Disclaimer information here… Click to edit Master title style QI 100 for Health Care Clinicians Unit 4: Health Care Change Systems Aligning Forces for.

Disclaimer information here…

Click to edit Master title style

QI 100 for Health Care Clinicians

Unit 4: Health Care Change

SystemsAligning Forces for Quality is supported by the Robert Wood Johnson Foundation, through a grant to the

Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning Forces for Quality is a joint project by the Wisconsin Collaborative for Healthcare Quality, the Wisconsin Hospital Association, and other organizations.


Click to edit Master title styleQI 100 Rules of Engagement

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Please read carefully:1. This powerpoint must be in “Slide Show” mode in order for all links to be active (see

the Slide Show menu at the top of your screen).

2. You must complete this unit in one sitting. You will not be able to exit and re-enter from where you left off.

3. This unit has three exercises and a five question quiz at the end. You must complete the quiz to get credit for Unit 4. You will be asked to enter your name.

4. CEU’s will be awarded after you have taken all five units and completed the Capstone Quiz – a link to this quiz is given in Unit 5.

5. The content provided in this unit is for educational purposes only and is not to be interpreted as an endorsement by WHA or any of it’s member or partner organizations.

6. This learning series is supported by the Aligning Forces for Quality grant. Aligning Forces for Quality is supported by the Robert Wood Johnson Foundation, through a grant to the Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning Forces for Quality is a joint project by the Wisconsin Collaborative for Healthcare Quality, the Wisconsin Hospital Association, and other organizations.

7. If you have questions or problems please e-mail: [email protected]


Click to edit Master title styleYou are here:

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Click to edit Master title styleIntroduction to Unit 4

You are about to participate in the QI 100 Unit 4: Health Care Change Systems

• Learn the difference between specific improvement and system improvement

• Learn about the various systemic change approaches in health care.

• Understand your role as a clinical staff person in systemic approaches.

• Describe the relationship between systemic improvement approaches and quality improvement efforts.

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Click to edit Master title styleGetting Credit for Unit 4

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• When you see a light bulb icon, you can access a brief exercise to reinforce the concept. Simply click on the light bulb.

• When you see a screen icon, you should access a quiz to test your knowledge. Simply click on the screen icon.

• When you are done with an exercise simply close the page by clicking the or at the top of the page.

• In order to officially participate in this unit, and receive continuing education credit, you need to complete the Unit 4 quiz.

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Click to edit Master title styleQI vs. System Improvements: The Difference

What is a Health Care Change System, and how is it different from improvement approaches such as PDSA or Lean?

Quality Improvement is a set of approaches and methods that address a specific issue or a specific problem.

To influence the pace of change, health care organizations sometimes engage in system-wide improvements to address multiple opportunities for improvement at the same time.

To better illustrate the difference, let’s review the concept of Systems Thinking.

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Click to edit Master title styleAbout Systems Thinking

What is Systems Thinking?• Systems thinking is the ability to see and analyze the many influences on an outcome.• It is an approach to problem solving by viewing "problems" as parts of an overall

system rather than reacting to present outcomes or events and implementing solutions that potentially contribute to the undesired issue or problem.

• Systems thinking requires an understanding of the linkages and interactions between the elements, or parts, that make up the system.

• Systems thinking acknowledges that an improvement in one area of a system can adversely affect another area of the system, so it also promotes organizational communication at all levels in order to avoid the silo effect.

Systems vs. Linear Thinking

Systems Thinking – all connected processes is the primary focus and the a single process is secondary.vs.

Linear Thinking – one process or parts of a process are the primary focus and the whole is secondary .

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Click to edit Master title styleThe Difference: Specific vs. System Improvements

Specific Improvements:• One issue • One or a few areas/depts.• Weeks or Months• Involves primarily

management & staff• Internal recognition• Effort of a few

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System Improvements:• Many connected issues• Whole organization• Years• Involves executives, the board, management

& staff• Public recognition• Effort of many


Click to edit Master title styleWhy is this important?

Many opportunities for improvement result from a problem in the system of processes that produce the result.

For example, let’s look at the issue of limited access to primary care in one county:

A linear approach to the problem might look like this:

Poor access Need more doctors Hire more doctors

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Click to edit Master title styleA Systems View

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A systems view of the same problem would look like this….

You can see how acting on a linear approach could result in unintended negative effects.


Click to edit Master title styleSpecific or Systemic?

Exercise #1 : Try this brief exercise to reinforce the concept of

systemic improvement.Are these improvements specific or systemic?

Just click on the light bulb

Choose the answer from the pop up list.

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XWhen you are done, simply close out by clicking the or at the top.


Click to edit Master title styleSystemic Change Approaches

When an organization chooses to move forward with a more comprehensive approach to improvement, there are a number of health care models to choose from.

Let’s review the most commonly chosen models and how each might influence a staff person’s role.

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Click to edit Master title styleMagnet Recognition ®

What is it?The Magnet Recognition Program® was developed by the American Nurses

Credentialing Center (ANCC) to recognize health care organizations that provide nursing excellence. The program also provides a vehicle for disseminating successful nursing practices and strategies. The Magnet Recognition Program is based on quality indicators and standards of nursing practice.

Successfully implementing the Magnet criteria embodies a professional environment guided by a strong visionary nursing leader who advocates and supports development and excellence in nursing practice.

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What does it mean for a staff person?• More involvement in decisions about patient care practices.• Opportunity to serve on a council.


Click to edit Master title styleMalcolm Baldrige National Quality Award (MBNQA)

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What is it?The Baldrige Award is given by the President of the United States to businesses—including health care – that apply and are judged to be

outstanding in seven areas: leadership; strategic planning; customer and market focus; measurement, analysis, and knowledge management; workforce focus; process management; and results.

Success is not based on meeting standards, but in achieving an demonstrating excellent results for patients & families and the stakeholders in the business.

The U.S. Commerce Department’s National Institute of Standards and Technology (NIST) manages the Baldrige National Quality Program.

What does it mean for a staff person?• A comprehensive understanding of the whole organization and its processes.• More involvement in planning and measurement. • More emphasis on the patient as a customer of the organization.


Click to edit Master title styleTransforming Care at the Bedside(TCAB)

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What is it?TCAB program is based on the original collaboration between the Robert Wood Johnson Foundation (RWJF) and the

Institute for Healthcare Improvement (IHI), and coordinated with the American Organization of Nurse Executives (AONE).

In 2003, through an initiative called Transforming Care at the Bedside (TCAB), these organizations created a framework for change on medical/surgical units built around improvements to the four main themes of TCAB — Safe and Reliable Care, Vitality and Teamwork, Patient-Centered Care, and Value-Added Care Processes.

What does it mean for a staff person?• Involvement in multiple improvement pilots, sharing feedback about pilot results, and assisting in the decision-making process.


Click to edit Master title stylePatient Centered Medical Home

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What is it?The Patient-Centered Medical Home (PCMH) has been developed over several years by the American College Physicians, American

Academy of Family Physicians, American Academy of Pediatrics and American Osteopathic Association and other organizations.

The aim is to assess whether physician practices are functioning as a health care setting which facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.

Building on the joint principles developed by the primary care specialty societies, it is based on the use of systematic, patient-centered, coordinated care management processes.

What does it mean for a staff person?Increased attention to coordination of care and improvement.

• Use of technology to achieve consistency for all patients.


Click to edit Master title styleShared Governance

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What is it?The Shared Governance model is an organizational structure in which clinical nurses have a voice in determining nursing practices, standards and

quality of care with a focus on providing high quality and cost-effective nursing care, to establish and monitor standards of clinical practice, and to promote excellence in professional performance among the nursing staff .

Within the Shared Governance model, nurses have a defined way to communicate concerns and work toward solutions through a series of councils. Shared Governance is characterized by clear accountability for decisions. It is not organized by any specific managing or professional organization.

What does it mean for a staff person?• More involvement in clinical care planning, and decision-making about changes in processes and practice in the clinical care areas by the direct patient care staff.


Click to edit Master title styleClinical Collaboratives

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What is it?Clinical Collaboratives are designed to enhance improvement efforts through shared

learning in a model where a variety of organizations work with each other to rapidly test and implement changes that lead to lasting improvement.

A Collaborative is typically a short-term effort is designed to help organizations close the gap between knowledge of effective practices and implementation of those practices.

The Institute for Healthcare Improvement (IHI) is one national organization promoting this model. States like Wisconsin have also used this model successfully to implement standardized practices and clinical improvements. An example of this is the effort to standardize wrist bands in Wisconsin.

What does it mean for a staff person?• Staff may be involved in learning a new method, assisting with measurement or tracking during the trial, and implementing changed practices while learning alongside other health care organizations.


Click to edit Master title styleMore About These Models

Learn more about one of these programs by clicking on the light bulb to the left.ANCC Magnet RecognitionMalcolm Baldrige National Quality AwardTransforming Care at the BedsideShared GovernanceThe Medical HomeClinical Collaboratives

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Exercise #2:

XWhen you are done, simply close out by clicking the or


Click to edit Master title styleWhat about the Joint Commission?

The Joint Commission is an accrediting organization. Accreditation has been defined as "A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards“.

In the first part of the 20th century, there was concern over how to best create an appropriate environment in which clinicians work. Specific standards to better control the hospital environment were generated, and these subsequently grew into accreditation schemes with the overarching goal for hospitals to achieve a baseline standard of care consistently present across facilities.

In contrast, systemic improvement approaches, such as those we have reviewed, are not tied to reimbursement or other requirements. They are adopted as a voluntary effort with aims such as achieving excellence in business, clinical excellence, being an employer of choice, achieving national recognition, or other goals beyond standards based performance.

(The Joint Commission recently adopted Lean as it’s internal improvement approach.)

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Click to edit Master title styleHow QI relates to system change

One might ask, “Why would my organization participate in Magnet or Baldrige, if we already use PDSA to improve?”

There may be a need or desire to improve beyond meeting state regulatory requirements or achieving accreditation standards, and specific methods to improve (such as Six Sigma) are important components under any systemic change approach.

A facility can have a defined improvement method without a systemic change approach, but a systemic change approach would be much less effective without defined improvement methods to go along with it.

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Click to edit Master title styleMost importantly…

A key takeaway is that you, and your participation in improvement, is important to make a difference for everyone!

It’s easy to miss ‘the big picture’ in the ‘busyness’ of the day to day work, but you are connected to the mission and vision of your organization. Let’s review an example:

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Click to edit Master title style Line of Sight – Connect to the “big picture”

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This is you

Everyone has a role in

“the big picture”.

Just look for the connections!

This is what an organization does …


Click to edit Master title styleUnit 4 Summary Quiz

Congratulations!You have completed Unit 4:

Health Care Change SystemsYou can now test what you have learned by taking a short 5

question assessment. Simply click on the screen icon

**Please note: You must take the assessment to get full credit for Unit 4

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XWhen you are done, simply close out by clicking the or at the top.


Click to edit Master title styleUnit 4 Resources

Baldrige Framework http://www.baldrige21.com/Baldrige%20Criteria%202009.html

Using a Malcolm Baldrige framework to understand high performing clinical microsystems. Tina C Foster, Julie K Johnson, et al. Qual Saf Health Care 2007;16:334–341.

http://www.thesystemsthinker.com/

http://sharedgovernance.org/

http://nursecredentialing.org/Magnet.aspx

http://www.ihi.org/IHI/Programs/StrategicInitiatives/TransformingCareAtTheBedside.htm

http://www.ihi.org/IHI/Programs/Collaboratives/

http://www.ncqa.org/tabid/631/Default.aspx

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Disclaimer information here… Click to edit Master title style QI 100 for Health Care Clinicians Unit 4: Health Care Change Systems Aligning Forces for.

Documents

improvement unit

quality matters unit

gains unit

healthcare quality

capstone credit unit

health care clinicians

quality grant

wisconsin collaborative