ca to qi: advanced skills session nancy dixon, director of strategic services healthcare quality...

CA to QI: Advanced skills session

Nancy Dixon, Director of Strategic Services

Healthcare Quality Quest (HQQ)

www.hqip.org.uk

Copyright © Healthcare Quality Quest, 2014

ClinicalAudit toQualityImprovement — Advanced skills

How can benchmarking, statistical processcontrol tools and demand-capacityanalysis support clinical audit

What’s involved in benchmarking

What’s involved in SPC

What’s involved in demand-capacityanalysis

The way forward

How can benchmarking, statistical processcontrol tools and demand-capacityanalysis support clinical audit

What’s involved in benchmarking

What’s involved in SPC

What’s involved in demand-capacityanalysis

The way forward

Quality improvement tools — How can they support clinical audit?

What is the nature of the cause of the variation in practice?

Do clinical audit findings ever question —

Do we have the resources needed to meetthe quality expectations measured by theclinical audit?

How do other NHS Trusts have so muchbetter results on a national clinical audit?

How can benchmarking, statistical processcontrol tools and demand-capacityanalysis support clinical audit

What’s involved in benchmarking

What’s involved in SPC

What’s involved in demand-capacityanalysis

The way forward

Benchmarking is the process of measuring and improving

products, services and practices in comparison tothe toughest competitors

or those organizations that are recognized as industry leaders

Benchmarking is about searching for ‘best-in-class’, finding out how they achieve

best performance and learning from the processes that

produce best performance

Establish improvement objectives based on aninformed view of what others do and achieve

Benefits of benchmarking

Learn about best practices in the field

Challenge thinking about what can be achieved

Learn about options for improvement

Provide a basis for decision-making on changesin practice

Achieve performance that is comparable orsuperior to others

Apply valid measures of quality

Provide an evidence-based approach to test performance

Benchmarking Benchmarks

Process of measuring and learning

Comparative data or targets=

=

Define what is to be benchmarking and the objective of benchmarking

Identify the best performers

Identify your organization’s performance onwhat is being benchmarked

How to do benchmarking — properly

Identify the performance of the best organization

Find the ‘gaps’ in care

Learn the process of the best organizationin relation to the gaps

Learn your organization’s process inrelation to the gaps

Identify where changes can be made in yourorganization’s processes to be closer to the processof the best organization — and implement changes

Measure the impact of the change

Work collaboratively with yourbenchmarking ‘partner’

How could you use benchmarking withnational clinical audits?

Can you identify best performance fromthe report?

Can you find the best performers?

For a national clinical audit —

Can you identify gaps between best andyour organization’s performance?

Can you arrange to learn from the best?

How can benchmarking, statistical processcontrol tools and demand-capacityanalysis support clinical audit

What’s involved in benchmarking

What’s involved in SPC

What’s involved in demand-capacityanalysis

The way forward

The team has to guess at the nature of any variation

Single-value statistics —such as a percentage —can hide variation

The team has a method for identifying the nature of the variation

SPC tools — run chartsand control charts —can highlight variation

Statistical process controlis a way of thinking about work

processes and tools —run charts and control charts

— to analyse variation in work processes

Types of variation

Common cause

Special cause

Common cause variation is variation in a process that –

results from the way a process is usually carried out

is random – no one cause

A process with common cause variation —

Is stable statistically

Has a known capability — you know how or how well the process works

Is predictable — you can tell how the process will work in the future

Is in statistical control

Special cause variation is variation in a process that –

results from factors that are not the way a process is usually carried out

has a special cause

A process with special cause variation —

Is not stable statistically

Does not have a known capability

Is not in statistical control

Is not predictable

A run chart is a display of data points in chronological order of the events represented by the

data, that is, the data points are plotted in the order in which

they occurred, for the purposes of finding the amount and type

of variation

Apply rules to your run chart

A rule appears special cause

A rule doesn’t appear common cause

=

=

Rule 1 — Shift

4

3

2

1

8

7

6

5

10

9 n = 25

0

11 13 15 17 19 21 23 251 3 5 7 9

MeasureMedian

Observations over time

Mea

sure

Median = 4

Rule 2 — Trend

Median = 10n = 25

11 13 15 17 19 21 23 251 3 5 7 9

MeasureMedian

8

6

4

2

16

14

12

10

18

0

Mea

sure

Observations over time

Rule 3 — Repeating pattern

0

20

15

10

5

35

30

25

Median = 17n = 25

Mea

sure

11 13 15 17 19 21 23 251 3 5 7 9

MeasureMedian

Observations over time

How to anticipate the type of action needed

Type of action

Commoncause Fix the process

Specialcause

Find and fix the special cause

How could you use run charts for clinical audits?

Can you identify consecutive caseperformance?

Can you plot a run chart?

For a clinical audit —

Can you plan the right type of action?

Can you apply the rules?

How can benchmarking, statistical processcontrol tools and demand-capacityanalysis support clinical audit

What’s involved in benchmarking

What’s involved in SPC

What’s involved in demand-capacityanalysis

The way forward

A team may need to know —

How much service does the current process actually deliver?

How much service could the current process deliver?

How much resource does this current process take?

How does the current amount of service compare with the amount of service needed?

What can be done to meet demand?

Demand-capacity analysis is a process to determine the

demand for and the capacity of a process or service in order to

make decisions on actions needed to balance

demand and capacity

Demand (workload to be met)

Capacity (potential

workload that can be met)

Activity(actual

workload met)

Demand is the amount of service required — the workload to be met expressed as:

Count of people or things or

Amount of time needed to meet the demand,that is, provide amount of service required

Demand may fluctuate — but if a process is capable of meeting demand, a smooth demand

results in a smooth process flow

Capacity is the amount of servicethat could be delivered by a current process

and available resources — the potential workload that could be met expressed as:

Count of people or things or

Amount of time the service is able to provide

Capacity varies according to theresources available and how well a process

works

Activity is the amount of service actually delivered — the actual throughput or

workload met by a current process and available resources expressed as:

Count of people or things or

Amount of time the service was provided

Activity varies by needs, number and experience of staff, functioning of needed resources and

the efficiency of processes

Queue is the number of people or thingsthat are waiting for a service to begin

Queues form when a process is operating close to or at capacity or when there is a

high degree of variation in demand

When to use demand–capacity analysis — to improve

Continuous process flow — avoiding stopping

Cycle time of a process — how long the process takes from beginning to end

Access to a service including waiting times

Ensuring that resources are provided at the right time in the right amount and in the

most efficient way

Demand–capacity analysis relies on —

Non-value-added steps

Process analysis

Bottlenecks

Run charts

Statistical process control

Control charts

How could you use demand-capacityanalysis for clinical audits?

Can you identify demand, capacity andactivity?

Can you identify shortcomings in demand,capacity and activity?

For a clinical audit —

Can you plan the right type of action?

How can benchmarking, statistical processcontrol tools and demand-capacityanalysis support clinical audit

What’s involved in benchmarking

What’s involved in SPC

What’s involved in demand-capacityanalysis

The way forward

The way forward

Benchmarking

Statistical process control charts

Demand-capacity analysis

What are opportunities for using the qualityimprovement tools in clinical audit —

What are the barriers?

Nancy.Dixon@hqq.co.uk

www.hqq.co.uk

Copyright © Healthcare Quality Quest, 2014

ClinicalAudit toQualityImprovement — Advanced skills