QI Undergraduate

QUALITY IMPROVEMENT PROJECTS

  • Presenter Information

    • Sarah Garnish

    • Clinical Lecturer, University of Reading

    • Lead Pharmacist, Homecare and Biologics, Hampshire Hospitals Foundation Trust (HHFT)

    • Acknowledgment to Marc Berry, HHFT QI Lead

AIM

  • To understand Quality Improvement Projects (QIP)

WHAT IS QIP?

Definition

  • Quality Improvement (QI): A combination of a change and a method intended to achieve a superior outcome (Health Foundation, 2013).

  • Quality Improvement Projects (QIP): Focus on improving service delivery and patient outcomes to achieve specific goals, which involves designing and implementing a change followed by measured evaluation (Royal College of General Practitioners (RCGP), 2024).

OBJECTIVES

  1. Define the term 'QIP'

  2. Understand why QI is used in clinical practice

  3. Describe the QI process

IMPORTANCE OF QI

First Principle of Improvement

  • Each system is perfectly designed to achieve the results it gets (Dr. Paul Batalden).

  • Note: Not all changes result in improvement.

Second Principle of Improvement

  • Everyone has two jobs:

    1. To perform their regular duties

    2. To seek improvement

  • There is always time for improvement.

  • No improvement is too small.

  • Improvement can be undertaken by anyone; waiting for the 'experts' isn't necessary.

Third Principle of Improvement

  • A method should be used.

    • Emerging evidence suggests that using a method enhances chances of successful outcomes.

    • Methods help identify what needs changing, generate creative solutions, and allow for quick tests of changes on a small scale.

    • Examples include the PDSA cycle, Model for Improvement, Lean methodology, and PRINCE2.

STRATEGIES FOR IMPROVEMENT

Model for Improvement

  1. What are we trying to accomplish?

  2. How will we know that a change is an improvement?

  3. What change can we make that will result in improvement?

  • Steps involved:

    1. Act

    2. Plan

    3. Study

    4. Do

Fishbone Diagram

  • A team exercise designed to identify all possible problems within various areas.

  • The team selects the most significant issues to focus on for improvement.

5 Whys Technique

  • Example scenario: A batch of chemotherapy has bacterial contamination.

    • Investigation reveals:

    • The isolator was closed for maintenance.

    • Technicians needed to renew training on aseptic techniques.

  • This scenario exemplifies how to investigate deeper into root causes.

Pareto Analysis

  • Described by the Pareto Principle (the 80/20 rule), where approximately 80% of outcomes stem from 20% of causes.

AIM CLARIFICATION

  • Importance of clearly defining the aim:

    • An aim should not be conflated with a solution.

    • Should be focused without vague or ambiguous terms (referred to as 'weasel words').

Examples of Clear Aims

  • Aim 1: To reduce infant mortality (deaths by 12 months of age, including stillbirths) by 15% by end of 2025.

  • Aim 2: To develop an effective pathway for knee replacements for patients aged 45–65 by December 2026.

  • Aim 3: To achieve 90% of patients expressing good satisfaction in pain management post-hip replacement.

STAKEHOLDER ENGAGEMENT

  • Critical step in gaining support for planned changes.

Stakeholder Analysis Categories

  1. Satisfy:

    • Keep opinion formers updated and satisfied with developments.

  2. Manage Closely:

    • Engage key stakeholders through full communication and consultation.

  3. Monitor:

    • This group may face neglect if resources are limited.

  4. Inform:

    • Patients often fall into this category; enhancing their influence can be achieved through group organization or active consultations.

KOTTER'S 8-STEP MODEL FOR CHANGE

  1. Create a Sense of Urgency

  2. Build a Guiding Coalition

  3. Form a Strategic Vision

  4. Enlist Your Army

  5. Enable Action

  6. Generate Short-Term Wins

  7. Implement Change

  8. Sustain Acceleration

INNOVATION ADOPTION CURVE

  • Breakdown of adoption rates for various change initiators:

    1. Innovators: 2.5%

    2. Early Adopters: 13.5%

    3. Early Majority: 34%

    4. Late Majority: 34%

    5. Laggards: 16%

DATA VARIATION IN IMPROVEMENT PROCESS

  • Monitoring patient waiting times:

    • Presentation of special causes signals unpredictability.

    • Improvement processes can become predictable when within control limits.

  • Model for improvement includes:

    1. Act

    2. Plan

    3. Study

    4. Do

PDSA CYCLES

  • Adjusting PDSA cycles may occur sequentially or simultaneously.

  • Caution against simultaneous changes, as one cycle may impact another's outcome.

QUESTIONS

  • Invitation for questions to clarify the concepts presented.