Fundamentals of Health Care Improvement

Transcription

1 Fundamentals of Health Care Improvement A Guide to Improving Your Patients Care Gregory S. Ogrinc, MD, MS Linda A. Headrick, MD, MS, FACP Amy J. Barton, PhD, RN, FAAN, ANEF Mary A. Dolansky, PhD, RN, FAAN Wendy S. Madigosky, MD, MSPH Rebecca S. (Suzie) Miltner, PhD, RN, CNL, NEA-BC Foreword by Don Goldmann, MD

2 Senior Editor: Laura Hible Project Manager: Allison Reese Associate Director, Publications: Helen M. Fry, MA Associate Director, Production and Meeting Support: Johanna Harris Executive Director, Global Publishing: Catherine Chopp Hinckley, MA, PhD Joint Commission/Joint Commission Resources Reviewers: Caroline Christensen, BS, Project Director and Certified Change Agent; Linda Faber, PhD, FACHE, Senior JCI Consultant Joint Commission Resources Mission The mission of Joint Commission Resources (JCR) is to continuously improve the safety and quality of health care in the United States and in the international community through the provision of education, publications, consultation, and evaluation services The Joint Commission and the Institute for Healthcare Improvement Joint Commission Resources, Inc. (JCR), a not-for-profit affiliate of The Joint Commission, has been designated by The Joint Commission to publish publications and multimedia products. JCR reproduces and distributes these materials under license from The Joint Commission. The Institute for Healthcare Improvement (IHI) ( is a leading innovator in health and health care improvement worldwide. An independent not-for-profit organization, IHI partners with visionaries, leaders, and frontline practitioners around the globe to spark bold, inventive ways to improve the health of individuals and populations. Recognized as an innovator, convener, trustworthy partner, and driver of results, IHI is the first place to turn for expertise, help, and encouragement for anyone, anywhere who wants to change health and health care profoundly for the better. Based in Boston, Massachusetts, with a staff of more than 140 people around the world, IHI mobilizes teams, organizations, and nations to envision and achieve a better health and health care future. All rights reserved. No part of this publication may be reproduced in any form or by any means without written permission from the publisher. Requests for permission to make copies of any part of this work should be sent to permissions@jcrinc.com ISBN: (soft cover) ISBN: (e-book) For more information about Joint Commission Resources, please visit ii FUNDAMENTALS OF HEALTH CARE IMPROVEMENT

3 Contents Foreword to the third edition...1 by Don Goldmann, MD Foreword to the second edition...3 by Maureen Bisognano, President Emerita and Senior Fellow Foreword to the first edition...5 by Paul Batalden, MD Introduction...7 Chapter 1: Creating Teams to Close the Quality Gap...11 Diagnosing a Health System That Is Ill...12 Finding the Quality Gap...12 Evidence-Based Improvement...14 The Model for Improvement...21 Summary...24 Study Questions...24 Chapter 2: Finding Scientific Evidence for Clinical Improvement...25 The Importance of Evidence-Based Practice...26 Formulating the Right Questions...29 Evaluating the Strength of Evidence...30 Choosing the Right Resource Based on the Question...33 Working with a Reference Librarian...33 Summary...36 Study Questions...36 Chapter 3: Identifying a Focus for Improvement...39 Step 1: Identifying an Improvement Area...40 Step 2: Narrowing the Focus of the Improvement Work...42 Step 3: Creating a Global Aim Statement...44 Summary...47 Study Questions...48 FUNDAMENTALS OF HEALTH CARE IMPROVEMENT iii

4 Chapter 4: Process Literacy and Systems in Health Care...51 Process Analysis...52 Process Analysis Methods...53 Culture, Context, and Systems...60 Summary...65 Study Questions...65 Chapter 5: Measurement Part 1:...67 Data Analysis for Decision Making in Health Care Objectives Contributing Author: Robert C. Lloyd, PhD Importance of Data for the Improvement of Health Care...68 Building Measurement Knowledge...71 Identifying a Balanced Set of Measures for Improvement...76 Displaying Measures for Analysis...83 Summary...83 Study Questions...85 Chapter 6: Measurement Part 2:...87 Using Run Charts and Statistical Process Control Charts to Gain Insight into Systems Contributing Author: Robert C. Lloyd, PhD QI Measurement Evaluating Systems over Time...89 Run Chart and Statistical Process Control (SPC) Charts: The Basics...91 Common and Special-Cause Variation...93 Interpreting Run and Statistical Process Control Charts...94 Summary Study Questions Chapter 7: Understanding and Making Changes in a System The Complexity of Systems Changes Managing Changes in a System Summary Chapter 8: Spreading Improvements Contributing Author: Marie W. Schall, MA Spread: Overview and Definition Step 1: Setting a Foundation for Spread Step 2: Developing an Initial Plan for Spread Step 3: Carrying Out and Refining the Spread Plan Summary Chapter 9: Publishing, Presenting, and Teaching Quality Improvement Using a Structured Framework to Design and Disseminate Improvement Work Differentiating between Improvement and Research General Principles for Educational Experiences in Health Care Improvement Health Professional Development in the Improvement of Health Care Quality Summary iv FUNDAMENTALS OF HEALTH CARE IMPROVEMENT

5 Appendix: Tools to Help Your Improvement Improvement Project Worksheet The Seven-Step Meeting Process Team Roles Team Charter Readiness for Change Stakeholder Assessment Complex Adaptive System Time Line Communication Plan Flowchart or Process Map Cause-and-Effect Diagram Tips for Developing a Survey and Collecting Real-Time Data Change Concepts Worksheet Plan Do Study Act (PDSA) Worksheet Team Evaluation Creating a Storyboard Index FUNDAMENTALS OF HEALTH CARE IMPROVEMENT v