Quality performance improvement
- 1. QUALITY PERFORMANCE IMPROVEMENT PROJECTS Mr.Thomaskutty Saji. Puthuparambil,RN,RM,MSN MOHAP Innovation Pioneer/ ER Nurse Saqar Hospital, RAK
- 3. ROAD TO QPIBEGINS WITH STRATEGIC PLANNING STRATEGY The plans and activities developed by an organization in pursuit of its goals and objectives, particularly in regard to positioning itself to meet external demands relative to its competition” (Shortell, Morrison, & Robbins, 1985) STRATEGY PLANNING The one way of coping with a dynamic and complex environment Mr. Thomaskutty Saji,RN,RM,MSN PRIORITIES FOR QUALITY AND PERFORMANCE IMPROVEMENT
- 4. GOALS OF STRATEGICMANAGEMENT (GINTER, SWAYNE & DUNCAN, 2002) • Provide a framework of thinking • Create a fit between the organization and its external environment • Provide a process for coping with change and organizational renewal • Foster anticipation, innovation and excellence • Facilitate consistent decision making and • Create organizational focus
- 5. CULTURE TO SUPPORTQUALITY A sense of identity for employees and commitment to something larger than themselves Enhance cooperation Create a system of informal rules spelling out how people are expected to behave & Creates distinctions between organizations, allowing a definite competition advantage to develop
- 6. GENERAL PRACTICES OFEXEMPLARY LEADERS (KOUZES & POSNER (2002)) • Inspire a shared vision • Challenge the system • Enable others to Act • Model the way • Encourage the Heart Mr. Thomaskutty Saji,RN,RM,MSN
- 7. DEVELOPMENT OF QPIACTION PLANS A standard format includes • Who(accountability) • What (Specific actions or steps to be followed) • When (Time frame) • Status (Progress made and ongoing monitoring) & • Completion (Closure or closing the loop)
- 8. Projects Goal: Improving adefined process to complete redesign or even designing a new process or system
- 9. FRAMEWORK FOR EXECUTIONOF PLANS FOR A QPI PROJECT (NOLAN, 2007) ENVIRONMENT INFRASTRUCTURE Provide Day-to-Day leaders for Microsystems Spread and Sustain Provide Leaders for Large System Projects Achieve strategic Goals Build Capability Manage local improvement
- 10. STEPS IN PROGRAMMEDEVELOPMENT • Determine who, what, when, where, how and why • Structure the design • Choose and develop a sampling method • Determine and conduct training • Delegate responsibilities • Facilitate coordination • Forecast budget • Conduct pilots or test of change
- 11. DECISION MAKING QPITOOLS • Brainstorming • Multivoting • Nominal Group technique • Delphi Method • Failure mode and Effect Analysis(FMEA) • Prioritization Matrix Mr. Thomaskutty Saji,RN,RM,MSN
- 12. BRAINSTORMING • Define thebrainstorming topic • Inform that all ideas are good ideas and all comments /evaluation should be held in abeyance until the brainstorming is complete • Give everyone a few minutes • Have the team members call out their ideas • One person should write the ideas on a flip chart Mr. Thomaskutty Saji,RN,RM,MSN
- 13. MULTIVOTING • It isan easy, quick method for determining the most popular or important items from a list • Uses a series of votes to cut the list in half each time, thus reducing the number of items to be considered
- 14. NOMINAL GROUP TECHNIQUE •Generating a large number of ideas in which each members works by himself or herself • More structured than brainstorming and multivoting
- 15. DELPHI METHOD • Combinationof brainstorming, multivoting and nominal group technique • Used when group members are not in one location and often is conducted by e-mail when a meeting is not feasible • After each step in process, the data are sent to one person, who compiles the data and send out the next round for participation to complete
- 16. FAILURE MODE ANDEFFECT ANALYSIS • Preventive approach to identify failures and opportunities for error and can be used for process as well as equipment • Healthcare FMEA used in healthcare
- 17. PRIORITIZATION MATRIX • Organizestasks, issues or actions and prioritizes them based on agreed –upon criteria • Combines tree diagram and L-shaped matrix diagram, displaying the best possible effect • Used before more complex matrices are needed • Applies options under discussion to the priority consideration of the organization
- 19. VARIATION Variation is criticalin QPI process COMMON-CAUSE VARIATION On a control chart, this type of variation is exhibited as points between the control limits in no particular pattern SPECIAL-CAUSE VARIATION Points that fall outside the control limits or, when inside the control limits, exhibit certain patterns ROOT-CAUSE ANALYSIS When a variation is inherent in the process and a reduction of the variations is desired, the root cause must be identified to eliminate tampering with the effective components of the process
- 20. AREAS NEED TOFOCUS IN ANALYSIS • Human Factors: Communication and Information Management Systems • Human factors : Training • Human Factors : Fatigue and scheduling • Environmental factors • Equipment factors • Rules, policies and procedures • Leadership systems and culture (White, 2004)
- 21. TOOLS USED TOELIMINATE OR MINIMIZE THE ROOT CAUSES OF THE VARIATION • Spaghetti Diagram/ layout diagram Graphic representation of the flow of traffic or movement • Checklist Standard way to ensure completion of critical tasks for a process or activity
- 22. • Checklist Standard wayto ensure completion of critical tasks for a process or activity • 5-S diagram Represents Sorts, Straighten, Scrub/Shine, Systematize/Sustain, Standardize
- 24. Value stream Mapping Mapof the process in which only value added steps for the customer are retained and other waste removed Mr. Thomaskutty Saji,RN,RM,MSN
- 25. • Voice ofthe customers List of needs, wants and desires of the customer of a process output • Supplier Input Process output customer(SIPOC) To identify the key drivers of a process
- 26. PROCESS STEPS INHEALTHCARE Note: Need clear understanding of data, types of data and tools
- 27. The Improvement processseeks to accomplish the following : • Ensure the project is a priority and is aligned with the strategic plan • Ensure leadership support and commitment • Assess the priority and feasibility of initiatives • Clarify the aim, stated in specific measurable terms • Present baseline data analysis • Demonstrate that the aim is based on own data and identified the specific problem to be solved , enhanced or redesigned • Select and interdisciplinary team • Map the current process and collect data on key aspects of the process • Define measures and collect data • Describe the change to be made • Implement the change(Pilot tests) • Study the effects of the changes and make a decision • Map the new process • Spread the change throughout in a defined implementation plan • Sustain the improvement by monitoring