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HOW-TO GUIDE:STARTING A STUDENT RUN QUALITY IMPROVEMENT PROJECT
TMIT Student Projects QuickStart Package ™
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Objectives
List overarching global aims of improvement
Form a multi-disciplinary team Begin to innovate, design, and
implement a student-run quality improvement project
Use Plan-Do-Study-Act cycles for improvement initiatives
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Outline
I. Introduction to Quality Improvement
II. From Innovation to DesignIII. The PilotIV. Implementation
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Outline
I. Introduction to Quality Improvement
1) Aims for improvement2) Multi-professional teamwork3) Students role
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So You Want To Create Change?
“While all changes do not lead to improvement, all improvement requires change.”
- Institute for Healthcare Improvement
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From Theory to Practice:“Check a Box. Save a Life.” The First Global Student Sprint to
Improve Healthcare
We will use this example to illustrate how students can design, pilot, and implement a project
The Innovation-Students taking the
lead with efforts in spreading the WHO Surgical Safety Checklist
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Aims for Improvement
We need healthcare that is:
Safe Avoid injuries to patients from the care that is intended to
help them.
Effective Match care to science; avoid overuse of ineffective care and
underuse of effective care. Patient-Centered
Honor the individual and respect choice. Timely
Reduce waiting for both patients and those who give care. Efficient
Reduce waste. Equitable
Close racial and ethnic gaps in health status.
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Multi-Professional Teamwork
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Students Role
There are hundreds of processes that can be improved in a system.
What you can do?Gain Knowledge
○ Raise awareness and share knowledge of the System
Be Active○ Pilot and implement a safe practice
Use Evidence○ Research latest evidence-based improvement
strategies○ Collect data before and after improvement
strategy
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Pharmacy: Track antibiotic use and costs for surgical patients.
Engineering: Examine patient flow and fit checklist into OR processes.
Health Admin: Determine the cost savings in your hospitals from the checklist.
Public Health: Track patient outcomes and measure impact.
MD//DO/RN: Engage your classmates to learn it, use it, and
seek advice from others.
Safe Surgery Student Sprint
Example: Multi-Disciplinary Student Involvement
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Outline
I. Introduction to Quality Improvement
II. From Innovation to DesignIII. The PilotIV. Implementation
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Outline
II. From Innovation to Design1. Forming Your Team2. Setting Aims3. Creating a Strategy4. Change Concepts5. Project Proposal
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Innovating, not reinventing
If you are talking to the right people, chances are you will stumble across someone who has had similar thoughts about changing the current system
Connect early and discuss methods that are already in place or being researched
Your greatest barrier can be your attempt to do this on your own
Get a team on board and work together!
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Forming Your Team
Collaborative PartnersMulti-disciplinary teamEach member with different expertise
Recruit key opinion leaders and advisorsFind a mentor who is connected to
your project through a department affiliation or quality improvement committee
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Example:Recruiting Key Opinion Leaders Safe Surgery Student Sprint
A student used an evidence-based improvement strategy such as the WHO Surgical Checklist
Introduced checklist to key opinion leaders of hospitals, including:Superintendant of
HospitalChair of SurgeryChief of Quality
Assurance
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Forming Your Team Leadership
Responsibility ChartingDistinguish individual roles with listed
activitiesUsing this tasking method gives the
whole team a global view of the project’s evolution
LogisticsCreate short deadlinesHave frequent update meetings
Team work! Team work! Team work!
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Example: Responsibility Charting Safe Surgery Student Sprint
Steps/Actions
Tasks Deadline Status Owner Notes
Creating a Vision/Strategy
Project Proposal
Action Plan
3/12/2009
3/15/2009
Complete
Pending
Sarah
John
Submitting to advisor
Will email
Pilot Studies Case studies
4/5/2009 Pending SarahJohnMichael
Draft #2
Deliverables
Student PowerPoint
5/1/2009 Pending Michael Draft #1 completed
Publications Poster session
5/1/2009 Pending John Will email committee
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Setting Aims
1. State your aim clearly2. Identify the population and system to be
improved3. Set numerical goals
To better measure outcomes
4. Set Stretch Goals Give yourself a timeline
○ Ex: Reduce infections by 50% in 6 months
5. Avoid Aim Drift Focus on your goal and try not to steer away
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Creating an Improvement Strategy
1. Critical thinking about the current system
2. Benchmarking 3. Using technology 4. Creative thinking 5. Using change concepts
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Change Concepts
An approach to change that has been useful in developing ideas for improvement efforts:
Eliminate Waste Improve Work Flow Manage Time Focus on Variation Change the Work Environment Error Proofing
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Example:Using a Change ConceptChanging the work environment
Building a new type of network
Instead of Hospital Administrators, in this project, Students were the Change Agents in spreading this quality improvement tool
Students used new social networking features as a primary means of building their project network
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Project Proposal
I. Vision/MissionII. Setting AimsIII. Proposal Outline
I. BackgroundII. The InterventionIII. Strategy for Implementation
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Outline
I. Introduction to Quality Improvement
II. Innovation to DesignIII. The PilotIV. Implementation
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Outline
III. The Pilot1) Using PDSA Cycles2) Communication3) Data Collection
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The Pilot
Start as a pilotSmall scale with a few
individuals testing your improvement method
Use Plan-Do-Study-Act (PDSA) cycles during this pilot phase
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The Pilot: Using PDSA Cycles
Run a test trial on a small scale
Follow a simple “PDSA” cycle for pilotPlanDoStudyAct
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Example: Using PDSA CyclesSafe Surgery Student Sprint
One student. One hospital. Three operating rooms.
Plan: Introductory seminar and
teaching with hospital administration and residents.
Do: One week trial using 3 ORs
Study: Feedback session given to
residents and surgical staff.. Act:
Continued piloting the checklist in 3 operating theaters with improvements in place.
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The Pilot: Communication
Background educationShare the factsAnswer questions ahead of time
Energize your teamGet them excited about change!
CommunicationEnsure that all of those participating in
pilot are aware of their roles and project aims
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The Pilot: Data Collection
Plot data over time Seek usefulness Use sampling Integrate measurement into daily
routine Use qualitative and quantitative
data
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ExampleData CollectionSafe Surgery Student Sprint
Wales, UK Jan – June 2009
Students were data collectors in OR25 students observed
83 operationsReported observations
into an online data form
Evaluated 5 items of standard procedure
Data used to encourage implementation
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Outline
I. Introduction to Quality Improvement
II. Innovation to DesignIII. The PilotIV. Implementation
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Outline
V. Implementation1. Pilot to Implementation 2. Keys to Successful Adoption3. Project expansion4. Leadership Changes
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Implementation
After the pilot, evaluate for ways you can make the project successful on a larger scale
Create a step-by-step process outline for easy engagement
Be ready for resistanceBe prepared to address counter
arguments Champions can lead the way Continue to Collect Data
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Keys For Successful Adoption
Relative AdvantageDegree to which an innovation is perceived as
being better than the idea it supersedes Compatibility
Degree to which an innovation is perceived to be consistent with the existing values, past experiences and needs of potential adopters
ComplexityDegree to which an innovation is perceived as
difficult to use Trialability
Opportunity to experiment with the innovation on a limited basis
ObservabilityDegree to which the results of an innovation
are visible to others
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Example: Spreading your project“Check a Box. Save a Live.”
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Leadership ChangePassing the Torch
Remember handoffs are a leading cause of error!
Ensure members of the original team will be able to continue carrying out efforts
Document logistical challenges and recommendations for the next leader
Keep lines of communication open
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Summary Objectives
List overarching global aims of improvement
Form a multi-disciplinary team Begin to innovate, design, and
implement a student-run quality improvement project
Use Plan-Do-Study-Act cycles for improvement initiatives
Be Bold. Be a Change Agent!