Quality Improvement Models, 2015: WPAFB
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1 Wright State University CORE Scholar Obstetrics and Gynecology Faculty Publications Obstetrics and Gynecology 2015 Quality Improvement Models, 2015: WPAFB Kelly A. Rabah Wright State University, Follow this and additional works at: Part of the Medical Education Commons Repository Citation Rabah, K. A. (2015). Quality Improvement Models, 2015: WPAFB.. This Presentation is brought to you for free and open access by the Obstetrics and Gynecology at CORE Scholar. It has been accepted for inclusion in Obstetrics and Gynecology Faculty Publications by an authorized administrator of CORE Scholar. For more information, please contact
2 Quality Improvement Models 2015 Resident Education Kelly Rabah, MSW, CPHQ, Six Sigma Greenbelt Healthcare, CPHRM 2015
3 What is Quality Improvement? Quality Improvement is a formal approach to the analysis of performance and systematic efforts to improve it. There are numerous models used. We will look at some commonly used models in HealthCare QI involves both prospective and retrospective reviews. It is aimed at improvement -- measuring where you are, and figuring out ways to make things better. It specifically attempts to avoid attributing blame, and to create systems to prevent errors from happening. ( QA, CQI, TQI) ontrasting_qi_qa.html
4 I can list 3 Quality Projects currently going on in my residency Program. A.True B.False 0% 0% True False
5 I am able to articulate how the work that I do Impacts Premier s Quality Scorecard A.True B.False 0% 0% True False
6 Quality & Safety- How did we get Here? IOM in 1999, To Err is Human: Building a Safer Health System. Tens of thousands of Americans die each year as a result of preventable errors. Comprehensive strategy for how healthcare providers, government, industry, and consumers can reduce medical error.
7 Crossing the Quality Chasm: A New Health System for the 21 st Century The next report by the IOM, which asserts that the gap between the care we now provide and the care we should give is not just a gap but a chasm. Factors contributing to the Chasm: Technology advancing at unprecedented rate Complexity of health care
8 Factors influencing Chasm (cont.) Rapid changes impede translation of knowledge into practice Americans living longer Aging population = increased prevalence of chronic conditions Focus on acute care verses prevention/primary care Care is Fragmented and uncoordinated
9 Quality Chasm cont Six Aims for Improvement Safe Effective Patient-centered Timely Efficient Equitable IHI s Triple AIM
10 Quality Chasm Cont Ten Rules for Redesign Care based on healing relationships Care is customized according to pt. needs and values Pt. is source of control Pt. has unrestricted access to their info. Safety is a system priority
11 Rules (cont.) Decision making is evidence-based Transparency is necessary Needs are anticipated Waste is decreased Cooperation among clinicians is a priority
12 Reports have led us to a Pay 4 Performance environment with a focus on Six Sigma Quality Models for Process Improvement. Kaoru ISHIKAWA Diagram
13 Six Sigma / DMAIC Edwards Deming
14
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16 The PDSA Model Dr. Edwards Deming
17 PDSA Worksheet
18 FMEA Tool GOAL is to proactively reduce risk Use the interactive Failure Modes and Effects Analysis Tool on IHI.org ( to create your FMEA, automatically calculate the risk priority number (RPN) of your process, evaluate the impact of process changes you are considering, and track your improvement over time.
19 Control Charts- Walter Shewart Variation is the Enemy of Quality Control
20 Swiss Cheese Model
21 Swiss Cheese in Healthcare poorly designed work schedules, lack of teamwork, variations in the design of important equipment between and even within institutions are sufficiently common that many of the slices of cheese already have their holes aligned. In such cases, one slice of cheese may be all that is left between the patient and significant hazard. Source:
22 Creating a Just Culture Shared accountability in managing risk, identifying and encouraging opportunities for incident-reporting to promote growth and learning, and implementation of findings to improve quality and safety. It s about asking what happened, Why did it happen, and How can we prevent it from happening again? It s also about assessing at risk behaviors where risk may not have been recognized or mistakenly believed not to have been there. This requires coaching. Finally Reckless Behavior, a very small percentage of cases, where guidelines, protocols, and risks were known but ignored or over-looked. This behavior requires remediation. Taken from IHI Website- Thomas Nolan and James Reason.
23 Negligent or Reckless?
24 Which of the following best describes a Just Culture? A. Culture of safety where all staff are treated equally B. Culture where Accountability & no blame are balanced C. Culture where consequences match the severity of the error / incident 0% 0% 0% Culture of safety where al... Culture where Accountabi... Culture where conseque...
25 Do You Believe you Practice in a Just Culture? A. Yes B. No 0% 0% Yes No
26 Which of the following are reportable incidents? A. A near miss B. A procedural complication C. Unanticipated patient deterioration D. Sentinel event E. A &D F. All of the above 0% 0% 0% 0% 0% 0% A near miss A procedural complication Unanticipated patient de... Sentinel event A &D All of the above
27 What Happened, why did it happen, and how can we prevent it from happening again?
28 Morbidity and Mortality Conference Discussions should include all of the following elements except: A. PHI (Protected Health Info.) B. Root cause analysis C. Action planning D. A standardized template for discussion E. Monitoring efforts F. Peer Review 0% 0% 0% 0% 0% 0% PHI Root cause analysis Action planning A standardized template... Monitoring efforts Peer Review
29 We practice in a complex world
30 Why are you being required to complete 23 IHI Modules in Q&S? A. Because your DIO, Dr. Albert Painter, thought it was a good idea B. Because your PDs didn t want to teach it C. Because your Director of PSQI for GME had nothing better to do D. Because a curriculum in patient safety & QI is required by ACGME and the RRC / Milestones. Because your DIO, Dr. Al... 0% 0% 0% 0% Because your PDs didn t... Because your Director of... Because a curriculum in...
31 Individual Quality Scorecard Priorities Review of results
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