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MRCPsych Part B > Quality Improvement > Flashcards

Quality Improvement Flashcards

1
Q

What is quality improvement?

A

Scientific approach to tackling the challenge of ensuring quality and safety in healthcare provision

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2
Q

What does QI method include?

A

Systematic analysis of performance and interventions to improve it

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3
Q

What is Quality Assurance?

A

Corporate management strategy that involves retrospective evaluation triggered in reaction to or avoid expected negative events.

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4
Q

What does QA focus on?

A

Where the system fails

Aims to replace failed components

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5
Q

Aims of QI

A

Improve current practice
Avoids blame
Create systems to prevent rather than rectify errors

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6
Q

Generalisability of QI projects

A

Not generalisable

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7
Q

Interventions in QI project?

A

Within established standards of care

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8
Q

Common QI approaches?

A 
PDSA
FADE
Six sigma
Lean
RCA
FMEA
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9
Q

What can be used to measure predicted change?

A

Statistical process control charts (SPC)
Pareto chart
Benefit realisation plan
Stakeholder analysis

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10
Q

Another name for SPC?

A

Run charts

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11
Q

What do SPC allow?

A

Helps to assess the system for predictability of outcome when change is implemented

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12
Q

Rules employed in SPC to identify a variation

A

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?

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13
Q

Importance of variations

A

Opportunity to study outside factors that influence the system

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14
Q

What is a pareto chart?

A

Bar chart - bars organised to show categories with most frequent events on left

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15
Q

What does pareto chart help with?

A

Visualise high-yield events which when focused on, give maximum improvement

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16
Q

What is a benefit realisation plan?

A

Table used to ensure that the intended benefits originally planned in a QI are actually delivered to stakeholders in a timely fashion.

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17
Q

What is stakeholder analysis?

A

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.

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18
Q

Types of stakeholders

A

High power, low impact
High power, high impact
Low power, low impact
Low power, high impact

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19
Q

What to do with high power, low impact stakeholders?

A

Keep satisfied

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20
Q

What to do with high power, high impact stakeholders?

A

Manage closely

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21
Q

What to do with low power, low impact stakeholders?

A

Monitor

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22
Q

What to do with low power, high impact stakeholders?

A

Keep informed

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23
Q

Name the 9 stakeholders

A 
Commissioners
Customers
Collaborators
Contributors
Channels
Commentators
Consumers
Champions
Competitors
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24
Q

What are commissioners?

A

Those that pay the organisation to do things

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25
Q

What are customers?

A

Those that acquire and use organisations products

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26
Q

What are collaborators?

A

Those with whom the organisation works to develop and deliver products

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27
Q

What are contributors?

A

Those from whom the organisation acquires content for products

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28
Q

What are channels?

A

Those who provide the organisation with a route to a market or customer

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29
Q

What are commentators?

A

Those whose opinions of the organisation are heard by customers and others

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30
Q

What are consumers?

A

Those who are served i.e. patients

31
Q

What are champions?

A

Those who believe in and will actively promote the project

32
Q

What happens during Plan in PDSA?

A

Identify and describe change to be tested or implemented

33
Q

What happens in Do during PDSA?

A

Carry out change

34
Q

What happens in Study during PDSA?

A

Examine/reflect on success of change using data before and after

35
Q

What happens in Act during PDSA?

A

Plan next change cycle before full implementation

36
Q

Who started PDSA?

A

Shewhart and Deming

37
Q

What is PDCA?

A

Plan do check act

38
Q

What is PDCA used for?

A

Context of error correction or fault detection

39
Q

Crucial ingredients for PDSA

A

Small-scale interventions
Iterative approach to test interventions
Rapid assessment of effect of change
Flexibility to adapt change according to feedback

40
Q

Why are small-scale tests important?

A

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

41
Q

What does focus stand for?

A 
Finding a process to improve
Organising a team
Clarifying current knowledge
Understanding cause of variation
Selecting process improvement procedures
42
Q

Who developed the FADE model?

A

Organisational Dynamics Institute, Wakefield, Massachusetts

43
Q

What does FADE stand for?

A

Focus
Analyse
Develop
Executive

44
Q

What happens during Focus of FADE?

A

Identify and sharply define process to e improved

45
Q

What happens during Analyze of FADE?

A

Systemically collect data to establish current state and identify root causes

46
Q

What happens during Develop of FADE?

A

Based on data analysis, develop action plans for improvement

47
Q

What happens during Execute of FADE?

A

Implement action plans on smaller scale

48
Q

What is fifth step of FADE?

A

Evaluate - install ongoing measuring/monitoring system for success

49
Q

What is Lean thinking?

A

A management philosophy

50
Q

Features of Lean thinking?

A
  1. Preserve value by identifying value stream
  2. reduce resource consumption by enabling process and value flow
  3. Reduce waste and develop pull systems
  4. Improve user satisfaction by pursuing perfection
51
Q

What is sigma in statistics?

A

Standard deviation - measure of dispersion

52
Q

What is the theory behind six sigma model?

A

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

53
Q

What does six sigma model focus on?

A

Regular measurements to improve performance and reduce problems

54
Q

Types of six sigma models

A

DMAIC

DMADV

55
Q

What does DMAIC stand for?

A 
Define
Measure
Analyze
Improve
Control
56
Q

Aim for DMAIC?

A

Improving existing processes that fall below specification.

Aimed at incremental improvement.

57
Q

What does DMADV stand for?

A 
Define
Measure
Analyze
Design
Verify
58
Q

What is DMADV used for?

A

To develop new processor products at superior performance levels

59
Q

What is MFI?

A

Extension of PDSA - needs to occur before PDSA

60
Q

Questions in MFI

A

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?

61
Q

What does root cause analysis (RCA) involve?

A

Retrospective investigation that occurs after an adverse event

62
Q

Aim of root cause analysis?

A

Identify causal factors and explain variation in performance that resulted in the event

63
Q

What does RCA focus on?

A

Individual events

64
Q

Problems with RCA

A

Hindsight bias

Cannot be generalised

65
Q

What is failure modes and effects analysis (FMEA) used for?

A

Assess risk of patient injury/adverse event by prospectively identifying potential system failures.

66
Q

What question does FMEA address?

A

How could the system fail?

67
Q

What question does RCA address?

A

Why did the system fail?

68
Q

Five steps of FMEA

A
  1. Team selection for focus group of multidisciplinary experts
  2. Process identification wherein group meets regularly to identify system risks
  3. Generating process flow diagram
  4. Failure mode identification and prioritising risk
  5. Action planning
69
Q

What is a failure mode?

A

Weak link in a system that can break down and adversely affect outcomes

70
Q

What is SQUIRE statement?

A

Standards for Quality Improvement Reporting Excellence

71
Q

What does SQUIRE consist of?

A

19 items checklist recommended when reporting formal studies of healthcare quality improvement

72
Q

What features need to be evaluated in a QIP

A 
Definition of change and explicit prediction of direction of change
Use of multiple iterations
Small-scale testing
Understanding of temporal variation
Documentation
73
Q

What does understanding of temporal variation mean?

A

Key feature of QIPs is building evaluation systems that account for complex but inherent variations that occur over time

74
Q

Why is documentation relevant for QIPs?

A

Essential for linking future cycles and transferring knowledge to others

MRCPsych Part B (64 decks)

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