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HQO QI Framework, ESC June 11, 12Sharon WhiteLinda HebelSue Jones

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HQO’s Quality Improvement Framework

PLANACT

STUDY DO

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 an improvement?

MODEL FOR IMPROVEMENT

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What would you say is the

difference between

Quality Improvement and

Quality Assurance?

Overview

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• Implement Spread Plan

• Communicate broadly

• Collect Measures, Look for Slippage

• Sustain Change

• Assemble Team

• Create Project Charter

• Set Aims

• Capture Voice of Customer

• Create and Validate Current State Map

• Identify Measures

• Create and Test Measurement Plan

• Gather and Share Baseline Data

• Create List of Improvement Opportunities

• Define Opportunity or Problem

• Analyze Data• Share Results• Future State

Map• Update Charter• Prioritize

Opportunities• Brainstorm

Change Ideas• Create Sub-

aims that Align with High-level Aims

• Create PDSA Plan

• Test Changes -PDSA

• Collect Measures – is there improvement?

• Share Results Broadly

• Formalize and Standardize Changes


• Sustain Change

• Implement Sustainability Plans

• Engage “Spread” team members

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GETTING STARTED

DEFININGTHE

PROBLEM

UNDERSTANDING YOUR SYSTEM

DESIGNING AND TESTING

SOLUTIONS

IMPLEMENTING AND SUSTAINING

CHANGES

SPREADING CHANGE

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Getting Started Phase

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Objectives• Introduce the phases of the HQO quality improvement

framework and key concepts of Emotional Intelligence (EI)

• Understand and apply the key activities of the Getting Started Phase and why EI is an effective self-management and leadership tool

• Learn individual and team strategies to enhance EI

• Introduce and apply the concept of the Voice of the Customer

• Understand and apply “Switch” change management to quality improvement initiatives.

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HQO QI Framework Primers to read/refer to Instruction Sheets Tools

Getting StartedQI Science QI Charter Charter template

QI Team Development and Organizational Culture PDSA PDSA Template

Voice of the Customer

Defining the ProblemMeasurement 5 Whys 5 Whys

QI Team Development and Organizational Culture Fishbone Fishbone

QI Science Measurement Plan Measurement Plan

Voice of the Customer PDSA PDSA Template

Process Mapping

QI Charter Charter template

Spaghetti diagram

Waste Walk Waste Walk

Tree Diagram

Defect Checklist

Understanding your SystemMeasurement Audit

QI Team Development and Organizational Culture Measurement Plan Measurement Plan

Change Ideas and Concepts PDSA PDSA Template

QI Charter Charter template

Designing and Testing SolutionsQI Science Measurement Plan Measurement Plan

Measurement Pareto Pareto

Change Ideas and Concepts QI Charter Charter Template

Implementing and Sustaining ChangesChange Management Audit

Implementation, Sustaining and Spread Communication Plan Communication Plan

Spreading ChangeChange Management Audit

Implementation, Sustaining and Spread

SWITCH: How to Change Things when Change is Hard

Institute for Healthcare Improvement: Open School for Health Professions

HQ

O products

supporting curriculumFoundational preparation

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QI

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ME&

Needs picture

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What is a

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Lessons from the Geese

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Existing teams might regress back to an earlier stage of developmentForming

Storming

Norming

Performing

Adjourning

Team DevelopmentA team may show characteristics of more than one stage, but one stage usually dominates

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Tuckman, B. W. (1965). Developmental sequence in small groups. Psychological bulletin, 63(6), 384.

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Emotional Intelligence (EI)

• HQO Framework – What

• EI - How

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How it all fits

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What it is

Emotional Intelligence is the ability to identify, use, understand and manage emotions in positive ways to reduce stress, communicate effectively, empathize with others, overcome challenges, and defuse conflict..TO ACHIEVE GOALS

Four Attributes1. Self-awareness2. Self-management3. Social awareness4. Relationship

management

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The Importance of EQ• Start with self

• IQ and EQ

• Strong EQ

– Better physical and mental functioning– Better communication and relationships– Improves productivity, self and team

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EQ Can be Learned

HOW?

• Recognize and reduce stress • Identify emotions• Improve non verbal communication• Use humour to deal with challenges• Resolve conflict positively

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Development of EI in Teams

BetterDecisions

Collaboration

Trust, Identity, Efficacy

Team Emotional Intelligence

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Capturing the Voice of the Customer (VOC)

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Capturing the Voice of the Customer

GROUP EXERCISE - Video

• How was Voice of Customer (VOC)captured?

• What are the benefits?• What will you do differently?• Why is capturing VOC such

an important part of this phase?

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http://www.institute.nhs.uk/quality_and_value/experienced_based_design/ebd_approach_videos.html




THE RIDER THE ELEPHANT & THE PATH

Introduction of Change Management

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Group ExerciseForm 2 groups : Group A: perspective of organization

Group B: perspective of individual

Apply the change framework to the Getting Started phase and answer the following questions:

• What might “spook” the elephant about this phase and what might be proactive actions?

• What might “spin” the rider and what might be proactive actions?

• What could you do to shape the path?

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Alignment of Strategic Priorities with Quality Improvement Initiatives

Organization’s Strategic Plan

Quality Improvement Plan

Indicators & Metrics Tracked

Quality Improvement Initiatives

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http://www.health.gov.on.ca/en/pro/programs/ecfa/docs/qi_pri_guidance.pdf

Aims Drive Your QI Charter

• Safe • Effective• Patient-Centred• Timely• Efficient• Equitable• & Integrated

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QIP Template (Excel)

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AIM

MEASURE

CHANGE

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Stakeholder Mapping

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LOW INFLUENCE / LOW IMPACT

Monitor

HIGH INFLUENCE / HIGH IMPACT

Manage Closely

HIGH INFLUENCE / LOW IMPACT

Keep Satisfied

LOW INFLUENCE / HIGH IMPACT

Keep Actively Informed& Engaged

High

Power/Influence

LowLow Interest/ Impact High

Stakeholder Mapping

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Using flipchart paper: place your sticky notes with stakeholder names on the 4x4 table

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Communications plan

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Sustainability…ongoing attentionand continuous improvement

“Sustainability is not a ‘project’ with an end-point. It is rather a constant effort to

embed a change into the fabric of daily work.”

“We do not actually want completely sustainable change because today’s sustained change becomes tomorrow’s resistance to change. Instead we want change that sustains itself until a better idea or a context-shift occurs – but not longer than that.”

Source: Improvement leaders’ guide to sustainability and spread. NHS Modernization Agency

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Need for Early Spread Planning

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Summary

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• Introduce the phases of the HQO quality improvement framework and key concepts of Emotional Intelligence (EI)

• Understand and apply the key activities of the Getting Started Phase and why EI is an effective self-management and leadership tool

• Learn individual and team strategies to enhance EI

• Introduce and apply the concept of the Voice of the Customer

• Understand and apply the “Switch” change management strategy.

Summary and Reflection

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Defining The Problem

Next Steps: Defining the Problem

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• Sustain Change

• Assemble Team


• Set Aims



















• Sustain Change



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GETTING STARTED

DEFININGTHE

PROBLEM



SOLUTIONS


CHANGES

SPREADING CHANGE

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Objectives

• Identify and understand the core concepts of pausing and probing in quality improvement

• Have an awareness of the various tools (process mapping, fishbone and 5 whys) for this Defining the Problem Phase

• Application of the various tools to define the problem

• Have an understanding of the types of measures used to probe a problem (Day 2)

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Defining the Problem

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“If I were given onehour to save the planet, Iwould spend 59 minutes defining the problem andone minute resolving it.”

- Albert Einstein

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“Our challenge is not to develop more sensitive ways to detect our risks, our errors, our flaws, our variation, our indignities, our fragmentation, our delays, our waste, our insults to the people we say we exist to serve.

Our challenge is to have the courage to name clearly and boldly the problems we have."

Donald Berwick, President and CEO of the Institute for Healthcare Improvement

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Pause & Probe

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Pausing and Probing Overview The strategic plans in Healthcare is focused on delivering demonstrably better care for patients/clients/residents. Also to reinforce the organization’s mission “to give the healthcare we’d like our loved ones to receive.”

The measures quality of care in two domains:1. clinical outcomes 2. patient and family experience with care.

The Brookings Institution, Improvements in Care-Transitions: A Case Study of St. Luke’s Hospital (2012), 4 - 5.

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Value Stream Analysis Preparation

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Current State

To Future State

Value Stream Analysis

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VSA and Identifying Waste

Value Addedfor the client

• Activities performed to meet the patient’s requirements

Non Value Added

(but value added for the organization)

Waste

• Steps are required

• Steps do not contribute directly to fulfilling patients needs

Steps in any process can be…

~95% of any process is Non-Value Added (NVA) from a client’s perspective

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Considerations for Generating a VSA

Source: Access and Patient Flow Toolkit. London Health Science Centre. McKinsey & Company. 2007.

• Map the patient’s journey

• Think in terms of the process

• Focus on the main flow

• Focus on getting a good snapshot of the actual process

• Include ‘informal’ information flows

• VSAs are non-evaluative

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The Elephant The Rider & the Path

Pause and Probe: Change Management

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Probing ToolsWhy Create a Process Map?

• Ensure that everyone has the same understanding of the process and guide quality improvement efforts

• Clarify roles and relationships in the process

• Reduce variation

• Plan a test of change (PDSA)

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Process Map

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Process Mapping Symbols

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Process StepDecision

Point

Document

Start

Stop

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Process Mapping Analysis With the patient and health care professional in mind, review your process map to see:

• How many steps are there?

• What are the gaps? Are there any of the 8 wastes?

• How many hand-offs are there?

• What opportunities are there for tests of change? PDSA’s generated?

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What Is A Fishbone Diagram?

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EFFECT / PROBLEM

Provider (Staff)

Policies Person

Place(Equipment)

Procedures

Effect: Head of the fish is the problem or effect we want to improve upon

Causes:Spines are the categories and the bones are the potential causes

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MH ICCP Team

Fishbone Diagram

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Problem / Effect

Why are there so many challenges documenting responsive behaviours?

Policies Provider/Staff Person

Place/Equipment Procedures

Not a new behavior No policy for

documenting RB

The policy is not clear on who should document

Not sure when to documentNot sure where to document the behaviour in the notes

We do not have enough space to do our documentation

Our electronic documentation tool does not allow for the different types of behaviours

Don’t know where to document

Not enough time

Policy does not include Residents with RB

Do not know what to document

Every resident has a behavioural issue

Duplication of documentation

Fishbone Diagram Example

5 Why Analysis

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What is 5 Why?

• Simple yet highly effective

• Any problem, any process, any system

• How to engage staff and use “why” to dig deep into the causes of an issue

• Identifying what the team has the power to change

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You don’t want to list 5 different reasons, you

want to go deep on 1 reason.

Caution:

• If your last answer is something you cannot control, go back up to the previous answer.

• Cannot be because of a person.

5 Whys Worksheet

Action:

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5 Whys Example

Why is the documentation of Responsive Behaviours inconsistent?

Because there is variation in coding.

Because staff differ in their interpretations.

Because RNs & PSWs differ in their definitions of RB is and how they code..

Because the organization has not developed standard definitions.Action:

Registered staff and PSWs will work together to develop definitions for each Responsive Behaviour to eliminate differences in staff interpretation and establish a common understanding.

WORLD CAFE

Instructions:

Participants are going to work in groups to practice using 3 different probing tools:

• Process Mapping

• Fishbone

• 5 whys

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Overview

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• Sustain Change

• Assemble Team


• Set Aims



















• Sustain Change



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GETTING STARTED

DEFININGTHE

PROBLEM



SOLUTIONS


CHANGES

SPREADING CHANGE

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Objectives

• Identify and understand the core concepts of pausing and probing in quality improvement

• Have an awareness of the various tools (process mapping, fishbone and 5 whys) for this Defining the Problem Phase

• Application of the various tools to define the problem

• Have an understanding of the types of measures used to probe a problem

?

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MEASUREMENT OVERVIEW

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Measurement for:

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Aspect Improvement & Learning

Research Accountability

Purpose To bring new knowledge into daily practice

To discover new knowledge

Comparison, choice, reassurance, spur for change

Tests Many sequential, observable tests

One large "blinded" test

No tests

Biases Stabilize the biases from test to test (accept consistent bias)

Control for as many biases as possible

Measure and adjust to reduce bias

Data Gather "just enough" data to learn and complete another cycle (small sequential samples)

Gather as much data as possible, "just in case"

Obtain 100% of available, relevant data

Determining if change is an improvement

Run charts or control charts

Hypothesis tests (T-tests, F-tests, Chi-square), p-value

No change focus

Source: Solberg L, Mosser G, McDonald S. The three faces of performance measurement: improvement, accountability and research. Joint Commission Journal on Quality

Improvement. 1997;23(3):135-147.www.HQOntario.ca

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The Quality Measurement Journey

• Link to AIM• Types: Outcomes, Process, and BalancingIdentify Measures

• Description in quantifiable terms of what to measure and the steps to follow to measure it consistently

Operational Definitions

• Need to determine what, who, why, when, how, data is collected. Consider sampling and stratification. Measurement Plan

• Try to use existing data, but may need to use some manual collection until changes are implemented.Data Collection

• Many types of analyses such as statistical, capability, probability dependent on the types of data collected.Analysis

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Lloyd, R. C. (2004). Quality Health Care: A Guide to Developing and Using Indicators. London: Jones & Bartlett Learning.

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Identify Measures• Outcome:

– Align with AIM – Reflect Voice of the Customer

• Process: – Focus on the system that affects the outcome– Reflect Voice of the System

• Balancing– Broad view of the system– Unexpected/unwanted effects

• PDSA– Align with Process Measure

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Sample – Family of MeasuresAIM: Reduce the number of falls resulting in injury by 50%, by March 31, 2013.

# people who experienced afall in the last 7 days

# people who experienced a fall and required ED care

# or % of people for whom a falls risk assessment was completed on admission

# or % of people who were assessed as medium- high risk as per Morse Fall Scale

# or % of people who were restrained (physically or chemically)

Outcome Process Balancing

Compliance with risk assessment

Completeness of risk assessment

Documentation and/or communication of risk assessment

Time from call bell to response

Time to gather resources (human, lifts)

Falls for person trying to get to washroom, or for meals, or showering

PDSA

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REVIEW HIGH-LEVEL AIM, OUTCOME AND PROCESS MEASURES

Aim:

Measure:

AIM OUTCOME MEASURES PROCESS MEASURES

Change concept and ideas

Measure:

Change concept and Ideas

Process Measure:

Process Measure:

Process Measure: ure:

Process Measure:

Measure:

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SAMPLE HIGH-LEVEL AIM WITH OUTCOME AND PROCESS MEASURES

Aim: Reduce inappropriate ED use among HL

cohort by 50% by Sept 2015

Measure: % ED visits for conditions best managed elsewhere


Change Idea:Extend Primary Care hours

Adjust to Peak Demand:-Use providers to full scope of practice

Process Measure: Survey staff re scope of practice- % feel used at full scope

--Posters in waiting rooms to advertise extended hours and indications when to go to GP and when to go to ED

Process Measure: Posters in each practice waiting room by Sept.

Measure: # of visits during “extended” hours

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CASE STUDY:

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At your table, choose:

real-time handover at dischargepatient education and discharge instructions,post-acute care follow-up visits

Brainstorm a family of measures for this issue. Write these measures on post-it notes

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Prioritize the OpportunitiesHow do we know which opportunities do we fix and in

what order?

• Subject matter experts• “Dotocracy”• Opportunity Prioritization Matrix

Consider adding a few extra opportunities in your final selection as some may be eliminated after further examination

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Impact – Difficulty Matrix

LOW

-

Imp

act

on

go

als

-

HIG

H

LOW - Difficulty to Implement - HIGH

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Example: Measurement Plan TOOL

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What? What is being measured? How is it related to other measures? What related data will be captured? Is it a process measure or an outcome measure? What type of data is being gathered (e.g., a process time, a defect count, etc.)?

How? How will the related data be captured? What data is produced by a computer and what is collected manually? If manually, which Data Collection Sheet is used?

When? When and how frequently will the data collection take place

(e.g., day of week, time of day, frequency)?

Where? On which unit, area, department

will the data be collected e.g.,

medication room unit 4F.

Who? Who is responsible for : capturing the raw data? aggregating/ collecting the data sheets? updating the quality board?

Process or Outcome Measure?

Measure Type of Data

Access: Outcome-

Percent of patients/clients able to see a doctor or nurse practitioner on the same day or next day, when needed

Attribute Paper Patient Survey: “The last time you were sick, how many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually SAW him/her or someone else in their office?”

random sample of 10% of visits after each visit with provider per month

Surveys will be handed out in FHT offices and submitted anonymously

Front office staff will collect and enter the data report to board monthly.

Access: Process-

Third Next Available Appointment

Attribute Count in the schedule Sample weekly on the same day at the same time

Each providers data would submit to FHT monthly

Scheduling staff to collect and collate reported monthlyto board

Access: Process-

Demand for visits

Attribute Track internal and external demand on paper

For two weeks starting next month for baseline, then once per week quarterly as needed

For each provider Scheduling staff to report quarterly

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Data Collection Tips

• Collect useful data, not perfect data• Use existing data if available• Manual collection if necessary• Use sampling to reduce collection burden• Use qualitative data to focus on best opportunities• Build data collection into regular day to day

processes

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MAKE DATA VISIBLE, ESPECIALLY TO THOSE INVOLVED

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Data collectionStratification• Separation & classification of

data according to predetermined categories

• Designed to discover patterns in the data

• For example, are there differences by shift, time of day, day of week, severity of patients, age, gender or type of procedure?

Sampling• Systematic sampling• Simple random sampling• Stratified sampling• Proportional stratified• Random sampling• Quota sampling• Judgment sampling• Convenience sampling

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Consider stratification BEFORE you collect the

data

Knowledge of sampling techniques will make data

collection much easier and less time consuming

Sampling Strategies Match the Examples

• By Doctor; 40% of X practice, 60% of Y practice

• By time of day, shift

• First choose males and females from two different doctor’s practices then sample proportionally.

• Complete defect form on every 10th

patient

• . Intake clerk determines sample.

• Next 5 patients

• Randomly choose three referrals weekly to audit

• Use random numbers program and choose from the entire referral list.

• Systematic sampling

• Simple random sampling

• Random sampling

• Stratified sampling

• Proportional stratified sampling

• Quota sampling

• Judgment sampling

• Convenience sampling

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THE RIDER ,THE ELEPHANT& THE PATH

Application: Change Management Framework

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Summary• Identify and understand the core concepts of

Pausing and Probing

• Have an understanding of the types of measures used to probe a problem

• Have an awareness of the tools/templates and resources available to support this phase

• Application of a change management framework to manage change

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Overview

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• Sustain Change

• Assemble Team


• Set Aims



















• Sustain Change



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GETTING STARTED

DEFININGTHE

PROBLEM



SOLUTIONS


CHANGES

SPREADING CHANGE

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To understand:

• Core concepts and key steps in Understanding your System Phase

• How run charts help understand how the system is currently functioning

• Concepts of common cause and special cause variation

• How to interpret data using run chart rules

• How to create a run chart using 5 steps

• How “Switch” change management strategies relate to measurement

Objectives

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“Every system is perfectly designed to get the results it gets.

If we want better outcomes, we must change something in the system. To do this we need to understand our systems.”

Donald Berwick, President and CEO

The Institute for Healthcare Improvement

Understanding Your System

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THE HUMAN WEB

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Interdependence

• A system is an interdependentgroup of items, people, or processesworking together toward a common purpose.

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Processes

People

Items

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Tools to assist understanding…

• Process & Emotion Mapping

• Going to Gemba

• Value Stream Analysis

• Fishbone & 5 Whys

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Using data to understand your system

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Causes of Variability• Common Causes

– Random variation (usual)– No pattern– Inherent in process– adjusting the process increases its variation

• Special Causes– Non-random variation (unusual)– May exhibit a pattern– Assignable, explainable, controllable– adjusting the process decreases its variation

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Common Cause Variation= Stable Process

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Common Cause

Special Cause

THE MANAGEMENT AND CONTROL OF QUALITY, 5e, © 2002 South-Western/Thomson LearningTM

Common Cause vs.Special Cause

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Understanding VariationWe use Run Charts and Control Charts to differentiate: • Common cause variation

– causes inherent in the system over time – affect everyone working in the system – If only common cause variation is present, then we need

to redesign the process for improvement to occur.

• Special cause variation – causes that are not part of the current process or do not affect

everyone – and that arise because of specific circumstances– We are trying to create special cause variation!

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SAMPLE RUN CHART

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# of

Pat

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Date (week)

#Patients30 DayRe-admitMedian

Target =5

Number of Patients from Health Link FHT re-admitted to Health Link Hospital in 30 Days *Specific Diagnosis.

Step 1. Create your baseline

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# of Patients

Number of Patients from Health Link (HL) FHT readmitted to HL Hospital in 30 days *specific dx

# Patients30 Day Re-admit

Median

Target =5

Improve

Step 2. Extend your median & begin testing changes

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Number of Patients from Health Link (HL) FHT readmitted to HL Hospital in 30 days *specific dx

# Patients30 DayRe-admit

Median

Target =5

PDSA

BEGIN

Improve

Step 3. Continue plotting data Step 4. Apply the rules

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Number of Patients from Health Link FHT readmitted to HL Hospital in 30 Days * specific dx


Median

Target =5

PDSA

BEGIN

Improve

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02-01-2013 02-02-2013 02-03-2013 02-04-2013 02-05-2013

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Number of Patients from Health Link FHT readmitted to HL Hospital in 30 Days * specific dx


Median

Target =5

PDSA

BEGIN

Step 5. If there is a signal, replot with new median

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Improve

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The Rules for Interpreting Run Charts• Rule One: A Shift

– Six or more consecutive points either all above or all below the median

• Rule Two: A Trend– Five or more consecutive points all going up or all going down

• Rule Three: An Astronomical Data Point– An obviously different value; anyone studying the chart would

agree that it is unusual

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Rule One: Shift• Six or more consecutive points either all above or all

below the median

• Values that fall on the median neither add to nor break a shift…skip them and continue counting

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Number of Patients from Health Link FHT readmitted to Health Link Hospital in 30 Days * specific dx

#Patients30 DayRe-admit

Median

Target=5

Rule One: Shift

Shift: 6 or more points on the same side of the median


Improve

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• Five or more consecutive points all going up or all going down

• If the value of two or more consecutive points is the same, ignore one of the points and continue counting

- Note: the starting point doesn’t count

- Note: either there is a trend (5 points) or there is not –there is no such thing as “trending”

Rule Two: Trend

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Rule Two: Trend

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#D

ays

to P

C v

isit

Date (week)

Number of Days from Discharge from HL Hospital to visit with HL Primary Care Provider per week * specific dx

Number of daysfrom hospitaldischarge tovisit withprimary careprovider

Median

Target= 7 days

Improve

Trend: 5 or more points ascending (may or may not cross median)

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Rule Three: Astronomical Point• An Astronomical data point is one that is:

– An obviously different value– Anyone studying the chart would agree that it is unusual– Every data set will have its high and low points, but not every

data set will have an astronomical point

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0

20

40

60

80

100

120

#D

ays

to P

C v

isit

Date (week)

Number of Days from Discharge from Heath Link Hospital to visit with Heath Link Primary Care Provider per week * specific dx

Number of daysfrom hospitaldischarge to visitwith primarycare provider

Median

Target= 7 days

Rule Three: Astronomical Point


Astronomical Point

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Run Chart Interpretation• All rules should be applied to each graph

– BUT– It is not necessary to find evidence of all rules to determine

that a change has occurred– Any single rule occurring is sufficient evidence of a non-

random signal change

• There is less than 5% probability that the first two tests will be positive just by chance

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110

Run Chart Activity: Lets Practice!• Please have a discussion about the sample data

provided and be prepared to share your thoughts on the following three questions:

1. Is this metric exhibiting common or special cause?

2. What is your interpretation of the situation? Was your interpretation different looking at the “static” vs. “dynamic” view of the data?

3. What, if anything, should be done?

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Date # Days to Specialist Median Target

3/13/2013 29 25 7

3/20/2013 26 25 7

3/27/2013 28 25 7

4/3/2013 27 25 7

4/10/2013 24 25 7

4/17/2013 25 25 7

4/24/2013 26 25 7

5/1/2013 22 25 7

5/8/2013 24 25 7

5/15/2013 25 25 7

5/22/2013 26 25 7

5/29/2013 23 25 76/5/2013 24 25 7

6/12/2013 25 25 76/19/2013 23 25 76/26/2013 24 25 77/3/2013 23 25 7

7/10/2013 22 25 77/17/2013 21 25 77/24/2013 19 25 77/31/2013 18 25 7

Run Chart Activity 1: Number of Days from referral from CHC to Patients' Specialist Consultation visit * specific dx

Answer: Run Chart Activity 1

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0

5

10

15

20

25

30

35

13-03-2013 13-04-2013 13-05-2013 13-06-2013 13-07-2013

# of

Day

sto

Spe

cial

ist

Number of Days from referral from CHC to Patients' Specialist Consultation visit * specific dx

# Days toSpecialist

Median

Target =7

Improve

113

Run Chart Demo in Excel

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Once you have analyzed the data, how do you make the Switch?

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Aims Drive Your QI Charter

• Safe • Effective• Patient-Centred• Timely• Efficient• Equitable• & Integrated


116

REVIEW HIGH-LEVEL AIM, OUTCOME AND PROCESS MEASURES

Aim:

Measure:


SubAim:

SubAim:

Measure:

Process Measure:

Process Measure:

Process Measure: ure:

Process Measure:

Measure:

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117

Summary• Understand the core concepts and key

steps in Understanding your System Phase

• Understand how to analyze your data and prioritize your opportunities

• Apply the change management strategy to keep your QI charter updated and relevant

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Next Steps

119




• Sustain Change

• Assemble Team


• Set Aims



















• Sustain Change



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GETTING STARTED

DEFININGTHE

PROBLEM



SOLUTIONS


CHANGES

SPREADING CHANGE

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