The Internist as Quality Advocate

Application of QI Tools

Kim Tartaglia, MD

Fall 2010

Objectives Review Model for Improvement Review steps for successful completion

of QI project Discuss additional resources and tools

The NY Times, Aug 21, 2010

Why Address QI Professional duty to provide high quality

of care Training Requirements (ACGME) Pay for Performance Maintenance of Certification Academic Medicine Niche Publication Worthy

IOM: Dimensions of Quality

• Safety

• Timeliness

• Effectiveness

• Efficiency

• Equity

• Patient Centered

Steps of QI project

• Identify opportunity and assemble team

• Review literature and best practices

• Identify current practice

• Collect baseline data (QI dept to help)

• Develop strategy for improvement

– Implement Model for Improvement

Importance of Creating Teams

• Stakeholder analysis

• Gain Buy-In

• Identify Champions

• Help Create Solutions

• Should be done at the beginning of a project!

Ideas for Developing Change Evaluate current system

Process Maps, Root Cause Analysis Review Best Practices

Benchmark to compare to current practice Technology Creative Thinking Change concepts

Using Process Maps A process map is a picture of the steps

in a process (in sequence) Must understand the current process in

order to make change and affect outcomes

Used to identify areas where change can be made

Root Cause Analysis Find and address the underlying cause of

a problem

Steps of QI project

• Identify opportunity

• Review literature and best practices

• Identify current practice

• Collect baseline data (QI dept to help)

• Develop strategy for improvement

– Implement Model for Improvement

AIM Statement Description of what you want to

accomplish Includes the following:

Quantification (How much?)

Time frame (By when?) Specific patient population that is the focus

(For whom?)

AIM Statement

Should be set high enough to have impact on care but not be unrealistic

Should be flexible to allow for different solutions

Measures

How will you know change is an improvement

Types of Measures Process (Hand-washing rates) Outcome (Rate of hospital-acq infection) Balancing (Decreased contact with patient)

Piloting an Improvement Idea“All improvement will require change, but not all

change will result in improvement.”

PDSA cycle:

– Used to test ideas for change

– Framework for creating an efficient trial-and-error process

Langley GL, et al, . The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.

PDSA cycle

PLAN:

– Develop interventions

– Plan to carry out changes and collect data

– “Who does what when?”

DO:

– Implement the necessary changes

– Document problems and observations

PDSA cycle

STUDY:

– Measure the effect of the change

– Complete data collection and analysis

ACT:

– Discuss changes to make for next cycle

– Develop a plan to hold any gain / spread the improvement

Linking PDSA cycles

• Each cycle builds on the next

• Cycles start out small and rapid, eventually get larger

Example: Linking PDSA cycles

Sharing Your Results

• SQUIRE Guidelines (Standards for Quality Improvement Reporting Exercise)

– http://squire-statement.org/

Additional Reading/Resources

Institute for Healthcare Improvement www.ihi.org (Open School QI modules

Langley GL, et al. The Improvement Guide

Gawande, A. The Checklist Manifesto