Identify the root cause of problems. An official website of the Department of Health and Human Services Latest available findings on quality and access to health care. Searchable database of AHRQ grants AHRQ projects funded by the Patient-Centered Outcomes Research Trust Fund. When working with any IQ method, the key is to carefully choose the strategies that have the best chance of improving the way your organization interacts with patients.
The Institute for the Improvement of Healthcare (IHI) improvement model is a simple but powerful model that focuses on setting objectives and selecting or developing measures to indicate if a change resulted in an improvement. At the heart of the Improvement Model is the Plan, Study and Act (PDSA) cycle (see Figure 4:. In the second part of the model, the QI team uses the RCI and the PDSA cycle to implement its action plan, with small-scale interventions introduced quickly to test the changes, learn from these tests, and then modify the intervention to implement it in another cycle. RCI is a practical, real-time approach that involves testing interventions on a small scale (for example,.
Numerous small cycles of change can successfully build up into big effects. For example, a doctor's office could improve quality by working on a series of cumulative and linked PDSA cycles in different aspects of care at the same time, for example,. RCI also limits measurement to what is sufficient to track progress. Lean, which is sometimes referred to as the Toyota Production System, is a tool used by companies to streamline manufacturing and production processes.
The main emphasis of Lean is to eliminate unnecessary and wasteful steps in creating a product or providing a service, so that only steps that directly add value are taken. A fundamental principle of Lean is the need to provide what the internal or external customer wants, that is,. Another is that any part of a process that doesn't add value is simply removed from the equation, leaving a highly simplified and cost-effective process that will flow smoothly and efficiently, creating additional capacity and, therefore, better performance. In health care, efficient thinking involves a clear understanding of the process under review, including all the steps involved, eliminating unnecessary steps, and basing the redesigned process on the patient's needs for attraction.
12 The purpose of the 5S is to improve the organization of space and eliminate the waste of time or movement that involves looking for things or preparing to work. The VSM, together with the 5S, are proven tools for creating processes that are more agile, offer more value to those involved in the process and increase the success rate of sustained process improvement. In a Lean culture, the focus is on interdisciplinary teams, where leaders are coaches and facilitators. There is a strong focus on the patient and decisions are based on data and processes.
The rewards fall on the team or group; however, the focus is maintained on the needs and expectations of the customer. For example, from the patient's perspective, a valuable process would include no unnecessary delays in accessing care, a process without errors, without long waiting times, and a satisfactory outcome. From the provider's perspective, a valuable process would make medical records, equipment, laboratories, and essential patient data easily available. Over a period of approximately 18 months, Altarum and its FQHC partners worked together to improve operations using Lean principles, tools, and techniques.
Staff members from the three organizations reported that the use of Lean allowed them to identify and make positive changes in several processes and workflows. Many of the improvements perceived by staff are interrelated. Standardizing a complex and slow process, for example, may have had a domino effect, allowing for improved patient flow, communication and collaboration; the provision of safer and better quality care; and better patient access to care. Virginia Mason Medical Center used Lean concepts to redesign its entire organization.
In outpatient care, these principles have improved preventive screenings, communication with patients, care coordination, and care management for patients with chronic diseases. The essential objective of Six Sigma is to eliminate defects and waste, thus improving quality and efficiency, by streamlining and improving all business processes. The Sigma classification indicates the percentage of defect-free products created by a process. A Six Sigma process is one in which 99.99966% of all production opportunities are expected to be defect-free.
While it was first designed for use in manufacturing and became fundamental to General Electric's business strategy in 1995, the healthcare industry uses Six Sigma to increase the reliability of the healthcare service delivery process. Six Sigma seeks to improve the quality of process results by identifying and eliminating the causes of defects (errors) and minimizing process variability. It uses a set of quality management methods and creates a special infrastructure of people within the organization who are experts in these methods (champions, black belts, green belts, yellow belts, etc.). This section summarizes two strategies that can help healthcare organizations implement a quality improvement model.
For many healthcare organizations, one of the biggest challenges in improving is getting a team of highly trained and busy professionals to work together effectively. TeamStepps is an evidence-based training program designed to improve quality and safety by improving communication and teamwork skills among health professionals. The program was jointly developed by the Department of Defense (DoD) and the Agency for Healthcare Research and Quality (AHRQ). TeamStepps teaches techniques to improve team structure, communication, leadership, understanding of what is happening (monitoring the situation) and mutual support among team members.
Taken together, these factors have a major influence on improving the quality and quality of care. Organizations can also use TeamStepps to train coaches or train the trainer. While TeamStepps was originally designed for the hospital environment, AHRQ also offers a primary care version of the TeamStepps training, in which the basic concepts of the program were adapted to reflect the environment of teams in primary care offices. Another common challenge for doctors' offices is not having the experience, time, or capacity to focus on designing and implementing a quality improvement program.
To help overcome that problem, organizations can seek the help of practice facilitators (PFs), sometimes referred to as quality improvement coaches or practice improvement assistants. PFs can also help improve communication and technology, promote adherence to best practices, and build the capacity to participate in and benefit from research. The VSM is extremely useful for mapping the steps a patient will take when visiting a doctor's office. For example, when nursing department staff reviewed patient education documentation as part of their continuous quality improvement efforts, they determined that each discipline was documented in a different place and that educational evaluation was not interdisciplinary.
The audits of the graphics had revealed a lack of documentation on teaching discharge planning, so the team decided that improving the documentation was a priority. The purpose of the 5S is to improve the organization of space and eliminate the waste of time or movement involved in looking for things or preparing to work. It is a systematic six-step approach to planning, sequencing and implementing improvement efforts using data and delves into the Shewhart cycle (plan, do, study, act). The first part of the improvement model is based on a trial-and-learn approach that uses rapid cycle improvement (RCI; see table below).
To do this, the team will have to discuss and agree on the sequential steps of the current process, from start to finish. The CIP provides a common language and methodology for understanding the improvement process. .
