Quality Management, PDSA, RCA – Flashcards

Nursing care places a very big emphasis on QUALITY -*American nurses association* -->code of ethics ------>The nurse participates in ESTABLISHING, MAINTAINING and IMPROVING health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action -->Standards of Professional Performance ------->Quality of Practice -BEST OUTCOMES for patients

Quality improvement Performance improvement Total quality management Continuous quality improvement *GOAL: is to improve overall quality of health care*

CUSTOMER SATISFACTION -Press Ganey Innovation -technology -creativity in design -asking Why not? Employee involvement -employees must be the DRIVING FORCE behind quality improvement

employees

Structure: is unit design leading to succcess? Process: laptops, internet connection - analysis of issues STRUCTURE PROCESS OUTCOMES

Managers and workers must be COMMITTED to quality improvement GOAL is to improve SYSTEMS and PROCESS CUSTOMERS define quality Quality improvement focuses on OUTCOMES Decisions based on data

Plan Do Study Act (PDSA) -Retrospective Six Sigma -Prospective ....TJC: prospective: looking at trends in data - address problems before they occur

Define opportunities Measure performance Analyze opportunity Improve Performance Control performance to improve existing process

Defect or rework: electronic health records OVERPRODUCTION Excess motion Over processing Wait times Excess inventory Transportation

Structured process, *team* facilitated, used to identify *undesired outcome* and ultimately develop corrective action Steps to follow: -identify the event or events -describe what happened -identify contributing factors -identify root cause -propose change or intervention

Fishbone diagram -Agree on a problem statement (effect). Write it at the center of the Flipchart or whiteboard. Draw a box around it and draw a horizontal arrow running to it. -Brainstorm the major categories of causes of the problem. If this is difficult use generic headings: methods, machines (equipment), people (manpower), materials, measurement, environment -Write the categories of causes as branches from the main arrow -Brainstorm at the possible causes of the problem. Ask "why does this happen?" As each idea is given, the facilitator writes it as a branch from the appropriate category. Causes can be written in several places if they relate to several categories -Ask "why does this happen? about each cause. Write sub causes branching off the causes. Continue to ask "why"? and generate deeper levels of causes . layers of branches indicate causal relationships -When the group runs out of ideas, focus attention to places on chart where ideas are few

What are we trying to accomplish (aim)? How will we know that change is an improvement (outcome measure)? What change can we make that will result in an improvement? -define current process (map/flow) -identify opportunities for improvement

Plan: exactly what are we going to do? Do: when and how did we do it? Study: what were the results? Act: what changes are we going to make based on our findings?

what change are you testing with the PDSA cycle (s)? What do you predict will happen and why? Who will be involved in this PDSA? (e.g. one staff member or resident, one shift?) Whenever feasible, it will be helpful to involve direct care staff Plan a small test of change. How long will the change take to implement? What resources will they need? What data need to be collected?

Carry out the test on a small scale Document observations, including any problems and unexpected findings Collect data you identified as needed during the 'plan' stage

Study and analyze the data Determine if the change resulted in the expected outcome Were there implementation lessons? Summarize what was learned. Look for: unintended consequences, surprises, successes, failures

based on what was learned from the test: Adapt - modify the changes and repeat PDSA cycle Adopt - consider expanding the changes in your organization to additional residents, staff, and units. Abandon - change your approach and repeat PDSA cycle