1. Steps in QI

► Step 1: Identifying a problem, forming a team and
    writing an aim statement
► Step 2: Analyzing the problem and measuring quality
    of care
► Step 3: Developing and testing changes
► Step 4: Sustaining improvement

2. Step 2 Learning objectives

► Tools for understanding processes and systems of
    healthcare and how to use them
► How these tools can help identify possible
    solutions to reach your aim
► How to choose indicators for process and outcome
► How to use indicators to track progress
    and improvement

3. Quality Improvement

“Business of Management” in Medicine

Every System is perfectly designed to achieve exactly the results it gets

4. People not understanding the concept of a system

An example

5. Seven Quality Tools

► Cause and Effect Diagrams
► Flow Charts
► Checksheets
► Histograms
► Pareto Charts
► Control Charts
► Scatter Diagrams

6. Step 2: Analyzing and measuring quality of care Cause & effect

► Why might a problem be happening?

► Get to the root cause of the quality issue (4P’s)
      ♦ People
      ♦ Places
      ♦ Procedures (practices)
      ♦ Policies
      ♦ anything else

7. Henry Ford

There are no big problems, there are just a lot of little problems.

8. Fishbone

► Get to the root cause of the quality issue(4P’s)

9. Establishing Skin to Skin Contact after delivery

10. Whys

► Curiosity killed the cat?
► You could be a child again !

When the “Why s” give you the “What” (..needs to be done?)

11. Tree Diagram-Graphic display of the 5 whys

12. Five whys

► Mothers are not breastfeeding – Why?

► They feel uncomfortable taking their gown off – Why?

► The gown opens at back, so they have to take entire gown
    off to breast feed, so they feel exposed. Why? they have
     this type gown?

► That is what store keeper orders. Why? doesn’t the store
    keeper order better gowns appropriate for breast feeding?

► Because no one has requested him to do that

13. Pareto charts

80% of the problem is due to 20% of causes

14. Pareto Charts

15. When to Use a Pareto Chart?

► When there are numerous causes to a problem

► When you want to analyze the frequency of the causes
    behind a problem

► When you want to categorize the problems having
    a potential to contribute to improving the problem you
    are addressing

16. Medication Error

17. Process flow chart

► How to develop a process flow chart

► Decide the beginning and end points of the process
    to be flow charted
► Identify the steps of the process as these are
    practiced at present
► Link the steps with arrows showing direction
► Review the chart to see whether the steps are in
    their logical order to achieve the end point efficiently:
    Is the order wrong, are some steps unnecessary?

18. How to create a process Flow chart

► One flow line out of step
► Two flow lines out of steps that lead to different options
► One flow line out of cloud steps that are not clear

19. Flow chart

20. Key tips

► Analysis helps to find out the root cause of problems
    Try to find few barriers that account for most of the problem
    Help the teams think about how re-organization can help
    with fixing the problem

Video on Pareto chart