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Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational Research Support Center Division of Infectious Diseases University of Louisville [email protected] Strategies to Facilitate Performance Monitoring

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Page 1: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Paula Peyrani, MDMedical/Project Director, HIV Program at the 550 ClinicAssistant Director, Research Design and Development

Clinical and Translational Research Support CenterDivision of Infectious Diseases

University of [email protected]

Strategies to Facilitate Performance Monitoring

Page 2: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Outline

• Quality improvement

• Model for improvement

• What can go wrong?

Page 3: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Outline

• Quality improvement

• Model for improvement

• What can go wrong?

Page 4: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

• Essential component of 21st century medicine.

QUALITY IMPROVEMENT

Page 5: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

• Essential component of 21st century medicine.• Used to create safer systems and implement safer

practices.

QUALITY IMPROVEMENT

Page 6: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

• Essential component of 21st century medicine.• Used to create safer systems and implement safer

practices.

QUALITY IMPROVEMENT

Page 7: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

• Essential component of 21st century medicine.• Used to create safer systems and implement safer

practices.• Process measure quantifies compliance with the

practices being implemented as part of an initiative.

QUALITY IMPROVEMENT

Page 8: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

• Essential component of 21st century medicine.• Used to create safer systems and implement safer

practices.• Process measure quantifies compliance with the

practices being implemented as part of an initiative.• An outcome measure assess the impact of the initiative

on a patient population or health-care system

QUALITY IMPROVEMENT

Page 9: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Process

QUALITY IMPROVEMENT

Outcome

Page 10: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Outline

• Quality improvement

• Model for improvement

• What can go wrong?

Page 11: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Page 12: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Page 13: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

The aim has to be:

Consistent with national goals and relevant to the length of the project

Page 14: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

The aim has to be:

Consistent with national goals and relevant to the length of the project

Bold in its aspirations

Page 15: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

The aim has to be:

Consistent with national goals and relevant to the length of the project

Bold in its aspirations Clear with measurable targets

Page 16: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

The aim has to be:

Consistent with national goals and relevant to the length of the project

Bold in its aspirations Clear with measurable targets

Outcome measure: To reduce the incidence of infections due to CRE

Page 17: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

The aim has to be:

Consistent with national goals and relevant to the length of the project

Bold in its aspirations Clear with measurable targets

Outcome: To reduce the incidence of infections due to CRE

Process: timing of swabbing upon admission to the hospital

Page 18: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Page 19: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Collect data to demonstrate whether changes result in improvement

Page 20: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Collect data to demonstrate whether changes result in improvement

Graphs: “run charts” or statistical process control charts

Page 21: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Collect data to demonstrate whether changes result in improvement

Graphs: “run charts” or statistical process control charts

Measures are tools for learning and demonstarting improvement, not for judgment.

Page 22: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Page 23: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

There are many potential changes that a team can make

Page 24: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

There are many potential changes that a team can make

There are a small number of changes that are most likely to result in improvement

Page 25: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

http://www.birdville.k.12.tx.us/staffdev/continuos_imprvmn.htmlt

MODEL FOR IMPROVEMENT

Page 26: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

WHY IS IMPORTANT TO ASSESS?

Page 27: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

WHY IS IMPORTANT TO ASSESS?

Evaluate how much improvement can be expected from the change

Page 28: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

WHY IS IMPORTANT TO ASSESS?

Evaluate how much improvement can be expected from the change

Decide whether the change will work in the actual setting

Page 29: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

WHY IS IMPORTANT TO ASSESS?

Evaluate how much improvement can be expected from the change

Decide whether the change will work in the actual setting

Evaluate costs, social impact, and side effects from a proposed change

Page 30: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

WHY IS IMPORTANT TO ASSESS?

Evaluate how much improvement can be expected from the change

Decide whether the change will work in the actual setting

Evaluate costs, social impact, and side effects from a proposed change

Minimize resistance upon implementation

Page 31: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

http://www.birdville.k.12.tx.us/staffdev/continuos_imprvmn.htmlt

MODEL FOR IMPROVEMENT

Page 32: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Plan

Page 33: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

PlanPlan the test or observation, including a plan for collecting data

Page 34: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

PlanPlan the test or observation, including a plan for collecting data• State the objective of the test• Make predictions about what

will happen and why• Develop a plan to test the

change (Who? What? When? Where? What data need to be collected?)

Page 35: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Do (test)

Page 36: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Do (test)Try out the test on a small scale

Page 37: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Do (test)Try out the test on a small scale• Carry out the test• Document problems and

unexpected observations• Begin analysis of the data

Page 38: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Study

Page 39: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

StudySet aside time to analyze the data and study the results.

Page 40: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

StudySet aside time to analyze the data and study the results.• Complete the analysis of the

data• Compare the data to your

predictions• Summarize and reflect on what

was learned.

Page 41: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

Act

Page 42: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

ActRefine the change, based on what was learned from the test.

Page 43: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

MODEL FOR IMPROVEMENT

StudyRefine the change, based on what was learned from the test.• Determine what modifications

should be made• Prepare a plan for the next test

Page 44: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Outline

• Quality improvement

• Model for improvement

• What can go wrong?

Page 45: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

WHAT CAN GO WRONG?

Page 46: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Palmetto Health Family Medicine Center (FMC), the teaching practice for the Department of Family and Preventive Medicine at the University of South Carolina School of Medicine

WHAT CAN GO WRONG?

Page 47: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Palmetto Health Family Medicine Center (FMC), the teaching practice for the Department of Family and Preventive Medicine at the University of South Carolina School of Medicine

Period of transformation by integrating QI principles into its clinical, educational, and research missions

WHAT CAN GO WRONG?

Page 48: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Palmetto Health Family Medicine Center (FMC), the teaching practice for the Department of Family and Preventive Medicine at the University of South Carolina School of Medicine

Period of transformation by integrating QI principles into its clinical, educational, and research missions

Teams began working on PDSA cycles targeted at clinical and operational problems

WHAT CAN GO WRONG?

Page 49: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Palmetto Health Family Medicine Center (FMC), the teaching practice for the Department of Family and Preventive Medicine at the University of South Carolina School of Medicine

Period of transformation by integrating QI principles into its clinical, educational, and research missions

Teams began working on PDSA cycles targeted at clinical and operational problems

Began looking for multiple ways to change previously well-established ways of working

WHAT CAN GO WRONG?

Page 50: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Signs of impairment after 18 months

WHAT CAN GO WRONG?

Page 51: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Signs of impairment after 18 months

Multitasking on various PDSA cycles

WHAT CAN GO WRONG?

Page 52: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Signs of impairment after 18 months

Multitasking on various PDSA cycles Not completing cycles

WHAT CAN GO WRONG?

Page 53: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Signs of impairment after 18 months

Multitasking on various PDSA cycles Not completing cycles Fatigue

WHAT CAN GO WRONG?

Page 54: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Signs of impairment after 18 months

Multitasking on various PDSA cycles Not completing cycles Fatigue Lack of commitment to sustainability

WHAT CAN GO WRONG?

Page 55: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

to sustainability

WHAT CAN GO WRONG?

Planning wasmuch easier than Doing

Page 56: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

WHAT CAN GO WRONG?

Page 57: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Treatment

WHAT CAN GO WRONG?

Page 58: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

TreatmentBecause we cannot advocate for systematic education of organizational members, a focus on behavioral therapy is offered.

WHAT CAN GO WRONG?

Page 59: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

TreatmentBecause we cannot advocate for systematic education of organizational members, a focus on behavioral therapy is offered.

Ensure proper motivation and buy-in among PDSA cycle participants (e.g. QI champion)

WHAT CAN GO WRONG?

Page 60: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

TreatmentBecause we cannot advocate for systematic education of organizational members, a focus on behavioral therapy is offered.

Ensure proper motivation and buy-in among PDSA cycle participants (e.g. QI champion)

Group accountability

WHAT CAN GO WRONG?

Page 61: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

TreatmentBecause we cannot advocate for systematic education of organizational members, a focus on behavioral therapy is offered.

Ensure proper motivation and buy-in among PDSA cycle participants (e.g. QI champion)

Group accountability Redirection of group members when they become

distracted

WHAT CAN GO WRONG?

Page 62: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

TreatmentBecause we cannot advocate for systematic education of organizational members, a focus on behavioral therapy is offered.

Ensure proper motivation and buy-in among PDSA cycle participants (e.g. QI champion)

Group accountability Redirection of group members when they become

distracted Planning itself needs to be conducted in a

purposeful manner to insure movement to the Do phase

WHAT CAN GO WRONG?

Page 63: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

Outline

• Quality improvement

• Model for improvement

• What can go wrong?

Page 64: Paula Peyrani, MD Medical/Project Director, HIV Program at the 550 Clinic Assistant Director, Research Design and Development Clinical and Translational

References

• Schriefer J, Leonard MS. Patient Safety and Quality Improvement: An Overview of QI. Pediatrics in Review 2012;33;353.

• http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/plan_do_study_act.html.Accessed on July 31, 2013.

• http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx Accessed on August 3, 2013.


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