Family Medicine and Public Health Clerkship Rotation University of Manitoba

Family Medicine and Public Health Clerkship Rotation
University of Manitoba
2010 - 2011
Amanda Condon MD CCFP
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Define and understand basic quality
terminology: quality and continuous quality
improvement (CQI)
List 4 main concepts of CQI and provide
clinical CQI examples
List and describe elements of PDSA cycle
Introduce tools and methods for improving
quality of care
Construct and present an idea for a CQI
project
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Quality can be defined by how well we meet
the needs of those we serve
Most problems are in process not people
Unintended variation in processes can lead to
unwanted variation in outcomes
Continual improvement can be achieved
through serial experimentation
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In health care, quality defined as: “doing the
right thing, the first time, in the right way at
the right time”
“Right thing, for every patient, every time”
Quality = extent to which health services
increase likelihood of desired health outcome
and are evidence based (Institute of
Medicine)
Measurement for research
Measure for learning and
process improvement
Purpose
To discover new knowledge
To bring new knowledge
into daily practice
Tests
One large “blind” test
Many sequential, observable
tests
Biases
Control for as many biases
as possible
Stabilize the biases from
test to test
Data
Gather as much data as
possible “just in case”
Gather “just enough” data to
learn and complete another
cycle
Duration
Can take a long time to get
results
“small tests of significant
change” accelerate the rate
of improvement
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Safe
Effective
Patient-Centred
Timely
Efficient
Equitable
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eliminate waste
improve work flow
optimize inventory
change the work environment
enhance the producer/customer relationship
manage time
manage variation
design systems to avoid mistakes
focus on the product or service
Langley, Nolan, Nolan, Norman & Provost
1999
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DPIN
MIMS
Breast Cancer Screening Program
Cervical Cancer Screening Program
Colorectal Cancer Screening Program
Care Maps (asthma, ACS etc.)
Standing Orders
Medication Reconciliation
Bridging Specialist and Generalist Care
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Store and Forward
Physician Integrated Network
EMR/EPR/EHR/PACS
1. Project Phase
2.Diagnostic Phase
3. Intervention Phase
• Plan a change
• Do it in a small test
• Study its effects
• Act on the result
4.Impact Phase
5.Sustaining Improvement Phase
Sourced from: NSW Department of Health (2002). Easy Guide to Clinical
Practice Improvement
Sourced from: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement
(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)
Identify appropriate interventions
Implement changes identified in the diagnostic phase
Undertake one or more PDSA cycles
Interventions phase
Decide on interventions
Undertake one or more PDSA
cycles
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use plan-do-study-act cycles
to conduct small-scale tests
of change in real settings
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plan a change
do it in a small test
study its effects
act on what learned
team uses and links small
PDSA cycles until ready for
broad implementation
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What are we trying to accomplish?
How will we know that a change is an
improvement?
What changes can we make that will result in
an improvement?
What are we trying to accomplish?
How we will know that a change is an improvement?
What change can we make that will result in an improvement?
ACT
STUDY
PLAN
DO
Langley, Nolan, Nolan, Norman & Provost 1999
Determines what
changes are to be made
Change or test
ACT
PLAN
STUDY
DO
Summarizes what
was learned
Carry out the plan
Langley, Nolan, Nolan Norman & Provost
1999
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Measure impact of changes/interventions
Record the results
Revise the interventions
Monitor impact
NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement
(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf
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Standardization of systems and processes
Documentation of policies, procedures,
protocols and guidelines
Measurement and review of practice to
ensure that change has become “standard”
Training and education of staff
NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement
(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)
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Identify an area for improvement, based on
clinical experience
Prepare proposal for initiative
implementation following PDSA method
Present proposal to clerkship group
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What irritates people, slows them down or
costs them money? Target your efforts at
relieving the worst of these problems.
Design a "best guess" solution -- a new
process model based on the best practice
your community has to offer.
Ensure that the new process won't irritate
people, slow them down or cost them money.
What are we trying to accomplish?
How we will know that a change is an improvement?
What change can we make that will result in an improvement?
ACT
STUDY
PLAN
DO
Langley, Nolan, Nolan, Norman & Provost 1999
1.
NSW Department of Health (2002). Easy Guide to Clinical Practice
Improvement(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)
2.
Jain, Manoj. Road Map for Quality Improvement – A guide for doctors.
3.
WHO Patient Safety Curriculum - Topic 7: Introduction to quality improvement methods.
4.
Djuricich, Alexander. Curriculum in Continuous Quality Improvement for Residents.
Indiana University School of Medicine, 2006.