improvement?
3. Change - what changes can we make that will result in improvement?
Part 2
Rapid cycle improvement (PDSA)

Question 4

What is an outcome measure?

Answer 4

The main goal that you want to achieve, specifically related to aim statement and is measurable
Ex. total number of falls on ACE unit

Question 5

What is a process measure?

Answer 5

A measure that captures change to the inputs/steps that contribute towards your main outcome. Focuses on parts of the system that are not performing as planned.
Ex. PT assessment, falls risk assessment

Question 6

What is a balancing measure?

Answer 6

Determine whether change to one area of the system are causing new problems in another part
Ex. change to LOS, increased workload/time to see PT

Question 7

What are two fundamental characteristics of a run chart?

Answer 7

Data plotted over time (usually time on x axis, outcome measure on y axis)
Median line showing historical performance

Question 8

What is the purpose of a run chart?

Answer 8

Find trends or patterns in the process
Determine if changes tested resulted in improvement
Identify sustainability of the improvement
Helps distinguish cause variation from normal variation
Determine if process is demonstrating non random pattern

Question 9

What are measures you use when analyzing a run chart?

Answer 9

1. Shift - 6+ consecutive points all above or all below the median
2. Trend - 5+ consecutive points all going up or down
3. Runs - too few or too many runs shows non-random pattern
4. Astronomical point - detects unusually large or small numbers