family medicine and public health clerkship rotation university of manitoba 2010 - 2011 amanda...
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Family Medicine and Public Health Clerkship RotationUniversity of Manitoba
2010 - 2011Amanda Condon MD CCFP
Define and understand basic quality terminology: quality and continuous quality improvement (CQI)
List 4 main concepts of CQI and provide clinical CQI examples
List and describe elements of PDSA cycle
Introduce tools and methods for improving quality of care
Construct and present an idea for a CQI project
Quality can be defined by how well we meet the needs of those we serve
Most problems are in process not peopleUnintended variation in processes can
lead to unwanted variation in outcomesContinual improvement can be achieved
through serial experimentation
In health care, quality defined as: “doing the right thing, the first time, in the right way at the right time”
“Right thing, for every patient, every time”
Quality = extent to which health services increase likelihood of desired health outcome and are evidence based (Institute of Medicine)
Measurement for research
Measure for learning and process improvement
Purpose To discover new knowledge
To bring new knowledge into daily practice
Tests One large “blind” test Many sequential, observable tests
Biases Control for as many biases as possible
Stabilize the biases from test to test
Data Gather as much data as possible “just in case”
Gather “just enough” data to learn and complete another cycle
Duration Can take a long time to get results
“small tests of significant change” accelerate the rate of improvement
SafeEffectivePatient-CentredTimelyEfficientEquitable
eliminate waste improve work flow optimize inventory change the work environment enhance the producer/customer
relationship manage time manage variation design systems to avoid mistakes focus on the product or serviceLangley, Nolan, Nolan, Norman &
Provost 1999
DPIN MIMS Breast Cancer Screening Program Cervical Cancer Screening Program Colorectal Cancer Screening Program Care Maps (asthma, ACS etc.) Standing Orders Medication Reconciliation Bridging Specialist and Generalist Care
Store and ForwardPhysician Integrated NetworkEMR/EPR/EHR/PACS
1.Project Phase2.Diagnostic Phase3.Intervention Phase
• Plan a change• Do it in a small test• Study its effects• Act on the result
4.Impact Phase5.Sustaining Improvement Phase
Sourced from: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement
Identify appropriate interventionsImplement changes identified in the diagnostic phase Undertake one or more PDSA cycles
Interventions phase
Decide on interventions
Undertake one or more PDSA cycles
Sourced from: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement
(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)
use plan-do-study-act cycles to conduct small-scale tests of change in real settings plan a change do it in a small test study its effects act on what learned
team uses and links small PDSA cycles until ready for broad implementation
What are we trying to accomplish?How will we know that a change is
an improvement?What changes can we make that will
result in an improvement?
What are we trying to accomplish?
How we will know that a change is an improvement?
What change can we make that will result in an improvement?
ACT PLAN
DOSTUDY
Langley, Nolan, Nolan, Norman & Provost 1999
ACT PLAN
DO
STUDY
Determines what changes are to be made
Summarizes what was learned
Change or test
Carry out the plan
Langley, Nolan, Nolan Norman & Provost 1999
• Measure impact of changes/interventions
• Record the results• Revise the interventions• Monitor impact
NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf
Standardization of systems and processes
Documentation of policies, procedures, protocols and guidelines
Measurement and review of practice to ensure that change has become “standard”
Training and education of staff
NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)
Identify an area for improvement, based on clinical experience
Prepare proposal for initiative implementation following PDSA method
Present proposal to clerkship group
What irritates people, slows them down or costs them money? Target your efforts at relieving the worst of these problems.
Design a "best guess" solution -- a new process model based on the best practice your community has to offer.
Ensure that the new process won't irritate people, slow them down or cost them money.
What are we trying to accomplish?
How we will know that a change is an improvement?
What change can we make that will result in an improvement?
ACT PLAN
DOSTUDY
Langley, Nolan, Nolan, Norman & Provost 1999
1. NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)
2. Jain, Manoj. Road Map for Quality Improvement – A guide for doctors.
3. WHO Patient Safety Curriculum - Topic 7: Introduction to quality improvement methods.
4. Djuricich, Alexander. Curriculum in Continuous Quality Improvement for Residents. Indiana University School of Medicine, 2006.