Quality Improvement Review

Food and Nutrition Learning Network

July 31, 2007

Quality Improvement Basics

• Quality Improvement– opportunity for improvement exists in every process on every

occasion– requires commitment to improve our operations, processes and

activities– needs measurement-to demonstrate if efforts lead to the intended

change – emphasizes a view of care that focuses on systems not individuals

• HIV Quality Learning Networks to improve the quality of HIV care and services

• Strengthen the quality infrastructure of HIV supportive service providers

• Find ways to accelerate change and improvements in F&N programs

The Model for Improvement

Act Plan

Study Do

What are we trying to accomplish?What are we trying to accomplish?

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

What changes can we make thatWhat changes can we make that

will result in an improvementwill result in an improvement??

PDSA-First Steps

• Starting point for quality improvement projects

• Forming your quality team-project participants

• Setting your goal/aim• Establishing measures• Selecting changes• Testing changes

PDSA Cycle

• Rapid cycle improvement tool– Need to understand current situation– Trial and learning approach– At beginning, small-scale, short timeframe

• Establish measures ‘want to see increase/decrease in # of clients who…’

• What (who when and where) is to be done– Assign specific tasks

PDSA Cycle-Elements

Plandevelop plan, goals

Dotest changes, measure

Studyanalyze data, compare with plan

Actsystematize changes

Building Knowledge-Using Multiple Cycles of PDSAs

Improve Access to HIV Primary Care

A P

S D

APS

D

A PS D

D SP A

DATAD S

P A

Cycle 1: RD adapts new assessment form & uses with 3 patients

Cycle 2: Revise form and test with all patients Monday.

Cycle 3:

Cycle 4: Test form with all clients for 1 week

Present refined form to all staff and document feedback

Add primary care questionsto assessment form

Ideas, theories, hunches,

predictions

Aim: Ensure that all F&N clients are receiving HIV primary care.

Cycle 5: Implement form for all and monitor results

Food and Nutrition Programs

Improving Performance

• Learning how to make change in your organization is the purpose of PDSA

• Experiment: test on a small scale and build knowledge sequentially

• The cycles build on each other over time as you design a change that will result in improvement

• Reach QI goal to implement change on broader scale or throughout your organization