Quality Improvement

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Chapter 1
Introducing Quality Improvement

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Chapter 1: Introducing Quality Improvement
S.A.F.E uses quality improvement (QI) as a core
methodology. This chapter will focus on
understand QI methods.

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Resources
• Plan Do Study Act Checklist and Log
• Driver Diagram
• Measurement Plan
• Stakeholder Map

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Domains of Quality
CROSSING THE QUALITY CHASM: A New Health System for the 21st Century
INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS
Person
centred
• What
matters
to me
Safe
• Do we
harm
patients?
Effective
• Do we
give the
right
treatment
every
time all
the time?
Equitable
• Are the
services
and
outcomes
equal for
all
Timely
• Is there
good
access?
Efficient
• Do we get
value?

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What is Quality Improvement?
Quality Improvement can be defined as the:
“combined and unceasing efforts of everyone –
healthcare professionals, patients and their families,
researchers, payers, planners and educators – to make
the changes that will lead to better patient outcomes
(health), better system performance (care) and better
professional development”
Batalden and Davidoff

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Deming
System
where you
work
Variation in
the system
Psychology
- the
people
Theory of
knowledge
Deming’s Profound Knowledge

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Staff
Patients
Performance
Leadership
Strong Leadership
Great Organizational Support
Focus on Staff (Professionals)
Education and Training of Staff
Interdependence of Care Team
Performance Result Focused
Process Improvement Focused
Patient-Centered (Patient Focus)
Community and Market Focus
Information & Information Technology Orientation
•Reference Nelson et al 2008
Reference Dartmouth
Microsystems

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Theory Method
Systems Variation
Psychology
Theory of
knowledge
Measure
Theory to method to measurement

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The Model for Improvement
What are we
trying to
accomplish?
How will we
know if the
change is
improvement?
What changes
can we make
that will result
in
improvement?
Plan Do
Study Act

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The individual
•Clinical skills
•Self management
•Personal
development
Clinical Micro
system
•Individual team
and patient
•Where
improvement
takes place
Meso system
•Supports micro system
Macro
organisation
•Connects meso
systems and micro
systems
Network district
regional
•Whole patient
journey
•Across organisations
Change in the Microsystem

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Purpose - Our aim and mission.
Patients - Our reason for doing our work.
People - Our staff who take care of patients.
Processes - Our interrelated process that make up the micro
system.
Patterns – The way we work and measure what we do
(Measurements, Data, Run Charts)
Reference Dartmouth
5 Ps to Assess Improvement in a Microsystem

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Model for Improvement
The PDSA Cycle
What change can we make that will result in an improvement ?
Langley Nolan et al. The Improvement Guide: A Practical Approach to Enhancing Organizational
Performance, 2nd Edition April 2009, Jossey-Bass P 89

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Where to start?
Define
area for
change
Set aims
Establish
measures
Test
changes
Implement
changes

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S.A.F.E Driver Diagram
Outcomes Primary Drivers Secondary Drivers
To reduce avoidable error and
harm to acutely sick children
through the introduction of a
culture based on safety. This will
be demonstrated by:
 A 50% reduction in unsafe
transfers.
 95% compliance at each site
with the locally agreed
parameters for huddles.
 Increased understanding in
clinical teams of the concepts
of situation awareness,
anticipation, containment and
reliability.
 Increased awareness of local
safety through improved
Sexton Safety Attitudes
Survey scores.
 Improved experience scores
and awareness of safety from
patients, parents and carers
through the PREMS and
Safety Awareness survey.
Improved Situation
Awareness
Developing a culture based
on safety
Improved engagement with
patients and their parents
and carers in delivering care
recognised as being safe.
 Introduction of the ‘huddle’ intervention and
development of scripts appropriate for local settings.
 Introduction and reinforcement (where appropriate) of
the use of SBAR.
 Introduction and development of other appropriate tools
and interventions.
 Development of a flexible intervention model to improve
situation awareness.
 Educating teams in concepts of situation awareness,
anticipation, containment and reliability.
 Introduction of both the Sexton Safety Attitudes Survey
(comparative) and MaPSaf (developmental) tools as
mechanisms for assessing safety attitudes.
 Developing an open approach to working as clinical
teams
 Introducing patients, parents and carers are key
components of the team.
 Engaging patients, parents and carers in the
development of local projects.
 Introduction of PREMS and a patient/parent safety
awareness survey.
 Introduction and development of tools, techniques and
interventions with a patient/parent engagement focus.

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PDSA Paper Aeroplane Activity
Quality Improvement in Action
Aim: Design a paper plan that will fly the
furthest distance
Think of the areas you need to consider:
• Design
• Construction
• Measurement
Run your tests a few times:
• What are you learning?
• How will you factor your learning into the next
test?
• Did your change result in improvement ?

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Spreading Change through Collaboration
The success of S.A.F.E has been in establishing,
encouraging, and supporting networks to share
learning, experiences, and ultimately, change.
What networks can you engage with to help
spread your improvements?