QUALITY IMPORVEMENT

Quality Improvement Mohamed Hany Kamel, MRCGP, MHPE MD, TQMD, DHHM

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What is Quality?

Satisfying customer needs, product features

Freedom from deficiency, lowest possible cost

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What is Quality improvement?

It is the use of captured metrics, and lessons learnt to continually improve quality

Juran trilogy diagram

Why has it happened?

The changing business conditions urges the need for adopting new trends of quality

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The Dual nature of medical quality (perceptions!)

Content quality

clinical expertise and technical aspects of healthcare (diagnosis, carrying out procedures)

Most patients assume that providers possess and deliver technical quality

Delivery/service quality

interpersonal components of care (e.g., empathy and communication) and to how well the patients’ requirements and expectations are being met (e.g., access, timely billing)

Where to start to improve quality?

A global role

85% faults in the managementcontrolled systems and processes

15% due to faults related to individuals

Failure to provide quality

Self-control

Principles of developing MWL 1- focus on health outcomes: Measurable improvements, focusing on real challenges 2- practice leadership at all levels 3- you can learn to lead: facing challenges, receiving support and feedback 4- Leadership is learned overtime 5- Sustain progress through management systems: integrate into the routine system

Think of something that you have accomplished in your life that you are proud of, something that was a challenge for you and for which you had to overcome big obstacles.

Do you notice how in each case there was a shift from seeing something as a problem (for someone else to solve), to taking it up as a personal challenge?

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A problem is “out there” and often blamed on external forces.

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A challenge is something you own and take on.

From vision to action 1- With your team review mission & strategic objectives 2- Create a shared vision that inspire team to face a new challenge 3- Agree on one measurable result that will move you closer to one aspect of vision 4- Assess current situation (scanning) 5- Identify obstacles & Select priority actions 7- Develop an action plan and implement

Mission and Vision

Personal mission    

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Each of us brings a contribution.

We know that when we are present, something unique is brought to the situation.

For example, some people bring humor, others bring order, and some bring clarity.

Think for a minute about a time when you felt you were really contributing. What did you bring to the situation?

Take a minute and write that down. Next, use what you wrote to figure out a mission for yourself in the workplace

Personal mission   

Why is it important to have a mission?

Does it give you clarity about what to do and where to spend your energy?

Being clear about your purpose helps you to focus.

Why does an organization need a mission? ď ˝

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Only when health workers are aware of the organizational mission, or ultimate purpose, will they fully understand the meaning and the value of their efforts.

Most organizations already have a mission statement, but these statements are often neglected or taken for granted by the staff

Constructing the mission statement 1. ď ˝

What do we do? define the needs of the populations to be served and specify which of those needs the organization intends to address.

2. Whom do we serve? ď ˝

define the target population.

Constructing the mission statement 3. How do we do it? 

the means, resources, or strategies by which the organization intends to reach its goals.

4. Why do we do it? 

the basic reasons behind the organization’s decision to do what it does.

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A well-framed mission will guide your organization’s work over the long term and inspire your staff.

The team will want to take the time to refine the language, asking for the opinions of staff who know the organization well.

Then you can finalize and disseminate the mission statement to staff and board members, those who are served by the organization, and the general public.

Mission statements    

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Does it clearly state what you do? (What business you are in ) Does it clearly state who you serve?

Does it describe your setting?

Is it broad enough so that all staff in the organization can see how they contribute?

Will it make sense to average citizen if they see it on the wall?

Will you be impressed if you see it on the front page of the newspaper?

Mission Vs. vision •A mission

states why something exists. •A vision is a picture of a desired future. It describes where the group or the organization wants to be in the future. It includes an image that you can see in your mind

PERSONAL VISION   

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Humans have a wonderful ability to create things in our minds, to dream, and to imagine the future.

Unfortunately, people can misuse this capacity by imagining the worst possible outcomes.

Most good outcomes in the world were first imagined by someone.

In order to play a role in creating the future, you must first imagine what you want to happen.

A vision is a picture we create in our mind of a desirable future toward which we can begin to act.

Exercise  

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Relax and think about yourself two years from now.

Imagine what you most want. Nothing will get in your way or stop you. If anything were possible, what would you really want to see?

You can close your eyes if it helps you to visualize.

Reflection

Organizational Vision

Where are we going? ď ˝

It is the moment to dream, to decide what your organization wants to be in the future and how it wants to be viewed by the outside world.

Vision ď ˝

It is a powerful picture of a desired state that provides a broad perspective and inspiration to keep working, overcome obstacles, and struggle to achieve results.

What experts say about vision ■ Burt Nanus (1986) says, “the vision is a realistic, believable, and attractive future for your organization…. such a motivating idea that it promotes the necessary skills, talents, and resources to make it happen and points out the way we intend to follow.”

■ For Jay Conger (2000), the vision is a mental image that represents a desirable future state, ideal, or dream with a vast scope.

It should be 

Tangible and descriptive 

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Compelling and inspiring 

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an image of the future that people can easily visualize. a powerful call to action.

Challenging enough to demand the best efforts of everyone in the organization Achievable so that people will work toward it.

Constructing the statement Step 1. Keep the big picture in mind. 

Refer to your organization’s mission and the population you are supposed to serve so that the vision aligns with the mission.

Step 2. Answer the following questions:   

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What will our organization look like in three to five years?

What aspects of the mission will we have achieved and in what areas will we excel?

What will make us most proud? (e.g., the health status of our beneficiaries, the quality of our services, the commitment and creativity of our staff, the financial stability of our organization).

What values do we uphold, and how will they be reflected in our services and the way we run our organization?

Write down the answers to each of these questions and come to a consensus within your team.

Constructing the statement Step 3. Look at your organization through the eyes of your target population, beneficiaries, donors, partners, collaborators, competitors, and society in general. For each of these groups, ask:   

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How do we want these groups to see our organization in three to five years?

What will they say about our services?

What will they say about our staff?

What will they say about our reputation in their communities?

Write down the answers to these questions and come to a consensus within your team.

Step 4. Translate these ideas into a few sentences that describe the desired future in a concrete manner,  Visions are often stated in the present tense

Review the shared vision and pick one aspect it to put into action.

What would be a compelling, measurable result that would indicate you are moving in the direction of the shared vision?

Lets try to make it SMARTer

SMART Specific — clearly written and understood

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Is it an absolute challenge? ◦

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we will totally solve the problem - such as immunizing all children in our area

or is it a relative challenge? ◦

we will make some improvement towards solving the problem such as holding special immunization days through which we can reach 60% of all children in our area

The desired result needs to be specific enough so that it can be measured by a frequency, a percent or a number.

Measurable — we can monitor progress towards results ď ˝

What are the indicators to monitor progress and evaluate results?

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What are the data sources needed to measure your indicators?

The desired performance must be framed in terms that are measurable

Appropriate — to the scope of your program or work activities Can your team affect the results given your level in the organization?  Are there actions your team can take to meet your selected challenge?  Do these actions contribute to the health outcomes you want to impact?  Are there any conflicting needs or interests in your organization that may affect your results?

The desired result must be appropriate to the goals of your team and to the mission of your organization 

Realistic — achievable and within your control

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Ask your manager and other key stakeholders if this challenge is something that your team can and should be working on.

Can the action plan be carried out with the resource available to the project?

You can realistically achieve the desired results in the time you have planned.

Time bound — with a specific time period for completion ď ˝ ď ˝

Can you achieve the results in the time you have planned?

If the result will take more time than you have planned, you may consider selecting another challenge.

There is a specific time period for achieving the desired results.

What do you have to scan in order to better understand the current situation as it relates to the result you want to achieve?  

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People’s health care needs Service statistics Goals of your organization National priorities Resource usage and needs Your team members’ strengths, needs, and concerns

Select one of the desired measurable results that a team formulated Why aren’t you already there?  What is blocking the way to this result?  Select obstacles for this exercise that are in your control, not outside your control  Write them down to your challenge model 

Priority matrix ď ˝

Now that you have identified your mission, vision, measurable result, current situation, and obstacles together with their root causes, you can define your challenge and add it to your Challenge Model.

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Then you can define actions to address your challenge.

write a challenge statement.

Begin each challenge statement with

“How will we achieve X result…in the face of Y obstacles…?”

- In your teams brainstorm actions for each of the root causes that you identified.

- We cannot possibly do everything.

- What are the criteria that we are going to use to prioritize our decisions?

Example

Priority actions

Criteria Train counselors

Conduct community education seminars

Renovate clinics

Time to implement (1 = the most time) (3 = the least time)

2

2

1

Cost to implement (1 = the most cost) (3 = the least cost)

2

3

1

3

2

2

Capacity to implement (1 = the least available) (3 = the most available)

1

3

1

Totals

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10

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(Rate from 1 to 3)

Potential for improving quality in the long term (1 = the least potential) (3 = the most potential)

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With your team use the priority matrix to choose the best actions

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Finish your challenge model now and share the selected actions with the group