Academic Pediatric Association

QUALITY

IMPROVEMENT TRAINING: Module #3

Initiating a QI projectInitiating a QI project

This work is supported by a grant from The Centers for Disease Control & Prevention.

National Partnership for Adolescent Immunization

PI: Peter SzilagyiCoordinators: Christina Albertin, Nui

Dhepyasuwan

Ed Marcuse (communication expert)

Cindy RandJan Schriefer (QI expert)Stanley SchafferJanet SerwintWilliam Stratbucker

Donna D'AlessandroWilliam AtkinsonPaul DardenSharon Humiston

(moderator)Keith Mann (QI

expert)

FACULTY & CONSULTANTS

This is part of the APA series on Quality Improvement. The examples focus on adolescent immunization, but the principles are widely applicable. The series includes:1. Overview: The Model for Improvement and

Deming’s System of Profound Knowledge 2. Improvement cycles and the psychology of

change 3. Initiating a QI project4. More tools to better understand the

system5. How will we know that a change is an

improvement? An introduction to QI measurement

6. Changes we can make that will result in improvement

Module 3 Objectives

After viewing this segment, you will be able to:

1.Identify roles and responsibilities of QI team members

2.Draft an Aim Statement (Describe your problem, timeline, scope, and target population)

3.Complete a charter4.Build a driver diagram

1. Identify roles &

responsibilities of QI team

members

“Including the right people on a process improvement team is critical to a successful improvement effort.”

Institute for Health Improvement

When putting together a QI team…How to choose team members:

Review the general mission What system will be affected by the improvement efforts?

Invite members familiar with different parts of the process

Size: 5-7 people at mostExecutive sponsor: takes responsibility

for the success of the project

Possible Team Members & Their Roles

Project sponsor/champion – oversee QI project (e.g., goal setting, data collection & analysis), advocate for & find resources to get project done

Clinical technical expert -- knows the subject intimately, understands the processes of care

Day to day leader – plan & deliver all training needed to implement the project; managing the implementation and testing the change

System leader -- advocate Other team members – “voice of experience”Outsider?QI expert if available

Some characteristics that make a good team

member:Good knowledge of process, product, and customer

Access to data about the process or product

Willingness to work cooperatively with other team members

Ability to devote 3-4 hours/week to data collection and team meetings

Ability to challenge the status quo

From The Six Sigma Way: Team FieldbookPS Pande, RP Neuman, RR Cavanagh

QUESTION #1True or False?

When developing your QI team, the project champion should emphasize that the project will take almost no time in order to attract important (i.e., busy) team members.

QUESTION #1(Answer)

False!

When developing your QI team, the project champion should acknowledge that QI takes time in order to attract team members prepared for the commitment.

2. Draft an Aim

Statement

AIM Statement

What are we striving to accomplish (measurable goal(s))?

When will this occur? (what is the timeline)?

How much? What is the specific, numeric improvement we wish to achieve?

For whom? Who is the target population?Why is it important?

See Jean Meeks on “Developing Clear Aim Statements” at http://positive-eye.com/2008/12/developing-clear-aim-statements/

QUESTION #2: Name at least 1 component (What, When, How much, For Whom, Why) that is missing from each of the following first draft AIM statements.A. Within the next 12 months we will increase

our first dose HPV vaccination rates by 50%.B. We will strive to achieve 100% HPV

vaccination of all adolescent patients in our clinic.

C. Between January 1 - June 30, 2014 we will improve HPV vaccination coverage among our patients (both males and females) who are 11 or 12 years of age as of January 1, 2014.

QUESTION #2: Name at least 1 component (What, When, How much, For Whom, Why) that is missing from each of the following first draft AIM statements.A. Within the next 12 months we will increase our

first dose HPV vaccination rates by 50%.Missing: For whom?

B. We will strive to achieve 100% HPV vaccination of all adolescent patients in our clinic.

Missing: When? C. Between January 1 - June 30, 2014 we will

improve HPV vaccination coverage among our patients (both males and females) who are 11 or 12 years of age as of January 1, 2014.

Missing: How much?

A Sample AIM Statement for HPV Vaccination

 

From http://tipqc.org/qi/jit/methods/developing-an-aim-statement/

Not so high that it paralyzes people because they know they can’t succeed

But it shouldn’t be so low that it just barely exceeds the status quo

“The measure of goodness is as much improvement as you can possibly accomplish.”

How high should we set our goals?

3.Complete a charter for

the project committee

 

What is in a project charter?

AIM Statement (includes goal and timeline)

Members and their responsibilities

Meetings--Timing (e.g., every Tuesday 12:00-12:50,

expectation to start & end on time)--Who will take notes, document

decisions?

(see template based on http://quality.wisc.edu/project-management-charter.htm)

Why use a project charter?

Defines the project and organizes critical pieces of info about a project in one place

Emphasizes approval by leadershipBuilds understanding, consensus,

and clarityIs a living document that evolves

using a structured approach

4. Build a driver

diagram  

Driver DiagramThe system can be described

through a graph called a driver diagram.

Purpose: to show the factors that cause an outcome

The outcome we are interested in is our Aim, so let’s start there.

Desired Outcome (Aim)

Desired Outcome Primary Drivers (Aim)

Desired Outcome Primary Drivers 2ndary Drivers(Aim)

Desired Outcome Primary Drivers Interventions(Aim)

Desired Outcome Primary Drivers Interventions(Aim)

QUESTION #3: Match the term on the left with the phrase on the right.

Aim statement

Project charter

Driver diagram

Graphic display of a system with the outcome of interest and the major influences on the outcome

An AIM Statement, the team’s members and their responsibilities, expectations for the meetings

A careful description of a desired outcome with respect to its importance, the desired measurable goal(s), the timeline, the target population

QUESTION #3 (Answer)A. Driver diagram – Graphic display of a

system with the outcome of interest and the major influences on the outcome

B. Project charter – An AIM Statement, the team’s members and their responsibilities, expectations for the meetings

C. Aim statement – A careful description of a desired outcome with respect to its importance, the desired measurable goal(s), the timeline, the target population

SummaryQI teams should include 5-6 people familiar with

different parts of the problem plus an executive sponsor.

An Aim Statement should explicate the measurable goal, the timeline, the numeric improvement you plan to achieve, the target population and why the issue is important.

Your team charter should include the AIM Statement, team members and their responsibilities, and details of meetings such as timing and note taking.

A driver diagram depicts the problem, the primary drivers, possibly the secondary drivers, and potential interventions to address the drivers.

The End of Module #3of Module #3

IHI. Science of Improvement: How to Improvehttp://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx