Transcript Quality & Performance Improvement

QUALITY &
PERFORMANCE
IMPROVEMENT
For Emergency Department Nurses
Definition

Quality & Performance Improvement are…





Continuous cycles of improvement
Driven by our mission and vision
That stimulate individuals and teams to look
at the way they deliver care and services
In order to identify the root causes of
problems in our systems and processes
And encourage innovation to make changes
that improve them.
The Goal of Improvement

To become a “highly reliable” health care
organization




Delivering the right care to the right patient, at right
time, every time (Sec. Michael Leavitt, HHS, 2007)
Humans are error-prone, not highly reliable
Systems and processes can be highly reliable
The goal of process and systems improvement is
to make it hard for staff to make an error, thus
making the care & services provided highly reliable
Quality Control (QC)



Routine checks are in place
that ensure your service or
output is safe, accurate and
effective
QC is required by licensing
agencies, routinely
documented and generally
easily shared among staff
Examples: temp checks,
routine preventive
maintenance, running test
controls
Quality Assurance (QA)

Shows where we are in
relation to where we want to
be
Percent ED Patients Immunized
100


Compares measured
performance to a
predetermined benchmark or
threshold
Examples: complete medical
record documentation;
compliance with care
guidelines for AMI, HF,
pneumonia, stroke patients
80
60
40
20
0
Nov
Dec
Jan
Influenzae vaccinations
Feb
Quality & Performance Improvement

Percent ED Patients Immunized
100
80
A

C
B
D
60
40


20
0
Nov
Dec
Jan
Feb
A: opportunity identified & vaccination
status added to admission assessment


B: standing orders implemented
C: protocol for nurse admin prior to
discharge implemented
D: goal achieved

Use collected data intentionally, to
make changes for the better
Opportunities for improvement are
identified and prioritized
Specific improvement goals are
established
Changes are tested to see if they
achieve the established goals
QI/PI rely on measuring progress
routinely
Quality Improvement focuses on
improving clinical quality
Performance Improvement focus is
organization-wide
But we already give good care …
PROVE
IT!
Health care systems as “pillars”



Service: consistently
exceeding customer
expectations results in
increased satisfaction
Clinical Quality: patientcentered care that is safe,
effectively, timely, efficient,
equitable
People: well-trained,
recognized, and rewarded
staff bring commitment and
dedication to the workplace



Finance: solid planning and
management results in a positive
margin to sustain current ops and
provide future needs
Growth: a well-researched,
methodical approach involving key
stakeholders results in steady
growth
The pillars work together,
synergistically, to achieve mission
Quint Studer, Hardwiring Excellence, © 2003
Centers for Medicare and
Medicaid Services (CMS)


An effective QA/PI program is a condition of
participation (required for Medicare/Mcaid payment)
Involves all patient care and other services affecting
patient health and safety

Includes nosocomial infections and medication therapy

Includes an annual evaluation of the CAH program
More Conditions of Participation

QI/PI program must include the quality and
appropriateness of diagnosis and treatment



AMI, HF, pneumonia, surgical site infection prevention
Considers the findings and recommendations
from the state Quality Improvement
Organization (QIO) and takes corrective action
Takes appropriate remedial action to address
deficiencies found through the program, including
regulatory survey deficiencies
National Patient Safety Goals






Improve medication safety
Reduce healthcare-acquired infections
Reduce the number of patient falls
Use at least two patient identifiers (2)
Improve communication among caregivers
Reduce preventable deaths
IHI 5 Million Lives Campaign






Prevent harm from high-alert medications
Reduce surgical complications
Prevent pressure ulcers
Reduce MRSA infection
Deliver evidence-based CHF care
Get boards on board the quality program
Department QI/PI

Everyone gets to demonstrate how they are…






Exceeding customer expectations
Improving the quality of care and/or services
Developing staff
Managing finances
Growing their service
Department managers & staff will…


Decide how they will measure their performance
Decide what processes need improvement and how to
improve them
Data Collection

“What gets measured gets managed.”


“BUT … not everything that can be measured is
worth managing…”


We pay attention to what we are measuring
Measure the most important things
“…and everything that should be managed can’t
always be easily measured.”

Use QI/PI to improve things you can actually measure
Some ED Nursing Measures





Service: Patient satisfaction survey results
Clinical Quality: All vital signs recorded on
arrival, at discharge, and at least every one hour
throughout the ED stay
People: all ED nursing staff are BLS or
ACLS certified
Finance: reduce utilization of per diem ED staff
Growth: facility works to achieve state trauma
receiving center designation
The PDCA Improvement Cycle
Understanding the Process
To Be Improved - Flowchart




Create a step by step
picture of a work
process
Identify and add
missing steps
Streamline areas of
overlapping efforts &
eliminate unnecessary
steps
Standardize the
process or systemthis means everyone
does it the same way
Reporting Data with Run Charts
“The ED Nurse explained my discharge instructions in a way I could understand.”
100
90
Target
80
Facility performance
70
60
50
1Q
06
20
2Q
06
20
3Q
06
20
4Q
06
20
1Q
07
20
2Q
07
20
3Q
07
20
4Q
07
20
1Q
08
20
Reporting Data with Run Charts
Chest Pain ED Patients: Number of Opportunities Missed to Complete
12-lead EKG within 10 minutes of Arrival
5
4
3
2
1
Goal = 0 missed
opportunities
0
n
Ja
b
Fe
ar
M
ril
Ap
ay
M
ne
Ju
ly
Ju
g
Au
pt
Se
ct
O
v
No
c
De
Reporting Data with Histograms
Per Diem ED Nurse Staff Dollars
3500
3000
2500
2000
1500
Target =
< $1000/mo
1000
500
0
Jan
Feb
Mar
Apr
May June July
Aug
Sept
Oct
Nov
Dec
Tips for Success

Start Somewhere
“If you put off everything till you’re sure of it, you’ll never get anything done.”
Norman Vincent Peale

Keep after it – your perseverance benefits the
patients, the hospital, the community & you personally


Keep quality reporting on your monthly staff meeting agenda
Share data collection and reporting responsibilities

It helps build competence, teams, and cooperation
Tips for Success

Don’t Bite off More than You Can Chew



Don’t Reinvent the Wheel


Make your projects worthwhile but not overwhelming
One major improvement project at a time is often enough
Research best practices; borrow from other facilities
Align Projects with the Department’s Priorities

We all have plenty to do; don’t make stuff up
Tips for Success

Use the Quality Coord/Director as a resource


Be Prepared when it is your turn to report


For ideas about data collection, reporting, display
“Excellence is a habit, not an event.” Aristotle
Attitude is Everything!


This doesn’t have to be a mindless paper-pushing exercise
YOU have the power to make it meaningful
Tips for Success

“Celebrate, celebrate!!
Dance to the music!”
Three Dog Night

Celebrate each success, no matter how small

Reward the entire team
Finally…..

Find joy in your work;
if you don’t, what’s the point?