HOW-TO GUIDE:STARTING A STUDENT RUN QUALITY IMPROVEMENT PROJECT

TMIT Student Projects QuickStart Package ™

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

Outline

I. Introduction to Quality Improvement

II. From Innovation to DesignIII. The PilotIV. Implementation

Outline

I. Introduction to Quality Improvement

1) Aims for improvement2) Multi-professional teamwork3) Students role

So You Want To Create Change?

“While all changes do not lead to improvement, all improvement requires change.”

- Institute for Healthcare Improvement

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

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.

Multi-Professional Teamwork

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

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

Outline

I. Introduction to Quality Improvement

II. From Innovation to DesignIII. The PilotIV. Implementation

Outline

II. From Innovation to Design1. Forming Your Team2. Setting Aims3. Creating a Strategy4. Change Concepts5. Project Proposal

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!

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

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

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!

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

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

Creating an Improvement Strategy

1. Critical thinking about the current system

2. Benchmarking 3. Using technology 4. Creative thinking 5. Using change concepts

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

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

Project Proposal

I. Vision/MissionII. Setting AimsIII. Proposal Outline

I. BackgroundII. The InterventionIII. Strategy for Implementation

Outline

I. Introduction to Quality Improvement

II. Innovation to DesignIII. The PilotIV. Implementation

Outline

III. The Pilot1) Using PDSA Cycles2) Communication3) Data Collection

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

The Pilot: Using PDSA Cycles

Run a test trial on a small scale

Follow a simple “PDSA” cycle for pilotPlanDoStudyAct

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.

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

The Pilot: Data Collection

Plot data over time Seek usefulness Use sampling Integrate measurement into daily

routine Use qualitative and quantitative

data

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

Outline

I. Introduction to Quality Improvement

II. Innovation to DesignIII. The PilotIV. Implementation

Outline

V. Implementation1. Pilot to Implementation 2. Keys to Successful Adoption3. Project expansion4. Leadership Changes

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

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

Example: Spreading your project“Check a Box. Save a Live.”

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

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!