View
2.928
Download
1
Embed Size (px)
DESCRIPTION
2013 Canadian Knowledge Mobilization Forum Cathy Howe NIHR CLAHRC for Northwest London
Citation preview
How do quality improvement (QI) tools and methods contribute to
healthcare improvement?
Cathy Howe, Julie Reed, Derek Bell
NIHR CLAHRC for Northwest London
CLAHRC NWL Approach
Quality Improvement Quality Improvement
Methods
Patient and Public
Involvement Engaging Patients and Staff
ResearchRigorous Design and Use of
Data
Education Training, Support and
Collaboration
A collision of different worlds…
NIHR CLAHRC For Northwest London
Health OutcomesPatient
Experience
Improve health outcomes and patient experience through delivery of clinically effective care.
Primary aim:
4 Rounds: 21 Projects over 55 Sites engaging
over 500 NHS staffsystematic approach
CLAHRC NWL AchievementsBeneficial impacts on care quality, outcomes, experience and costs• COPD discharge care bundle:
– Improved compliance with ‘best care’ (from 0% baseline - 70%)– reduced length of stay (e.g. by 2.5 days) – costs savings (e.g. estimated at £123,410/year)
• Medicines Management: – ADR identification (e.g. 70% potential ADR)– medication reduction (e.g. 52% meds)– cost avoidance (e.g. estimated net £145,000/yr) – co-designed “My Medication Passport” (paper & app, c.9,000 copies)
• Diabetes Improvement through Peer Led Education (DIMPLE): – Built capacity: 31 “community champions‟, 6 peer educators and 9 peer
mentors – engaged over 9,182 people through 352 events inc BME groups, – Social return on investment estimated at £11 for every £1 invested.
Demonstrated Patient & Public Engagement & Involvement benefits
Include (3 examples):
Conceptual Framework for delivering improvement in healthcare
Act scientifically and
pragmatically
Engage and empower
Embrace Complexity
Support for long term success
Understand and utilise existing knowledgeIterative DevelopmentCapture and produce new knowledgeActive engagementFacilitate dialogueFreedom to act and willingness to learnUnderstand services and processesUnderstand variationIdentify and act on systemic issuesProvide headroom and resourcesPolitical and Strategic AlignmentInvest in continual improvement
Values
Principles
Contribution of QI tools and methods : The CLAHRC NWL approach
Resources/ Funding£100k or £50k to develop or ‘roll-out’ projects matched funded by NHS and/or industry partners.
.
Model for Improvement
Three questions and rapid-cycle small tests of change.Measurement for Improvement
A ‘few key weekly measures’ to show progress using run charts and automated SPC charts.
Representative Team (Centre)Clinical lead, project manager, information lead and executive sponsor, plus others including patients.
Process MappingRepresentation of activities
and branching points in a care or data process.
Patient & Public Involvement Patient advisors, digital stories, focus groups…
Action Effect Method
A facilitated approach to represent the ‘theory of
change’ including a patient-focused aim, contributing
factors, and ideas for interventions.
Outcome MeasurementOne or two measures to show impact of the work on outcomes, qualitative or quantitative.
ReviewsTwo-way formative 6 month reviews exploring how teams use and engage with QI tools.
Sustainability Model
NHS III Sustainability Model to identify and address factors that affect sustainability.
Stakeholder MappingTwo-by-two matrix to identify key
stakeholders interest and influence plus management plan.
Act Scientifically & Pragmatically: Utilise existing knowledge
.
Model for Improvement
Process Mapping
Action Effect
Method
Act Scientifically & Pragmatically: Iterative Development
.
Model for Improvement
Measurement for Improvement
Representative Team (Centre)
Act Scientifically & Pragmatically: Capture & produce new knowledge
.
Model for Improvement Measurement for Improvement
Representative Team (Centre)
Process Mapping
PPE/I
Action Effect
Method
Outcome Measurement
Reviews
Sustainability Model
Stakeholder Mapping
Contribution of QI tools : Act Scientifically & Pragmatically
.
Model for Improvement Measurement for Improvement
Representative Team (Centre)
Process Mapping
PPE/I
Action Effect
Method
Outcome Measurement
Reviews
Sustainability Model
Stakeholder Mapping
Contribution of QI tools : Engage & Empower
.
Model for Improvement Measurement for Improvement
Representative Team (Centre)
Process Mapping
PPE/I
Action Effect
Method
Outcome Measurement
Reviews
Sustainability Model
Stakeholder Mapping
Financial Support
Contribution of QI tools : Embrace Complexity
.
Model for Improvement Measurement for Improvement
Representative Team (Centre)
Process Mapping
PPE/I
Action Effect
Method
Outcome Measurement
Reviews
Sustainability Model
Stakeholder Mapping
Contribution of QI tools : Support Long Term Success
.
Model for Improvement Measurement for Improvement
Representative Team (Centre)
Process Mapping
PPE/I
Action Effect
Method
Outcome Measurement
Reviews
Sustainability Model
Financial Support
QI tools contribution
• All tools make social and technical contributions
• All tools contribute to two or more values
• Most tools contribute to most values• Tools contribute differently to all
values – but exactly how, is still to be explained
• No ‘super-tool’ or subset of ‘super-tools’
QI tools in practice
Model for Improvement Sustainability Model Driver Diagram Measuring for Improvement Process Mapping Stakeholder Engagement PPI Dissemination of Learning Project MedianRound 1
1 1 1 2 3 1 2 2 5 22 3 2 2 3 1 2 5 5 2.53 1 1 2 2 0 2 0 6 1.54 5 1 2 2 1 2 5 6 25 5 1 2 2 6 5 2 6 3.56 3 1 2 6 6 2 2 6 2.5
Median 3.0 1.0 2.0 2.5 1.0 2.0 2.0 6.0
Round 21 5 1 5 3 5 6 5 5 52 5 6 5 3 6 3 6 5 53 5 2 2 4 3 5 3 2 34 3 2 2 2 2 2 2 5 25 1 2 2 2 5 3 2 2 26 5 2 2 3 6 2 2 5 2.57 3 2 2 3 5 3 2 5 38 3 2 2 1 0 2 3 5 29 1 1 2 0 0 1 2 6 1
10 2 2 2 1 0 1 2 1 1.511 2 1 2 1 0 2 3 6 212 5 3 2 0 0 3 2 5 2.513 3 1 2 2 0 2 2 5 214 5 1 2 5 3 3 2 6 315 3 1 5 5 3 3 5 5 416 5 0 2 5 0 2 2 6 217 3 1 2 0 0 1 2 5 1.5
Median 3.0 2.0 2.0 2.0 2.0 2.0 2.0 5.0
Round 31 6 5 6 6 6 5 5 5 5.52 5 0 6 0 6 2 2 5 3.53 1 3 5 1 6 2 5 5 44 3 3 5 1 6 2 6 5 45 1 3 5 0 6 2 5 5 46 4 3 5 5 5 5 2 2 4.57 1 0 1 2 0 2 2 5 1.58 3 1 2 2 3 5 2 0 29 5 0 5 5 6 5 5 5 5
10 5 3 5 5 6 2 2 5 511 6 0 2 0 6 5 2 5 3.512 5 3 6 5 6 4 5 5 513 3 0 5 3 6 6 5 2 414 5 0 5 6 1 6 6 5 515 5 3 5 5 6 6 6 5 516 5 2 6 5 4 2 2 6 4.517 5 3 5 3 6 2 2 5 418 3 3 5 5 6 5 2 3 419 4 0 5 3 6 5 5 2 4.520 4 3 5 5 4 6 5 5 5
Median 4.5 3.0 5.0 4.0 6.0 5.0 5.0 5.0
• The degree of engagement with each of the QI tools and methods varied within and across projects.
• More projects engaged with more methods in each round.
NIHR CLAHRC for Northwest London
Find us at…
W: www.clahrc-northwestlondon.nihr.ac.uk/home
T: @CLAHRC_NWL
Find me at…
W: www.cathyhowe.net
T: @cathgreenhalgh