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HRET HIIN Virtual Event Accelerating Improvement Fellowship

HRET HIIN Virtual Event Accelerating Improvement Fellowship :Measuring Changes: How Will We Know that a Change is an Improvement ?Wednesday, February 28| Call #4 | 12:30-1:30 , CTWelcome and IntroductionsMallory Bender, Program Manager, HRET2 WEBINAR PLATFORM QUICK REFERENCEMute computer audio To d a y spresentationDownload slides/resourcesRegister for upcoming eventsChat with participants3 Agenda12:30-12:35 Welcome and IntroductionMallory Bender, HRET12:35-12:45 Action Period Discussion PDSA reviewLauren Macy, IHI12:45-1:15 Measuring Changes: How will we know a change is an Improvement ?

Accelerating Improvement Call Topic Schedule Date Topic. January 17 th. The Model for Improvement & Setting Up Your Team; January 31. st. Setting Aims & Developing Your Theory. ... Quality Improvement Fundamentals LLC. The centerline (CL)on a Run Chart is the Median. Oneeasure at a time, m could be a percent, count,

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Transcription of HRET HIIN Virtual Event Accelerating Improvement Fellowship

1 HRET HIIN Virtual Event Accelerating Improvement Fellowship :Measuring Changes: How Will We Know that a Change is an Improvement ?Wednesday, February 28| Call #4 | 12:30-1:30 , CTWelcome and IntroductionsMallory Bender, Program Manager, HRET2 WEBINAR PLATFORM QUICK REFERENCEMute computer audio To d a y spresentationDownload slides/resourcesRegister for upcoming eventsChat with participants3 Agenda12:30-12:35 Welcome and IntroductionMallory Bender, HRET12:35-12:45 Action Period Discussion PDSA reviewLauren Macy, IHI12:45-1:15 Measuring Changes: How will we know a change is an Improvement ?

2 Using of data for Improvement vs. research and accountability Developing a family of measures Project and PDSA level measurementLauren Macy, IHI1:15-1:25 Assignments, Suggested Tasks & Additional MaterialsLauren Macy, IHI1:25-1:30 Bring It Home Mallory Bender, HRET4 Objectives for Today Using data for Improvement vs. research and accountability Developing a family of measures Project and PDSA level measurement5 Accelerating Improvement Call Topic ScheduleDateTo p i cJanuary 17thThe Model for Improvement & Setting Up Your TeamJanuary 31stSetting Aims & Developing Your TheoryFebruary 14thDeveloping Change Ideas & Testing with PDSAF ebruary 28thMeasuring Changes: How will we know a change is an Improvement ?

3 March 14thUsing and Analyzing Run ChartsMarch 28thPractical Strategies for Managing Improvement ProjectsApril 11thTesting vs. ImplementationMay 9thScale Up & Spreading Successful ChangesJune 6thSustainability: Making Your Improvements StickJuly 11thCelebration!6 Reminders! Self-Assessment Today is the deadline! We will share analysis next time Discussion Board Please post your aim statement and give feedback to your colleagues The question will change by Friday to share the Plan of a Period Assignment Discussion How have you developed (2ndorder) change ideas?

4 Change package? Brainstorming? Creative thinking? Logical Thinking: Cause & Effect/Fishbone Process Map8 Poll: At which point is your project? formed + aim formed + aim statement + driver formed + aim statement + driver diagram + change ideas formed + aim statement + driver diagram + change ideas identified + testing9 MEASURING CHANGES: HOW WILL WE KNOW THAT ARE CHANGES ARE BRINGING Improvement ?10 Langley, J. et al. The Improvement Guide. Jossey-Bass Publishers, Model for Learning and ChangeMeasuresImprovement isn t only about measurement, but without measurement we will never know if we are 11 The Three Faces of MeasurementCharacteristicImprovementAcco untabilityResearchThe AimImprovement of careComparison, choice, reassurance, spur for changeNew knowledgeBiasAccept consistent biasMeasure and adjust to reduce biasDesign to eliminate biasSample Size Just enough data, small sequential samplesObtain 100% of available.

5 Relevant data Just in case dataFlexibility ofHypothesisHypothesis flexible, changes as learning takes placeNo hypothesisFixed hypothesisTesting StrategySequential testsNo testsOne large testDetermining if aChange is anImprovementRun charts or Shewhart control chartsNo change focusHypothesis, statistical tests (t-test, F-test, chi square), p- valuesConfidentiality ofthe DataData used only by those involved with improvementData available for public consumption and reviewResearch subjects identities protectedSource: Solberg, Moser, McDonald12 Source: R.

6 Lloyd. quality Health Care: A Guide to Developing and Using Indicators. Jones and Bartlett Publishers, (How good? By when?) Concept/IdeaMeasureOperational DefinitionsData Collection PlanData CollectionAnalysisACTIONThe Milestones in the quality Measurement JourneySource: R. Lloyd. quality Health Care: A Guide to Developing and Using Indicators. Jones and Bartlett, 2004. 13 Source: R. Lloyd. quality Health Care: A Guide to Developing and Using Indicators. Jones and Bartlett Publishers, (How good? By when?) Concept/IdeaMeasure Operational DefinitionsData Collection PlanData CollectionAnalysisThe Milestones in the quality Measurement JourneySource: R.

7 Lloyd. quality Health Care: A Guide to Developing and Using Indicators. Jones and Bartlett, 2004. 14 ConceptPotential MeasuresPatient Falls Percent of patients who fell once or moreFalls rate (# falls per 1000 patient days)Number of fallsPatient harmPercent compliance with central line bundleMedication error rateDays since the last C. diff episodePatient and Family EngagementPercent of patients with an all about me # of QI teams with a patient on the teamEvery Concept Can Have Many Are NOT Measures!Reduce wait timesImprove patient satisfactionExpand market shareBe more efficientIncrease health and well-beingReduce wasteImprove our financial situationReduce inpatient discharge delaysEnhance Patient educationDeliver safeservicesThey are part : Dr.

8 Robert Lloyd IHI16 Three Types of MeasuresMeasure TypeCharacteristicsNumber Outcome Voice of the customer or patient How is the system performing? What is the result? Always links back to your aim1-2 Process Voice of the workings of the system Are the parts/steps in the system performing as planned? ooCan be an early indication of Improvement in the outcomeCareful not to over do the number 3-5 Balancing Looking at a system from different directions/dimensions Looks at the impact a change may have on other parts of the system ooUnintended consequencesUpstream/downstream Optional, but wise1-217 No Pass Zone in effect(Outcome)

9 The Relationship between PROCESS and OUTCOME MeasuresLeft devices all operational and have standardized beltsFall Assessment at admissionNon-cluttered patient room with equipment in correct positionFocusing on just the results (OUTCOME) is the old American Management by Objective Reminders to nurses about need to prevent falls. Negative consequences for a nurse whose patient fallsFalls(process)(process)(process)(pr ocess)(process)Number of Falls(Outcome measure)Number of Catches(process measure)(trash it in favor of a Just Culture )Percent FA at Admin(process measure)Number of Device Errors(process measure) Percent SupraNeat or maybe Count of Clutter quality Improvement Fundamentals LLCE xample Family of Measures: Readmissions AIM: Reduce readmissions related to colorectal surgery by 5% by December 31, 2017 Lacy Phillips Outcome.

10 % of patients being readmitted within 30 days after colorectal surgery Process: % of patients who at the time of discharge had a f/u visit scheduled in accordance with their risk assessment % of patients successfully able to te ach back discharge instructions one day prior to discharge Balancing: Patient Satisfaction19 Example Family of Measures: Sepsis Aim: Increase sepsis bundle compliance by 37% from year-end average for 2016 (36%)by end of first quarter 2018. Anne Engleman Outcome: % sepsis bundle compliance (# patients with sepsis getting the bundle/# of patients with sepsis) Process: % of ED patients identified with 2 SIRS criteria with sepsis bundle initiated within 1 hour % of ICU patients identified with 2 SIRS criteria with sepsis bundle initiated within 1 hour % of patients identified with sepsis getting the bundle within 3 hours Balancing.


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