Quality Improvement: Essential Leadership

Transcription

1 Quality Improvement: Essential Leadership Anne Matlow, September 30, 2016

2 I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization. Je n ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d appareils médicaux ou un cabinet de communication. Anne Matlow, September 30, 2016

3 INTRODUCTIONS

4 Learning objectives Discuss the importance of Quality improvement to everyday practice Identify an area needing process improvement Describe the 5 steps of developing a quality improvement project Apply 2 tools for process analysis Understand the role of leadership in effecting change

5 BACKGROUND WHAT IS QUALITY? Doing the right thing at the right time in the right way for the right person. 5

6 Quality is personal. ITEM My desk is always clean. I am caught up on my work. SCORE I exercise daily. I see my friends regularly. I get enough exercise. I am satisfied with my work-life balance. TOTAL 6

7 WHAT IS QUALITY? Doing the right thing at the right time in the right way for the right person.? QUALITY HEALTHCARE? Safe, effective, efficient, equitable, patient-centred, timely IOM 2001 Doing the right thing at the right time in the right way for the right person. 7

8 Quality of care: a global view Commonwealth Fund Study 2013

9 The Mission: Quality Health Care FISHBONE (Cause and Effect) DIAGRAM F QHC 9

10 Leadership and QI There is clear evidence of the link between leadership and a range of important outcomes within health services, including patient satisfaction, patient mortality, organisational financial performance, staff wellbeing, engagement, turnover and absenteeism, and overall quality of care. West M et al. Leadership in health care: a summary of the evidence base. Faculty of Medical Leadership and Management and King s Fund

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12 What are you going to do about it, Mr PM? 12

13 OK,I want to make things better. 13

14 Hall Barber. Academic Medicine October

15 Personal Improvement Project Papers and books, pens and empty coffee cups ITEM My desk is never clean. I gotta get this under control! What would being in control look like? OK: Get started. My precise goal: What? by how much? Where? By when? 15

16 TOOLS OF QI Set SMART* AIM 5 why s Graph it out Fishbone diagram Walk it out Process flow map Match solution to problem, small tests of change Measurement SMART aims: specific, measurable, achievable, realistic, time-based Eg: By Nov 30, 2016 all papers on my desk will be filed by the end of each day 16

17 Assemble team Set SMART* aims 5 why s Graph it out Fishbone diagram Walk it out Process flow map QI is a team sport Match solution to problem, small tests of change Measurement SMART aims: specific, measurable, achievable, realistic, time-based 17

18 Outpatient Calls to a Tertiary Oncology Service The Quality Problem: Patients experiencing a medical issue can wait long periods of time for a callback from the on call MD. Slides courtesy of Dr.Chris Willis, McMaster U

19 Who should be on the team? Provide input to the process Perform one or more of the process steps Receive output from the process The Team Chief Resident (Team Lead) Program Director Lead MD Oncology Hospital Paging Answering Service ER Resident Outpatient RN

20 Outpatient Calls to a Tertiary Defining the problem Oncology Service

21 Outpatient Calls to a Tertiary Oncology Service Understanding the system

22 Process flow map

23 Paging Spaghetti diagram Patient Answering Service Provider

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25 PDSA PDSA 25

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27 Outpatient Calls to a Tertiary Oncology Service

28 Small group activity IT S YOUR TURN

29 The Change Opportunity You are a PGY3 who has just completed a two month elective in internal medicine at Elsewhere General Hospital. You were impressed by the way the weekly Morbidity and Mortality Rounds (MMRs) were conducted at Elsewhere General Hospital; the philosophy behind MMRs there was one of continuous learning and improvement, and not one of shame and blame. Now back home after your elective, you are struck by how much finger-pointing actually goes on during MMRs at your own organization, and by the reluctance of trainees to speak up lest they get blamed and/ or accused of making a stupid or irrelevant comment. At the last evaluation, 50% of trainees said they did not find MMRs useful. You would like to see the approach to MMRs improved to more closely resemble those at Elsewhere General Hospital, and are prepared to work with others to improve the process using the Model for Improvement Framework.

30 In your groups 1. Complete the project charter for this project. 2. Present your SMART aim statement. 3. Using the Model for Improvement describe how you will approach improving the MMRs at your hospital. What will you try to achieve with your first two PDSA cycles? 4. Discuss with your group leadership strategies that will help you to implement change ideas for MMRs.

31 Conclusions There are lots of opportunities to improve the delivery of health care (TIP: if you don t know where to start, count something) There is a 5 step framework for doing QI Medical leadership is essential

32 BACK-UP SLIDES

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34 The main ingredient for successful QI LEADERSHIP

35 When things go wrong: STAFFORD HOSPITAL uploads/attachment_data/file/226703/berwick_report.pdf From January 2005 and March 2009, 400-1,200 patients died as a result of poor care. Public inquiry: - neglect - pain relief late or not at all. - patients unwashed - etc Exerpted from

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37 When things go very well.. 37

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39 Med Educ Jan;46(1): Educational activities 1. formal curricula that teach concepts or methods intended to facilitate trainees participation in QI activities; 2. educational activities that impart specific related skills (i.e. disclosure of medical errors), and, 3. QI initiatives that involve trainees as active or passive participants. 39

40 Academic Medicine October

41 EVALUATING YOURSELF

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43 ITEM My dictated notes don t reach the GP soon enough!!! WE gotta get this under control! What would being in control look like? OK: Get started. OUR precise goal: What? by how much? Where? by when? 43

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45 Leadership styles 45

46 Culture + Persistence QI IN RESIDENCY

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49 SETTING AIMS