Quality Improvement in Healthcare.ppt

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					Quality Improvement in
      Healthcare
 The National Opportunities
         24-10-07
Two patients limp into two different medical clinics
with the same complaint. Both have trouble walking and
appear to require a hip replacement. The first patient is
examined within the hour, is x-rayed the same day and
has a time booked for surgery the following week.

The second sees his family doctor after waiting a week
for an appointment, then waits eighteen weeks to see a
specialist, then gets an X-ray, which isn't reviewed for
another month and finally has his surgery scheduled for a
year from then.

Why the different treatment for the two patients?

 The first is a Golden Retriever. The second is a Senior Citizen.
           Three Part Problem...

• Improve Individual Experience

• Improve Population Health

• Control Inflation of Per Capita Costs

    The root of the problem in health care is that the business
    models of almost all health care organizations depend on


The Triple Aim
  keeping these three aims separate. Society on the other hand
      needs these three aims optimized (given appropriate
         weightings on the components) simultaneously.
                      --- (Tom Nolan, PhD)
 17 years to apply 14% of research
     knowledge to patient care!


Balas EA, Boren SA. Managing clinical knowledge for health care
   improvement. Yrbk of Med Informatics 2000; 65-70
     Misuse
McGlynn, et al: The quality of health care delivered
  to adults in the United States. NEJM 2003; 348:
  2635-2645 (June 26, 2003)
   – 439 indicators of clinical quality of care
   – 30 acute and chronic conditions, plus prevention
   – Medical records for 6712 patients
   – Participants had received 54.9% of scientifically
     indicated care (Acute: 53.5%; Chronic: 56.1%;
     Preventive: 54.9%)
 Conclusion: The “Defect Rate” in the technical
          quality of American health care is

              approximately   45%
        Quality Improvement
“Health Care Quality Improvement is a
  broad range of activities of varying
  degrees of complexity and methodological
  and statistical rigor through which health
  care providers develop, implement and
  assess small-scale interventions and
  identify those that work well and
  implement them more broadly in order to
  improve clinical practice.”
               Mary Ann Bailey, The Hastings Center
“A New Health System for the 21st
            Century
The Improvement Guide, API
                   Aim
•   Aligned
•   Timed
•   Numeric
•   Unachievable
Measures
  “When you have two
  data points, it is very
  likely that one will be
different from the other.”
                                  W. Edwards Deming



       R Lloyd, Institute for Healthcare
                 Improvement
                    80    70
                    70
Cycle Time (min.)

                    60
                    50
                    40               35
                    30
                    20
                    10
                     0
                          Avg     Avg After
                         Before    Change
                         Change
                                                          100
                                                           90




                                Cycle Time (min.)
                                                           80
                                                           70
                                                           60
                                                           50
                                                                                                                           Unit 1
                                                           40
                                                           30
                                                           20                                     Change
                                                           10                                      Made
                                                            0




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Cycle time results for                          100
                                                 90
units 1, 2 and 3


                          Cycle Time (min.)
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                                                 60                                                                          Unit 2
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                                                           90
                                      Cycle Time (min.)




                                                           80
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                                                           30
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                     R Lloyd, Institute for Healthcare
                               Improvement
Scottish Patient Safety
       Alliance
         Step 1

The Scottish Patient Safety
      Programme
                   Aims
• Make care safer by a measurable amount
  – Mortality: 15% reduction
  – Adverse Events: 30% reduction
• Build improvement capacity in NHS
  Scotland
                  Interventions
• Critical Care
  – E.g: ventilator acquired pneumonia rate
• Ward
  – E.g.: Crash call rate
• Medicines management
  – E.g.: Adverse drug events
• Theatres
  – E.g.: Surgical site infection rate
• Leadership
  – E.g.:Safety walkarounds
             New lessons
• 1  2  5  all
• Spread and sustainability
• Capacity building
        Board/Hospital Structure
                              Coordinator



            Communication
             infrastructure


Hospital Coordinator   Hospital Coordinator   Hospital Coordinator
   /Clinical lead         /Clinical Lead         /Clinical Lead



  Front-line teams       Front-line teams       Front-line teams
          NHS - opportunity for
       Improvement in Healthcare?

For                       Against

•   Single system         •   Negativity
•   Universal access      •   Sparse clinical leadership
•   Population approach   •   Professional silos
•   Team working          •   Organisational silos
•   No other incentives   •   Low level of improvement
•   Loyal and motivated       skills
    workforce
“Do not be content with mediocrity.
  Do your job so well that nobody
        could do it better. “
          Martin Luther King



              www.ihi.org

        j.leitch@dental.gla.ac.uk

				
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