Pamela S. Gillam, MPA

1. QualityQuality ImprovementImprovement– What– What
Is it and How Can It HelpIs it and How Can It Help
Me?Me?
Pamela S. Gillam, MPAPamela S. Gillam, MPA

2. OBJECTIVES:OBJECTIVES:
 Recognize the definition of QualityRecognize the definition of Quality
Improvement (QI)Improvement (QI)
 Understand the difference b/w QI andUnderstand the difference b/w QI and
Quality Assurance (QA)Quality Assurance (QA)
 Demonstrate the use of the Model forDemonstrate the use of the Model for
Improvement/PDSA CycleImprovement/PDSA Cycle

3. Why You Should Care About QIWhy You Should Care About QI
If you plan to be a:If you plan to be a:
 Health Educators- It is an effective approach forHealth Educators- It is an effective approach for
implementing evidence based practices!implementing evidence based practices!
 Researcher-- Evaluation is a requiredResearcher-- Evaluation is a required
component of most research grants and QIcomponent of most research grants and QI
enhances it; Funders (Feds!) are counting on itenhances it; Funders (Feds!) are counting on it
 Administrator– Hospitals are using it;Administrator– Hospitals are using it;
Reimbursement depends on it; manyReimbursement depends on it; many
organizations are in desperate need for it!!!!organizations are in desperate need for it!!!!

4. What is Quality?What is Quality?
American Society for Quality (ASQ)American Society for Quality (ASQ)
definition—definition—
1. the characteristics of a product or service1. the characteristics of a product or service
that bear on its ability to satisfy stated orthat bear on its ability to satisfy stated or
implied needs;implied needs;
2. a product or service free of deficiencies.2. a product or service free of deficiencies.
“Fitness for Use”- Joseph Juran “Conformance to
Requirements”- Philip Crosby

5. 55
What is Quality?What is Quality?
Quality is a never-endingQuality is a never-ending
cycle of continuouscycle of continuous
improvement.improvement.
-Deming

6. 66
The Quality JourneyThe Quality Journey
Quality Assurance
Quality Improvement
Rapid Cycle Quality Improvement

7. 77
Quality Alphabet SoupQuality Alphabet Soup
lean

8. Quality ImprovementQuality Improvement
 Aimed at improvement -- measuringAimed at improvement -- measuring
where you are, and figuring out ways towhere you are, and figuring out ways to
make things bettermake things better
 Specifically attempts to avoid attributingSpecifically attempts to avoid attributing
blameblame
 Attempts to create systems to preventAttempts to create systems to prevent
errors from happeningerrors from happening

9. Models for QIModels for QI
Six Sigma (6s) Lean Model for Improvement
Focus on Critical-to-Customer
Quality Focus- Identify Value
Focus- Improvement through Small
Scale Testing
Focus- Culture and
Infrastructure Eliminate Waste Test ideas to meet overarching goals
Reducing Variation
Increase Processing
Speed/Reduce WIP
Test ideas under a variety of
conditions
Remove Causes of Defects Process Mapping, Takt time PDSA
DMAIC, Cpk
Use this when you have ideas of what
can be done or adapting EBP
Use this when you don't know
what to do
Common across all three:
•Need to understand the process flows
•Need to understand the overall goal and strategy of Operations
•Need for leadership and organizational buy-in
•Importance of the “voice of the customer” (internal and external)
•Need for data and measurements, i.e., evidence-based changes
•Use of teams

10. Common QI ToolsCommon QI Tools
 Control Charts, Pareto Charts, GANTTControl Charts, Pareto Charts, GANTT
chartscharts
 Plan Do Study Act (PDSA) CyclePlan Do Study Act (PDSA) Cycle
 Root Cause Analysis- Ishikawa/FishboneRoot Cause Analysis- Ishikawa/Fishbone
DiagramDiagram
 Nominal Group TechniqueNominal Group Technique
 Flow chartsFlow charts
 FMEAFMEA

11. QI isQI is
ALWAYSALWAYS
aboutabout
THETHE
CUSTOMER!!!CUSTOMER!!!

12. An Integrated Approach To ImprovementAn Integrated Approach To Improvement
Top down
Bottom up
Leadership level
• Determine aims
• Identify resources (staff/$$)
• Continuous support
Strategies for Improvement:
• Make changes in other areas
• Use collaborative model in other areas
• Fundamental change in how the
organization/division does business
• Local incremental improvements
• Control what’s going to happen
Local level
• Understand capacity needs
• Knows what will work/won’t work
Results
• Reduce cost/improve
productivity
• Provide different/
new services
• Improve quality

13. 1313
QA vs. QIQA vs. QI
Quality AssuranceQuality Assurance
 Conform toConform to
standardsstandards
 Relies onRelies on
inspectioninspection
 Focus on itemsFocus on items
 Quality is separateQuality is separate
functionfunction
 DepartmentalDepartmental
functionfunction
Quality ImprovementQuality Improvement
 ImprovedImproved
performanceperformance
 Monitor over timeMonitor over time
 System orientationSystem orientation
 Quality integratedQuality integrated
in organizationin organization
 InterdisciplinaryInterdisciplinary
functionfunction

14. QA vs. QI (cont’d)QA vs. QI (cont’d)
Quality AssuranceQuality Assurance
Focus on improvingFocus on improving
individual's faultsindividual's faults
ReactionaryReactionary
Use of “minimum”Use of “minimum”
standardsstandards
Time-limitedTime-limited
Quality ImprovementQuality Improvement
Focus on systems andFocus on systems and
process improvementprocess improvement
ProactiveProactive
Use of “benchmark” andUse of “benchmark” and
“best practices”“best practices”
ContinuousContinuous

15. Short Example of QI vs. QAShort Example of QI vs. QA
From the following statements, which do you thinkFrom the following statements, which do you think
have a QA focus and which have a QI focus?have a QA focus and which have a QI focus?
1.1. Which staff member failed to transfer the call to theWhich staff member failed to transfer the call to the
correct extension?correct extension?
2.2. Are we creating an environment encouraging cliniciansAre we creating an environment encouraging clinicians
to report errors?to report errors?
3.3. How do we reduce billing errors by our staff?How do we reduce billing errors by our staff?
4.4. Patient had a bad outcome; were the doctors orPatient had a bad outcome; were the doctors or
nurses at fault?nurses at fault?
5.5. What could we do to increase the efficiency of chartWhat could we do to increase the efficiency of chart
filing?filing?

16. The Model forThe Model for
ImprovementImprovement
TestingTesting
and Implementingand Implementing
ChangesChanges

17. Model for Improvement
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?
Act Plan
DoStudy
From: Associates in Process
Improvement
AIM
MEASURE
CHANGES

18. Aim StatementAim Statement
aka “What are you trying toaka “What are you trying to
improve?”improve?”
 Involve senior leadersInvolve senior leaders
 Focus on issues that are important to yourFocus on issues that are important to your
organizationorganization

Connect the team Aim statement to theConnect the team Aim statement to the
Strategic PlanStrategic Plan

Build on the work of others (StealBuild on the work of others (Steal
Shamelessly!)Shamelessly!)

19. Measures- 3 TypesMeasures- 3 Types
1.1. Outcome MeasuresOutcome Measures- Voice of the Customer.- Voice of the Customer.
How is the system performing? What is theHow is the system performing? What is the
result?result?
2.2. Process MeasuresProcess Measures- Voice of the workings of- Voice of the workings of
the system. Are the parts/steps in the systemthe system. Are the parts/steps in the system
performing as planned?performing as planned?
3.3. Balancing MeasuresBalancing Measures- Looking at a system from- Looking at a system from
different directions. What happended to thedifferent directions. What happended to the
system as we improved the outcomes/processsystem as we improved the outcomes/process
(e.g. unanticipated consequences, other factors(e.g. unanticipated consequences, other factors
influencing outcome)?influencing outcome)?

20. ChangesChanges
 Practices from other industriesPractices from other industries
 Evidence-based PracticesEvidence-based Practices
 Promising PracticesPromising Practices
 Ideas from staffIdeas from staff

21. Model for Improvement
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?
Act Plan
DoStudy
From: Associates in Process
Improvement
AIM
MEASURE
CHANGES

22. PDSA Cycle for Learning andPDSA Cycle for Learning and
Improvement: Use it All!Improvement: Use it All!
Plan
• Objective
• Questions and
Predictions (Why?)
• Plan to carry out the
cycle (who, what, where,
when)
Do
• Carry out the plan
• Document problems
and unexpected
observations
• Begin analysis
of the data
Study
• Complete the
analysis of the
data
• Compare data to
predictions
• Summarize what
was learned
Act
• What
changes are
to be made?
• Next cycle?
What will
happen if we
try
something
different?
Let’s try it!!Did it work?
What’s
next?

23. Use the PDSA Cycle for :Use the PDSA Cycle for :
 Testing or adapting a changeTesting or adapting a change
ideaidea
 Implementing a changeImplementing a change
 Spreading the changes to theSpreading the changes to the
rest of your systemrest of your system

24. Why Test?Why Test?
 Increase your belief that the change willIncrease your belief that the change will
make improvementmake improvement
 Predict how much improvement you canPredict how much improvement you can
expect from the changeexpect from the change
 Learn how to adapt the change in yourLearn how to adapt the change in your
settingsetting
 Figure out the costs and side-effects of theFigure out the costs and side-effects of the
changechange
 Minimize resistance upon implementationMinimize resistance upon implementation

25. To be considered a real testTo be considered a real test
 Test was planned, including a plan forTest was planned, including a plan for
collecting datacollecting data
 Plan was carried out and data werePlan was carried out and data were
collectedcollected
 Time was set aside to analyze data andTime was set aside to analyze data and
study the resultsstudy the results
 Action was based on what was learnedAction was based on what was learned

26. Repeated Use of the PDSA CycleRepeated Use of the PDSA Cycle
Hunches
Theories
Ideas
Changes That
Result in
Improvement
A P
S D
A
PS
D
A P
S D
D S
P A
DATA
Very Small
Scale Test
Follow-up
Tests
Wide-Scale Tests of
Change
Implementation of
Change

27. Aim:Aim: Reduce smoking rates by implementingReduce smoking rates by implementing
the 2 A’s and R CPG standardthe 2 A’s and R CPG standard
Conducting 2 A’s
and R will
increase Fax
Referrals
Reduced
Smoking Rate
A P
S D
A
PS
D
A P
S D
D S
P A
DATA
D S
P A
Cycle 1: Test the 2 A’s and R with 5 patients on Tuesday.
Cycle 2: Change forms, process.
Cycle 3:
Cycle 4: Standardize process
Cycle 5: Educate staff in
new process
Test new form, process with 10 patients.

28. Let’s practice!!!Let’s practice!!!

29. Questions???Questions???
gillamps@sc.edugillamps@sc.edu
OrOr
803-777-0304803-777-0304