AEQUIP QUALITY IMPROVEMENT

Quality Improvement for Healthcare Natasha Carr Birmingham City University

What is QI?

Quality Improvement is defined as the application of a systematic approach that uses specific techniques to improve quality.https://learn.nes.nhs.scot/4095/quality-improvement-zone

Influencers on QI

Don Berwick is President Emeritus and Senior Fellow at the US Institute for Healthcare Improvement (IHI), where he was President and Chief Executive Officer for nearly 20 years until 2010. The IHI, based in Boston, is a leading innovator in health and healthcare improvement worldwide and has had considerable influence on the application of quality improvement in the ealthcare sector he roots of quality improvementThe IHI has adapted the US Institute of Medicine’s x dimensions of quality (see page 6) into a ‘noneedless’ framework which aspires to promote: no needless deaths - no needless pain or suffering - no helplessness in those served or serving - no unwanted waiting - no waste - no one left out

Maternity and Nursing focus on QI;some natioanl examples

https://www.rcm.org.uk/promoting/professional-practice/safety-quality-improvement/ https://www.rcn.org.uk/westmidlands/get-involved/qin-network

Where is the QI in A-EQUIP?

• A-Equip is an acronym for Advocating for Education and Quality Improvement

• Monitoring, evaluation and quality control
• Personal Action for quality improvement

What does quality mean to you?

• Menti.com

What is quality?

Within healthcare, there is no universally accepted definition of ‘quality’. However, the following definition, from the US Institute of Medicine, is often used:[quality is] the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.The Institute of Medicine has identified six dimensions of healthcare quality. These state that healthcare must be:

1. • safe
2. • effective
3. • patient-centred
4. • timely
5. • efficient
6. • equitable

6 dimensions of healthcare quality

https://www.youtube.com/watch?v=I8Y962VTiBY

How can we improve quality?

There are also a range of models and methods that individual organisations can put in place themselves. These were originally developed within an organisational or industrial context. Organisations develop and set their own goals, with full staff engagement, and employ a systematic approach to implementing change and monitoring progress.

The Health Foundation believes that a combination of approaches is needed to ensure sustained improvements in healthcare quality

Quality Improvement Journey

https://learn.nes.nhs.scot/4095/quality-improvement-zone/improvement-journey

PDSA Cycle

• Plan
• Do
• Study
• Act
• https://www.youtube.com/watch?v=szLduqP7u-k

PDSA

1. This is an approach to continuous improvement where changes are tested in small cycles that involves planning, doing, studying, acting (PDSA), before returning to planning, and so on. These cycles are linked with three key questions.
2. ‘What are we trying to accomplish?’
3. ‘How will we know that a change is an improvement?’
4. ‘What changes can we make that will result in improvement?’
5. Each cycle starts with hunches, theories and ideas and helps them evolve into knowledge that can inform action and, ultimately, produce positive outcomes.

http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/Whiteboard5.aspx

• “Insanity: doing the same thing over and over again and expecting different results”

Your QI project

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Think of a potential projectWhat is the issue? ....... What can you chage? What will happen? Prepare, start small, monitor progress, reflect, what has changedFollow the steps of the PDSA cycle Image: https://www.youtube.com/watch?v=szLduqP7u-k

Fabulous ideas

Put them into action!Use ideas for your assessment?

Can you think of any challenges to QI?

Think generalThink specific Think your workplace

Challenges and SolutionsDixon-Woods M, McNicol S, Martin G (2012) Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature. . BMJ Qual Saf p.2 – 9. ). doi:10.1136/bmjqs-2011-000760(2012).

Challenge 3:Data collection and monitoring systems This always takes much more time and energy than anyone anticipates.

Challenge1: Convince people that there’s a problem

Challenge2:If you do it, will it work?

Solution 2:Convince people of the solution. Come prepared with clear facts and figures, have convincing measures of impact and be able to demonstrate the advantages of your solution

Solution 1: Use hard data and to secure emotional engagement by using patient stories and voices.

Solution 3:It’s worth investing heavily in data from the outset. Assess local systems, train people and have quality assurance

Challenges to QI and Solutions

Challenge 6:Tribalism and lack of staff engagement

Challenge 4:‘Projectness’ and ambitions

Challenge 5:Organisational context, culture and capacities

Solution 6: Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns theproblem and solution, agree roles and responsibilities at the outset, work to common goals and use shared language.

Solution 5:Explain requirements to people and then provide ongoing support. Make sure improvement goals are aligned with the wider goals of the organisation, so people don’t feel pulled in too many directions

Solution 4:Over-ambitious goals and too much talk of ‘transformation’ can alienate staff Be SMART

Challenges to QI and Solutions

Challenge 7:Leadership

Challenge 8:Incentivising participation and ‘hard edges’

Solution 7:Getting leadership for quality improvement right requires a delicate combination of setting out a vision and sensitivity to the views of others. ‘Quieter’ leadership, oriented towards inclusion, explanation and gentle persuasion, may be more effective.

Solution 8:Relying on the intrinsic motivations of staff for quality improvement can take you a long way, especially if ‘carrots’ in the form of incentives are provideddbut they may not always be enough. It is important to have ‘harder edges’dsticksd to encourage change but these must be used judiciously

Challenges to QI and Solutions

Challenge 9:Securing sustainability

Challenge 10: Side effects of change

Solution10:It’s not uncommon to successfully target one issue while also causing new problems elsewhere. This can cause people to lose faith in the project. Be vigilant about detecting unwanted consequences and be willing to learn and adapt.

Solution 9:Sustainability can be vulnerable when efforts are seen as ‘projects’ or when they rely on particular individuals.

Metrics; our evidence

https://www.managementstudyguide.com/what-are-metrics.htm

https://www.klipfolio.com/resources/articles/what-are-business-metrics

Resources

QI Resource websitehttp://www.vle.eastmidlandsdeanery.nhs.uk/course/view.php?id=934Dixon-Woods M, McNicol S, Martin G (2012) Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature. . BMJ Qual Saf p.2 – 9. ). doi:10.1136/bmjqs-2011-000760(2012). The Health Foundation (2013) Quality improvement made simple. What everyone should know about health care quality improvement. http://www.health.org.uk/sites/health/files/QualityImprovementMadeSimple.pdf A useful website for an overview of the history of quality improvement is: www.businessballs.com/qualitymanagement. htm https://www.youtube.com/watch?v=szLduqP7u-k: PDSA CycleAn essential resource – tool kits, case studies etc. http://www.ihi.org/Pages/default.aspx https://www.nes.scot.nhs.uk/our-work/quality-improvement/#aboutqualityimprovement1 Jones B, Horton T and Warburton W (2019) The improvement journey Why organisation-wide improvement in health care matters, and how to get started. The Health Foundation .