CAPA and QI: a match made in heaven Jane Cullen Health Quality and Safety Commission
This session will cover: Introduction to the Health Quality & Safety Commission What is quality & quality improvement? Quality improvement tools and methods CAPA synergies A quality improvement project in primary care
The Health Quality & Safety Commission We are responsible for assisting providers across the whole health and disability sector private and public to improve service safety and quality and therefore outcomes for all who use these services in New Zealand. Professor Alan Merry
Mental Health & Addiction Improvement 5 priority areas: 1. Learning from adverse events and consumer experience 2. Maximising physical health 3. Improving service transitions 4. Minimising restrictive care 5. Improving medication management and prescribing
Progress to date: Launch of Zero Seclusion - towards eliminating seclusion by 2020. 23 Mental Health & Addictions Quality Improvement Facilitators graduate (20 from DHBs including two consumer advisors). Second course to commence in June. Preparation for a staff culture survey in June.
WHAT IS IT? http://www.envirosep.com/improving-project-qualitymodularization/
Some quality definitions Doing the right thing, right, every time (TQM) Meeting the needs of the customer, now and in the future (Deming) Fitness for purpose (Juran)
Defining quality The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (Donaldson, Corrigan,...and & Kohn, 2000) Institute of Medicine. consumer values.
Care Capacity Demand Management Care Capacity Demand Management ensures that DHBs have: The right number of staff Who are appropriately skills In the right place At the right time With the appropriate resources To meet patients needs (demand) and deliver safe, effective and efficient care
The Choice & Partnership Approach Doing the right things, right goals, right people, right skills at the right time. Service users are at the heart of the process.
Defining quality improvement the combined and unceasing efforts of everyone healthcare professionals, patients and their families, researchers, planners, payers and educators to make the changes that will lead to better health outcomes (health), better system performance (care) and better professional development (learning). (Batalden and Davidoff, 2007)
The tools of quality improvement 7 basic quality tools 1. Process map 2. Check sheet 3. Pareto Chart 4. Cause & Effect diagram 5. Brainstorming 6. Run & SPC charts 7. Scatter diagram 7 management & planning tools 1. Affinity diagram 2. Interrelationship diagraph 3. Tree diagram 4. Prioritisation matrices 5. Matrix diagram 6. Process decison program chart 7. Activity network diagram Brassard, M. (1989). The Memory Jogger Plus+ TM: Featuring the seven management and planning tools. Goal/Qpc.
Process map
Process mapping
Value stream map
Checksheet
Pareto chart: Reasons for not following medication instructions
Cause & effect diagram https://qi.elft.nhs.uk/resource/cause-and-effect-diagram-fish-bone/
Brainstorming Clix Marketing
Charts Run chart Control chart
Scatter diagram
Affinity diagram Design Thinking: uxdict.io
Prioritisation matrices
Tools Techniques - Methodology Tool an item or implement used for a specific purpose. Can be a physical or technical object or concept Technique A systematic procedure, formula, or routine by which a task is accomplished Methodology - A system of broad principles or rules from which specific methods or procedures may be derived to interpret or solve different problems within the scope of a particular discipline. Unlike an algorithm, a methodology is not a formula but a set of practices. (http://www.businessdictionary.com/)
So which system is best? Dreamstime.com
MFI Six Sigma Lean Co-design Incremental testing of change ideas Reduce variation Reduce waste Understand consumer requirements Define Measure Analyse Improve Control Identify value Identify value stream Flow Pull Perfection Engage Plan Explore Develop Decide Change Problem focused Problem focused Flow focused Consumer focused
7 Helpful Habits compared CAPA 1. Handle demand referrals management 2. Extend capacity know capacity, avoid unnecessary follow-up & meetings 3. Let go of families Clinical, use a systematic approach, careplans & review 4. Process map map patient journey (waits, bottlenecks, hand-offs) Quality Lean, Care, Capacity, Demand Management (CCDM) - 20 DHBs CCDM, Theory of Constraints (TOC), Lean Lean, PDSA, clinical audit Lean, TOC, patient safety, co-design
7 Helpful Habits compared CAPA 5. Flow management dedicated administation time, identify bottlenecks 6. Use care bundles reliability, best practice, measure compliance 7. Look after staff job plans, team away days, annual appraisal, listen to, value and involve staff Quality TOC, Lean Reliability science, care pathways, care bundles, clinical audit, Six Sigma Joy in work, Quadruple Aim, human resources
The Model for Improvement
WHAKAKOTAHI: PRIMARY CARE IMPROVEMENT
Hutt Union & Community Health Service and Te Awakairangi Health Network Diabetes Improvement Project
Why focus on diabetes?
Fishbone diagram
Affinity tool
Prioritisation Matrix
Testing change ideas: Plan Do Study Act
Te Kete Hauora - Patient Co-Design
Progress to date Average Hba1c Cohort 1 Pharmacist started Whakakotahi started
Progress to date % Patients with Hba1c <65 Pharmacist started Whakakotahi started
What we have learned? Communication is key Patient co-design rocks Co-leading has made it possible for us Needs whole team engaged and involved in leadership including doctors, nurses, administrators, community workers, etc Needs commitment, time and energy Takes a lot of resource so sustainability is a challenge Contact Details Sally Nicholl : sally@huchs.org.nz
Capability Building Programme 2016 2017 2018 QI Advisor 24 24 22 + 12 starting QI Facilitator 17 (IPC) 19 Primary care 24 MH & A 20 Primary care started
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