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  • Science of Improvement: Forming the Team
    and the strategic aims of the organization provide resources and overcome barriers on behalf of the team and provide accountability for the team members The Sponsor is not a day to day participant in team meetings and testing but should review the team s progress on a regular basis Example 1 Improving Care in Office Practices Aim We will improve care for all our patients with chronic disease by making improvements in our clinic that impact the six dimensions of quality as outlined in the Institute of Medicine report Crossing the Quality Chasm A New Health System for the 21st Century Team Technical Expert MD Physician at downtown clinic Day to Day Leader RN Manager of downtown primary care clinic Additional Team Members Patient educator medical assistant clerk scheduler laboratory manager quality expert Sponsor MD Medical Director for primary care practices Example 2 Improving Patient Safety Aim Reduce adverse drug events ADEs on all medical and surgical units by 75 percent within 11 months Team Clinical Leader MD Chair Pharmacy and Therapeutics Committee Patient Safety Officer Technical Expertise RPh Director Clinical Pharmacist Day to Day Leadership RN Manager Medical Surgical Nursing Additional Team Members Risk Manager Quality Improvement Specialist Staff Nurse Staff Education and Information Technology Sponsor MD Chief Medical Officer Example 3 Improving Critical Care Aim Redesign the leadership and care systems of our Medical Intensive Care Unit MICU in order to reduce harm and improve outcomes for patients Team Clinical Leader MD Medical Director Medical Intensive Care Unit MICU Technical Expertise MD Intensivist Day to Day Leadership RN MICU Manager Additional Team Members Respiratory Therapy Quality Improvement Specialist Staff Nurse Clinical Pharmacist Clinical Nurse Specialist Sponsor MD Chief Operating Officer Example 4 Improving Flow Aim Ensure that patients receive timely access to appropriate care in our hospital and move through the system efficiently Emergency Department Team Clinical Leader Medical Director or Physician Technical Expertise Director or Nurse Manager Day to Day Leadership Front line nurse Two continuity staff with a cross organizational view of flow e g Operations Engineer or vice president with management responsibilities across departments services who will be assigned to this work over time Intensive Care Unit Team Clinical Leader Intensivist or Medical Director Technical Expertise Director or Nurse Manager Day to Day Leadership Front line nurse Two continuity staff with a cross organizational view of flow e g Operations Engineer or vice president with management responsibilities across departments services who will be assigned to this work over time Operating Room Team Clinical Leader Surgeon or Anesthesiologist Technical Expertise Director or Manager of Surgical Services Day to Day Leadership Operating Room OR Nurse circulating or scrub nurse Surgery Technician One continuity staff with a cross organizational view of flow e g Operations Engineer or vice president with management responsibilities across departments services who will be assigned to this work over time Project Sponsor Chief Executive Officer Average Content Rating 2 users Your comments were submitted successfully Please enter a comment Please login to rate or

    Original URL path: http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementFormingtheTeam.aspx (2016-02-01)
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  • Science of Improvement: Setting Aims
    overuse of ineffective care and underuse of effective care Patient Centered Honor the individual and respect choice Timely Reduce waiting for both patients and those who give care Efficient Reduce waste Equitable Close racial and ethnic gaps in health status Many organizations use the six IOM aims to help them develop their aims See also Tips for Setting Aims Examples of Effective Aim Statements For Patient Safety Reduce adverse drug events ADEs in critical care by 75 percent within 1 year Improve medication reconciliation at transition points by 75 percent within 1 year Reduce high hazard ADEs by 75 percent within 1 year For example reduction of 75 percent in one of the following Overdoses from benzodiazepines and narcotics Percentage of patients with incidence of bleeding in patients being treated with anticoagulant medications Percentage of patients on insulin with any blood sugar 50 Increase the number of surgical cases between cases with a surgical site infection by 50 percent within 1 year Achieve 95 percent compliance with on time prophylactic antibiotic administration within 1 year For Clinic Access Reduce waiting time to see a urologist by 50 percent within 9 months Offer all patients same day access to their primary care physician within 9 months Reduce waiting time to see a physician to less than 15 minutes within 9 months For Flow all goals to be achieved within 9 months Transfer every patient from the Emergency Department to an inpatient bed within 1 hour of the decision to admit Transfer every patient from the Post Anesthesia Care Unit PACU to an inpatient bed within 1 hour from the time patient is deemed ready to move from the PACU Transfer every patient from the Intensive Care Unit ICU to an inpatient bed within 4 hours from the time the patient is deemed ready to move from the ICU Transfer every patient from the inpatient facility to a long term care facility within 24 hours after the patient is deemed ready to transfer For Critical Care Reduce ICU mortality by 20 percent within 9 months Reduce incidence of ventilator associated pneumonia by 25 percent Reduce average ventilator days by 2 to 4 days per discharge Reduce adverse drug events ADEs per ICU day by 75 percent or absolute number of less than 0 10 ADE per ICU day Reduce incidence of oversedation or too lengthy sedation by 40 percent Reduce complications of ICU stay by 40 percent Development of deep vein thrombosis Gastrointestinal bleeding from stress ulcers Line infections Reduce the average length of stay for Medical ICU patients by 50 percent within 9 months Average Content Rating 1 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments by RAMESH CHANDNA 12 8 2015 1 54 06 AM Very helpful loading Did you find this user comment useful people found this user comment useful Report This by Connie Bowler 11 2 2014 2 53 48 PM Very helpful loading Did

    Original URL path: http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementSettingAims.aspx (2016-02-01)
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  • Science of Improvement: Establishing Measures
    Care Unit ICU percent unadjusted mortality For medication systems Adverse drug events per 1 000 doses Process Measures Are the parts steps in the system performing as planned Are we on track in our efforts to improve the system For diabetes Percentage of patients whose hemoglobin A1c level was measured twice in the past year For access Average daily clinician hours available for appointments For critical care Percent of patients with intentional rounding completed on schedule Balancing Measures looking at a system from different directions dimensions Are changes designed to improve one part of the system causing new problems in other parts of the system For reducing time patients spend on a ventilator after surgery Make sure reintubation rates are not increasing For reducing patients length of stay in the hospital Make sure readmission rates are not increasing Sample Measures See the Measures section of the Knowledge Center for sample measures Using Sampling An Example Here is how one team used sampling in measuring the time for transfer from Emergency Department ED to inpatient bed Rapid movement from the Emergency Department ED after a decision to admit the patient is critical flow for entry to the entire system for emergent patient care It represents the ability of patients with various illnesses to get into the system through the most common admission route Sampling approach The measurement will consist of 6 weekly data collections of 25 patients each The patients can be sampled in several ways 5 patients per day for 5 days of the week The patients must be consecutive and at least one day must be a weekend day or 25 consecutive patients regardless of any specific day except that it must include some weekend admissions or If there are fewer than 25 admissions for a week the total admissions for the week should be included in the sample The time is measured from the decision to admit to the physical appearance of the patient into the inpatient room The destination cannot be a holding area but must be a real inpatient bed The sample collection should be done in real time so a data collection process needs to be worked out by members of the team to achieve this goal The collections must be done weekly and summarized as the percentage of patients in the sample that achieved the goal for that week Six weeks of data needs to be collected and six data points placed on a run chart Plotting Data Over Time Plotting data over time using a run chart is a simple and effective way to determine whether the changes you are making are leading to improvement Annotate the run chart to show the changes you made You can use the Improvement Tracker to automatically plot your data over time Example 1 Example 2 Average Content Rating 6 users Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments by Duke Rohe 1 24 2016

    Original URL path: http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementEstablishingMeasures.aspx (2016-02-01)
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  • Science of Improvement: Selecting Changes
    kinds of changes that will lead to improvement but these specific changes are developed from a limited number of change concepts A change concept is a general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement Creatively combining these change concepts with knowledge about specific subjects can help generate ideas for tests of change After generating ideas run Plan Do Study Act PDSA cycles to test a change or group of changes on a small scale to see if they result in improvement If they do expand the tests and gradually incorporate larger and larger samples until you are confident that the changes should be adopted more widely The change concepts included here were developed by Associates in Process Improvement See The Improvement Guide Langley GJ Nolan KM Nolan TW Norman CL Provost LP San Francisco Jossey Bass Publishers Inc 2009 for a list of hundreds of change concepts as well as examples of how they were applied in process improvement both inside and outside of health care Examples of Change Concepts For more detailed information on specific change concepts see Using Change Concepts for Improvement and the Changes section See also Testing Changes Implementing Changes Spreading Changes Eliminate Waste Look for ways of eliminating any activity or resource in the organization that does not add value to an external customer Improve Work Flow Improving the flow of work in processes is an important way to improve the quality of the goods and services produced by those processes Optimize Inventory Inventory of all types is a possible source of waste in organizations understanding where inventory is stored in a system is the first step in finding opportunities for improvement Change the Work Environment Changing the work environment itself can be a high leverage opportunity for making all other process changes more effective Producer Customer Interface To benefit from improvements in quality of products and services the customer must recognize and appreciate the improvements Manage Time An organization can gain a competitive advantage by reducing the time to develop new products waiting times for services lead times for orders and deliveries and cycle times for all functions in the organization Focus on Variation Reducing variation improves the predictability of outcomes and helps reduce the frequency of poor results Error Proofing Organizations can reduce errors by redesigning the system to make it less likely for people in the system to make errors One way to error proof a system is to make the information necessary to perform a task available in the external world and not just in one s memory by writing it down or by actually making it inherent in the product or process Focus on the Product or Service Although many organizations focus on ways to improve processes it is also important to address improvement of products and services Average Content Rating 2 users Your comments were submitted successfully Please enter a comment Please login to

    Original URL path: http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementSelectingChanges.aspx (2016-02-01)
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  • Science of Improvement: Testing Changes
    1 Plan Plan the test or observation including a plan for collecting data State the objective of the test Make predictions about what will happen and why Develop a plan to test the change Who What When Where What data need to be collected Step 2 Do Try out the test on a small scale Carry out the test Document problems and unexpected observations Begin analysis of the data Step 3 Study Set aside time to analyze the data and study the results Complete the analysis of the data Compare the data to your predictions Summarize and reflect on what was learned Step 4 Act Refine the change based on what was learned from the test Determine what modifications should be made Prepare a plan for the next test Example of a Test of Change Plan Do Study Act Cycle Depending on their aim teams choose promising changes and use Plan Do Study Act PDSA cycles to test a change quickly on a small scale see how it works and refine the change as necessary before implementing it on a broader scale The following example shows how a team started with a small scale test Diabetes Planned visits for blood sugar management Plan Ask one patient if he or she would like more information on how to manage his or her blood sugar Do Dr J asked his first patient with diabetes on Tuesday Study Patient was interested Dr J was pleased at the positive response Act Dr J will continue with the next five patients and set up a planned visit for those who say yes Average Content Rating 2 users Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments by Mary Ann Mecca Monahan 1 12 2016 11 26 33 AM sounds good loading Did you find this user comment useful people found this user comment useful Report This by sacha coodye 5 10 2015 5 52 24 AM Excellent tools simple to understand and follow to teach others and really satisfying to see when change and improvements have happened loading Did you find this user comment useful people found this user comment useful Report This by Olusola Ogbajie 12 12 2014 12 11 30 AM Helpful loading Did you find this user comment useful people found this user comment useful Report This by Nancy Shumway 1 9 2014 8 33 20 AM I don t understand why you use this PDSA All nurses have been trained in the Nursing Process and have used it for years loading Did you find this user comment useful people found this user comment useful Report This by Nejib Lanouar 6 14 2013 8 59 52 AM 5 loading Did you find this user comment useful people found this user comment useful Report This by Kelly Groth 11 7 2012 10 02 07 AM PDSA is an excellent tool for any organization to create a continuous cylcle of learning improvement loading

    Original URL path: http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspx (2016-02-01)
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  • Science of Improvement: Implementing Changes
    on a broader scale for example for an entire pilot population or on an entire unit Implementation is a permanent change to the way work is done and as such involves building the change into the organization It may affect documentation written policies hiring training compensation and aspects of the organization s infrastructure that are not heavily engaged in the testing phase Implementation also requires the use of the PDSA cycle See also Testing Changes Tips for Testing Changes Linking Tests of Change Testing Multiple Changes Implementing Changes Spreading Changes Example Testing a change Three nurses on different shifts use a new medication reconciliation and order form Implementing a change All 30 nurses on the pilot unit begin using the new medication reconciliation and order form Average Content Rating 2 users Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments by Abbas Ibrahim 1 3 2015 3 34 02 PM Its a sientific way of change i will use it in my health facility to give a better care to our patients loading Did you find this user comment useful people found this user comment useful Report This Show More Comments Loading You are about to report a violation of our Terms of Use All reports are strictly confidential Reason Select One Contains profanity or violence Spam Defamatory Illegal Unlawful Copyright Violation Other Please select a reason for this report Add a Note Your comments were submitted successfully There was an error reporting your complaint How to Improve Introduction Forming the Team Setting Aims Establishing Measures Selecting Changes Testing Changes Spreading Changes Featured Content first last A Framework for Spread From Local Improvements to System Wide Change A key factor in closing the gap between best practice and common

    Original URL path: http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementImplementingChanges.aspx (2016-02-01)
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  • Science of Improvement: Spreading Changes
    change Spread efforts will benefit from the use of the PDSA cycle Units adopting the change need to plan how best to adapt the change to their unit and to determine if the change resulted in the predicted improvement Example If all 30 nurses on a pilot unit successfully implement a new medication reconciliation and order form then spread would be replicating this change in all nursing units in the organization and assisting the units in adopting or adapting the change See also Testing Changes Tips for Testing Changes Linking Tests of Change Testing Multiple Changes Implementing Changes Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments by Kristine Dela Cruz 11 8 2015 4 25 00 PM It s good loading Did you find this user comment useful people found this user comment useful Report This Show More Comments Loading You are about to report a violation of our Terms of Use All reports are strictly confidential Reason Select One Contains profanity or violence Spam Defamatory Illegal Unlawful Copyright Violation Other Please select a reason for this report Add a Note Your comments were submitted successfully There was an error reporting your complaint How to Improve Introduction Forming the Team Setting Aims Establishing Measures Selecting Changes Testing Changes Implementing Changes Featured Content first last A Framework for Spread From Local Improvements to System Wide Change A key factor in closing the gap between best practice and common practice is the ability of health care providers and their organizations to rapidly spread innovations and new ideas Spread Planner The Spread Planner is a set of questions designed to assist organizations in identifying the key actions they can take to turn a local success into

    Original URL path: http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementSpreadingChanges.aspx (2016-02-01)
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  • The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd Edition)
    Customized Services Blogs and User Groups Home Resources Publications The Improvement Guide A Practical Approach to Enhancing Organizational Performance 2nd Edition Publications Resources Resources How to Improve Measures Changes Improvement Stories Tools Publications IHI White Papers Case Studies Audio and Video Presentations Posterboards Other Websites IHI LR Wide The Improvement Guide A Practical Approach to Enhancing Organizational Performance 2nd Edition Page Content Langley GL Moen R Nolan KM Nolan TW Norman CL Provost LP San Francisco California USA Jossey Bass Publishers 2009 The Model for Improvement an integrated approach to process improvement that delivers quick and substantial results in quality and productivity in diverse settings is explored This updated edition includes new information on accelerating improvement by spreading changes across multiple sites A practical tool kit of ideas and examples from diverse industries including health care and international improvement efforts are shared Order this book Average Content Rating 2 users Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments by Mohammad Draz 1 26 2016 2 57 44 AM add loading Did you find this user comment useful people found this user comment useful Report This by Alexia Green 10 13 2014 7 31 02 PM Great framework for Quality Improvement Sciences Great tool kit as well lots of how to info contained in this excellent text loading Did you find this user comment useful people found this user comment useful Report This by Gina Palmese 6 19 2012 3 39 06 PM Excellent session loading Did you find this user comment useful people found this user comment useful Report This Show More Comments Loading You are about to report a violation of our Terms of Use All reports are strictly confidential Reason Select One Contains profanity or violence

    Original URL path: http://www.ihi.org/resources/Pages/Publications/ImprovementGuidePracticalApproachEnhancingOrganizationalPerformance.aspx (2016-02-01)
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