How to Design a Quality Improvement Project Kendiss Olafson MD FRCPC MPH Assistant Professor Section of Critical Care University of Manitoba.

How to Design a Quality Improvement Project

Kendiss Olafson MD FRCPC MPHAssistant ProfessorSection of Critical CareUniversity of Manitoba

What is Quality Improvement?

• Quality improvement is a formal approach to the analysis of performance and systematic approach to improving it.

Institute of MedicineTo Err is Human (1999)• Brought issue of patient safety and medical

errors to for front• 2% of all deaths are due to preventable

medical errorsCrossing the Quality Chasm (2001)• Urgently calls for changes to health care

processes to improve quality of care• Sets up framework for healthcare quality

improvement• Brings importance of patient and family

centered healthcare to frontline

Quality Improvement versus Research

Traditional Research• Goal is to attain new

generalizable knowledge

• Trial new methods• Data for publishing

Quality Improvement• Goal to improve care• Based in established

knowledge and applying this to local site

• Data internal use (usually but not always)

How to Design a Quality Improvement Project

1) Identify Gap in Care

Quality of Care Indicators (STEEPS)SAFE • Hospital Acquired Infections (VAP,

C. Dificle, CLI, Post-op Infection)• Medication Errors

TIMELY • Waiting times (See specialist, start chemo)

EFFECTIVE • Patient Mortality• Organ Donation rates• ASA use post MI

EFFICIENT • Hospital LOS• Health care Costs

PATIENT-CENTERED (FAMILY CENTERED)

• Patient/Family Satisfaction

STAFF WORKLOAD • Staff turnover and burn out

How to Design a Quality Improvement Project

1) Identify Gap in Care2) Review Literature – Identify

Evidence based practices

Use Pre-existing Bundles and Toolboxes

How to Design a Quality Improvement Project

1) Identify Gap in Care2) Review Literature – Identify

Evidence based practices3) Quality Improvement Tools

Quality Improvement Strategies• Continuous Improvement (PDSA)• Total Quality Management• Six Sigma• Lean

Quality Improvement Tools• Process map• Cause-Effect Diagram• Pareto Chart• Control Charts

• Scatter Diagram• Fishbone Diagram• Decision Matrix

Strategies and tools to help organize, analyze and impact change within a process

Develop protocols and Bundles of Care

Educate and Engage

Reminders and Forced

Function

• Antibiotic Auto-stop• Automatic orders• Surgical Checklists

Address Infrastructure

• Workplace Design• Equipment• Human Resources

Audit and

Feedback

How to Design a Quality Improvement Project

1) Identify Gap in Care2) Review Literature – Identify

Evidence based practices3) Quality Improvement Tools4) Measuring Impact

Quality Improvement StudiesChallenges to Measuring Impact

• Involves Healthcare Systems and Health Care Delivery Not just single intervention– Randomized Controlled trials of Health care

systems• Multiple interventions are tested over time

– Empiric Research with repeated measurements over time

Traditional Medical Research

Data collection Data collection

Time

Measure Outcome

Measure Outcome

Inte

rven

tion

MeasureDifferences

in Outcomes

Time Consuming

Expensive

Only One intervention tested

Quality Improvement Model

Data collection and Measuring Outcomes

Time

Measure Difference

Inte

rven

tion

Measure Difference

Inte

rven

tion

Measure Difference

Inte

rven

tion

HOW ?

Statistical Process Control

• Statistical Process Control measures the variation associated with the outcome of a process

Process required to make a nut and bolt

Process required to make a sick person well

Manufacturing

Healthcare

Statistical Process Control

• Differentiate common cause variation from extraordinary variationGoal is to optimize outcomes:• Identify extraordinary variation early and act on it• Limiting variation associated with a process

Process required to make a sick person well

Type of Illness

Severity of Illness

Co-morbidities

Demographics

Health Care Workers

Resources

Treatment given

Complications occurringVariation in Outcomes

Creating a Quality Improvement Project

1) Identify Gap in Care2) Review Literature –

Identify Evidence based practices

3) Quality Improvement Tools

4) Measuring Impact