quality imporvement
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Quality Improvement
Mohamed Hany Kamel, MRCGP, MHPE MD, TQMD, DHHM
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What is Quality?
Satisfying customer needs, product features
Freedom from deficiency, lowest possible cost
What is Quality improvement?
It is the use of captured metrics, and lessons
learnt to continually improve quality
Juran trilogy diagram
Why has it happened?
The changing
business
conditions urges
the need for
adopting new
trends of quality
The Dual nature of medical quality
(perceptions!)
Content quality
clinical expertise and technical aspects of
healthcare (diagnosis, carrying out procedures)
Most patients assume that providers possess and deliver technical
quality
Delivery/service quality
interpersonal components of care (e.g., empathy and
communication) and to how well the patients’
requirements and expectations are being
met (e.g., access, timely billing)
Where to start to improve
quality?
A global role
Failure to provide quality
%15
due to faults related to
individuals
%85
faults in the management-
controlled systems and processes
Self-control
1- focus on health outcomes: Measurable
improvements, focusing on real challenges
2- practice leadership at all levels
3- you can learn to lead: facing challenges, receiving
support and feedback
4- Leadership is learned overtime
5- Sustain progress through management systems:
integrate into the routine system
Principles of developing MWL
Think of something that you have
accomplished in your life that you are
proud of, something that was a
challenge for you and for which you had
to overcome big obstacles.
Do you notice how in each case there was a shift from seeing something as a problem (for someone else to solve), to taking it up as a personal challenge?
A problem is “out there” and often blamed on
external forces.
A challenge is something you own and take on.
1- With your team review mission & strategic objectives
2- Create a shared vision that inspire team to face a new challenge
3- Agree on one measurable result that will move you closer to one aspect of vision
4- Assess current situation (scanning)
5- Identify obstacles & Select priority actions
7- Develop an action plan and implement
From vision to action
Mission and Vision
Personal mission
Each of us brings a contribution.
We know that when we are present, something
unique is brought to the situation.
For example, some people bring humor, others bring
order, and some bring clarity.
Think for a minute about a time when you felt you
were really contributing. What did you bring to the
situation?
Take a minute and write that down. Next, use what
you wrote to figure out a mission for yourself in the
workplace
Personal mission
Why is it important to have a mission?
Does it give you clarity about what to do and where
to spend your energy?
Being clear about your purpose helps you to focus.
Why does an organization need a
mission?
Only when health workers are aware of the
organizational mission, or ultimate purpose, will they
fully understand the meaning and the value of their
efforts.
Most organizations already have a mission
statement, but these statements are often neglected
or taken for granted by the staff
Constructing the mission statement
1. What do we do?
define the needs of the populations to be served and
specify which of those needs the organization intends to
address.
2. Whom do we serve?
define the target population.
Constructing the mission statement
3. How do we do it?
the means, resources, or strategies by which the
organization intends to reach its goals.
4. Why do we do it?
the basic reasons behind the organization’s decision to do
what it does.
A well-framed mission will guide your organization’s
work over the long term and inspire your staff.
The team will want to take the time to refine the
language, asking for the opinions of staff who know
the organization well.
Then you can finalize and disseminate the mission
statement to staff and board members, those who
are served by the organization, and the general
public.
Mission statements
Does it clearly state what you do? (What business you
are in )
Does it clearly state who you serve?
Does it describe your setting?
Is it broad enough so that all staff in the organization
can see how they contribute?
Will it make sense to average citizen if they see it on
the wall?
Will you be impressed if you see it on the front page of
the newspaper?
Mission Vs. vision
•A mission states why something exists.
•A vision is a picture of a desired future. It describes where
the group or the organization wants to be in the future. It
includes an image that you can see in your mind
PERSONAL VISION
Humans have a wonderful ability to create things in
our minds, to dream, and to imagine the future.
Unfortunately, people can misuse this capacity by
imagining the worst possible outcomes.
Most good outcomes in the world were first imagined
by someone.
In order to play a role in creating the future, you must
first imagine what you want to happen.
A vision is a picture we create in our
mind of a desirable future toward
which we can begin to act.
Exercise
Relax and think about yourself two years from now.
Imagine what you most want. Nothing will get in your
way or stop you. If anything were possible, what
would you really want to see?
You can close your eyes if it helps you to visualize.
Reflection
Organizational Vision
Where are we going? It is the moment to dream, to decide what your
organization wants to be in the future and how it
wants to be viewed by the outside world.
Vision
It is a powerful picture of a desired state that
provides a broad perspective and inspiration to keep
working, overcome obstacles, and struggle to
achieve results.
What experts say about vision
■ Burt Nanus (1986) says, “the vision is a realistic,
believable, and attractive future for your
organization…. such a motivating idea that it
promotes the necessary skills, talents, and
resources to make it happen and points out the way
we intend to follow.”
■ For Jay Conger (2000), the vision is a mental image
that represents a desirable future state, ideal, or
dream with a vast scope.
It should be
Tangible and descriptive
an image of the future that people can easily visualize.
Compelling and inspiring
a powerful call to action.
Challenging enough to demand the best efforts of
everyone in the organization
Achievable so that people will work toward it.
Constructing the statement
Step 1. Keep the big picture in mind.
Refer to your organization’s mission and the population you are supposed to serve so that the vision aligns with the mission.
Step 2. Answer the following questions:
What will our organization look like in three to five years?
What aspects of the mission will we have achieved and in what areas will we excel?
What will make us most proud? (e.g., the health status of our beneficiaries, the quality of our services, the commitment and creativity of our staff, the financial stability of our organization).
What values do we uphold, and how will they be reflected in our services and the way we run our organization?
Write down the answers to each of these questions and come to a consensus within your team.
Constructing the statement
Step 3. Look at your organization through the eyes of your target population, beneficiaries, donors, partners, collaborators, competitors, and society in general. For each of these groups, ask: How do we want these groups to see our organization in three
to five years?
What will they say about our services?
What will they say about our staff?
What will they say about our reputation in their communities?
Write down the answers to these questions and come to a consensus within your team.
Step 4. Translate these ideas into a few sentences that describe the desired future in a concrete manner,
Visions are often stated in the present tense
Review the shared vision and pick one
aspect it to put into action.
What would be a compelling, measurable result that
would indicate you are moving in the direction of the
shared vision?
Lets try to make it SMARTer
Is it an absolute challenge? ◦ we will totally solve the problem - such as immunizing all children
in our area
or is it a relative challenge? ◦ we will make some improvement towards solving the problem -
such as holding special immunization days through which we can
reach 60% of all children in our area
The desired result needs to be specific enough so that it
can be measured by a frequency, a percent or a number.
SMART
Specific — clearly written and understood
What are the indicators to monitor progress and
evaluate results?
What are the data sources needed to measure your
indicators?
The desired performance must be framed in terms that
are measurable
Measurable — we can monitor progress
towards results
Can your team affect the results given your level in the
organization?
Are there actions your team can take to meet your
selected challenge?
Do these actions contribute to the health outcomes you
want to impact?
Are there any conflicting needs or interests in your
organization that may affect your results?
The desired result must be appropriate to the goals of
your team and to the mission of your organization
Appropriate — to the scope of your program
or work activities
Ask your manager and other key stakeholders if this
challenge is something that your team can and
should be working on.
Can the action plan be carried out with the resource
available to the project?
You can realistically achieve the desired results in the
time you have planned.
Realistic — achievable and within your
control
Can you achieve the results in the time you have
planned?
If the result will take more time than you have
planned, you may consider selecting another
challenge.
There is a specific time period for achieving the
desired results.
Time bound — with a specific time period for
completion
What do you have to scan in order to better
understand the current situation as it relates to the
result you want to achieve?
People’s health care needs
Service statistics
Goals of your organization
National priorities
Resource usage and needs
Your team members’ strengths, needs, and concerns
Select one of the desired measurable
results that a team formulated
Why aren’t you already there?
What is blocking the way to this result?
Select obstacles for this exercise that are in your
control, not outside your control
Write them down to your challenge model
Priority matrix
Now that you have identified your mission, vision,
measurable result, current situation, and obstacles
together with their root causes, you can define your
challenge and add it to your Challenge Model.
Then you can define actions to address your
challenge.
write a challenge statement.
Begin each challenge statement with
“How will we achieve X result…in the face of Y
obstacles…?”
- In your teams brainstorm actions for each of the root
causes that you identified.
- We cannot possibly do everything.
- What are the criteria that we are going to use to
prioritize our decisions?
Example Criteria
(Rate from 1 to 3)
Priority actions
Train counselors
Conduct
community
education
seminars
Renovate clinics
Time to implement
(1 = the most time)
(3 = the least time) 2 2 1
Cost to implement
(1 = the most cost)
(3 = the least cost) 2 3 1
Potential for improving
quality in the long term
(1 = the least potential)
(3 = the most potential) 3 2 2
Capacity to implement
(1 = the least available)
(3 = the most available) 1 3 1
Totals 8 10 5
With your team use the priority matrix to choose the
best actions
Finish your challenge model now and share the
selected actions with the group