Quality Improvement and PDSA Cycle: Understanding the Model for Improvement, Exams of Total Quality Management (TQM)

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 To gain an understanding of:

◦ Quality ◦ Quality improvement ◦ The Model for Improvement ◦ The PDSA cycle

 Patient Safety- Quality Improvement: “A formal

approach to the analysis of performance and systematic

efforts to improve it”.

 Safe

 Effective

 Patient-centered

 Timely

 Efficient

 Equitable

IHI, 2011a  How can we improve a system to achieve better results in the dimensions of quality?

Step 1: Three questions

Step 2: PDSA cycle

Model of Improvement

API, 2010

What are we trying to accomplish?

How will we know that a change is

an improvement?

What change can we make that will

result in improvement?

MODEL FOR IMPROVEMENT

The Change The Measure The Aim API, 2010

Step I:

Questions

Step 2:

PDSA

 Eliminate Waste

 Improve Work Flow

 Optimize Inventory:

 Change the Work Environment

 Producer/Customer Interface

 Manage Time

 Focus on Variation

 Error Proofing

 Focus on the Product or Service

IHI, 2012

All improvement will require change, but not

all change will result in improvement

 Do: the action part of the

process

◦ document problems and unexpected results ◦ collecting and analyzing data ◦ meeting with involved parties

 Study

◦ Analyze process improvement data ◦ Compare data to prediction ◦ Summarize what was learned ◦ Some focus areas of improvement are:  Clinical Outcomes  Cost  Access to Care  Satisfaction  Community Service  Regular Satisfaction Surveys

 Start small and think ahead a few steps.

 Test changes.

 Continuous improvement often requires a few

sequential PDSA cycles.

Ideal Situation Present Situation

Change usually comes after a series of successful

tests

 Educate and train everyone involved.  Make changes to job descriptions, policies, procedures, forms.  Address supply and equipment issues.  Assign day-to-day ownership for the maintenance of the new process. (Langley, Moen, Nolan, Nolan, Norman & Provost, 2009)

 Institute of Health Improvement (IHI). (2012). Using Change Concepts for Improvement. Retrieved from http://www.ihi.org/knowledge/Pages/Changes/UsingChangeConceptsforImprovement.a spx  Institute of Medicine (IOM). (1999). Measuring the quality of health care. IOM.  Langley, G. L., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd ed.). San Francisco, CA: Jossey-Bass Publishers.  Lloyd, R. (2004). Quality Health Care: A Guide to Developing and Using Indicators. Sudbury, MA: Jones and Bartlett Publishers.  Patient Safety – Quality Improvement. (n.d.). What is Quality Improvement? Duke University Medical Center. Retrieved from http://patientsafetyed.duhs.duke.edu/module_a/introduction/introduction.html  Quality Digest (2001). Definition of Quality: How do you define it? Retrieved from http://www.qualitydigest.com/magazine/2001/nov/article/definition-quality.html