quality improvement introduction to reliability this material (comp12_unit3) was developed by johns...

Quality Improvement

Introduction to Reliability

This material (Comp12_Unit3) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000013.

Introduction to ReliabilityLearning Objectives

• Discuss the basic concepts of reliability.

• Understand what makes organizations highly reliable.

2Health IT Workforce Curriculum Version 3.0/Spring 2012

Quality Improvement Introduction to Reliability

What Is Reliability?

“The extent to which an experiment, test, or measuring procedure yields the same results on repeated trials”

(Webster’s Dictionary)

“Reliability principles, used to design systems that compensate for the limits of human ability, can improve safety and the rate at which a system consistently produces desired outcomes.”

(Nolan, T., Resar, R., Haraden, C., Griffin, F.A.)



Which Clinic Would You Prefer?



How Do We Measure Reliability?Reliability = # of actions that achieve the intended result ÷

Total # of actions taken

• Reliability is expressed as an order of magnitude.

– Unstable process

• More than 1-2 defects per 10 attempts

– 10-1

• 1-2 defects per 10 attempts

– 10-2

• 1-2 defects per 100 attempts



– 10-3

• 1-2 defects per 1000

– 10-4

• 1-2 defects per 10,000

– 10-5

• 1-2 defects per 100,000

– 10-6

• 1-2 defects per 1,000,000

– And so on…

Examples of Reliability in Health Care



Strategies to Improve Reliability



Example: Improvement of Diabetes Care

• Guideline recommendation: >3 Hemoglobin A1c every 2 years

• You are tasked with improving the rate patients being tested appropriately

• Since you are in the HIT department, you will use HIT tools to improve the reliability of the process



Prevention of Failure

• Strategies• Using intent and

standardization

• Segmentation

• Tools• Basic standardization• Best practice guidelines,

tools, techniques• Memory aids, such as

checklists• Feedback mechanisms

regarding compliance with standards

• Awareness campaigns



Identification and Mitigation

Strategies• Human factor changes

• Redundancy• Independent double checks

Tools• Reduce fatigue and distraction• Schedule key tasks• Take advantage of habits and

patterns• Decision aids & reminders built

into the system• Differentiation• Constraints• Affordances



Redesign for Success

• Understand where the failure is occurring

• Determine the remedy– Failure modes

• What could go wrong?

– Failure causes• Why would the failure happen?

– Failure effects• What would be the consequences of each failure?



Bundles

• A "bundle" is a group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually.

• Providing each element of care within a bundle leads to more reliable care for patients.



Example:Improvement of Diabetes Care

• What would you include in a diabetic bundle?

• The example of a good diabetic bundle is that used to enhance reliability at CareSouth Carolina

• It includes: BMI, education, 2 HgbA1c tests, LDL test, use of statin



Introduction to ReliabilitySummary

• Designing a reliable system is a stepwise process that requires the incorporation of prevention of failure, identification and mitigation of failure and system redesign from failure

• Different processes require different levels of reliability



Introduction to ReliabilityReferences

References• Elgert, S. Reliability Science: Reducing the Error Rate in Your Practice. These seven principles can help ensure

that your patients receive the right care at the right time every time. Fam Pract Manag. 2005 Oct;12(9):59-63.• Nolan, T., Resar, R., Haraden, C., Griffin, F.A. Improving the Reliability of Health Care. IHI Innovation Series white

paper. Boston: Institute for Healthcare Improvement; 2004. Available from: www.IHI.org• Merriam-Webster’s Dictionary. Available from: http://www.merriam-webster.com/dictionary/reliability • Reliability: Sepsis Management Bundle. Available from:

http://www.ihi.org/knowledge/Pages/Measures/ReliabilitySepsisManagementBundle.aspx• When Good Enough Isn’t … Good Enough: The Case for Reliability. Institute for Healhcare Improvement.

Available from: http://www.ihi.org/IHI/Topics/Reliability/ReliabilityGeneral/ImprovementStories/WhenGoodEnoughIsntGoodEnoughTheCaseforReliability.htm

Charts, Tables, Figures

3_1 Which Clinic Would You Prefer? Courtesy Dr. Anna Maria Izquierdo-Porrera

3_2 Examples of Reliability in Health Care. Courtesy Dr. Anna Maria Izquierdo-Porrera

Images

Slide 7: Strategies to Improve Reliability. Adapted from Olan, T., Resar, R., Haraden, C., Griffin, F.A. Improving the Reliability of Health Care. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2004. Available from: www.IHI.org



quality improvement introduction to reliability this material (comp12_unit3) was developed by johns...

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