O uality & 42 QUALITY & SAFETY
A column by Maureen Flynn
Safety
Introduction to the quality improvement toolkit
This month’s column focuses on meth- ods for quality improvement (QI). The Framework for Improving Quality 1 guides thinking, planning and delivery of QI in the Irish health service. One of the six drivers is ‘Use of Improvement Methods’. A new online resource is now available to assist anyone using improvement methods in undertaking a QI project. It applies tried and tested improvement methods to the The HSE National QI Team developed the QI toolkit as a resource to support people working on QI projects using the Model for Improvement method. 2 The model tries to balance the desire and reward from taking immediate action with the wisdom of care- ful study. The model itself has two parts. The first has three questions: • What are we trying to accomplish? • What changes can we make that will result in improvement? • How will we know that a change is an improvement? The second part is a cycle for learning and improvement called the Plan Do Study Act Cycle. These two components together comprise a simple but powerful framework and roadmap for accomplishing processes, successful outcomes and system improve- ment. The tools and templates are designed to help develop a consistency in approach and a common understanding of improve- ment as you work together. Using the toolkit You can use resources at the frontline, management, board or national level. There are some tools that you will find helpful for all QI projects and some tools may be more applicable to your project than others. A project map shares the four phases of the project starting out with a ‘light bulb’ moment right through to the sustainability plan ( seeTable ). This is where you are embedding the improvements you have achieved. The project lead is the person with ownership for the delivery of process of improving quality. Quality Improvement Toolkit
Table: Using the QI toolkit
Phase
Steps of the QI process
QI tools & resources
• Identify an improvement opportunity • Discuss with manager • Formulate improvement aim and objectives • Discuss with stakeholders and form an improvement team and develop a QI Charter • Analyse the system to be improved mapping the pathway. Map the new pathway demonstrating improvement • Generate change ideas • Develop a measurement plan
Tool 1. Project on a page Tool 2. Stakeholder map Tool 3. Aim statement and driver diagram
Phase 1: Light bulb Idea
Phase 2: Planning
Tool 4. Project charter Tool 5.Communications plan and actions Tool 6.Effective team meetings Tool 7.Process mapping Tool 8.Cause and effect fishbone diagram Tool 9. Five Whys - finding the root cause Tool 10. Measurement plan
• Implement PDSAs, test and monitor changes • Log and act on issues and progress report • Avail of coaching
Phase 3: Making it happen
Tool 11. Run chart Tool 12. Plan, do, study, act (PDSA) cycle
Tool 13. Progress story board Tool 14. Coaching template
• Document QI effort and communicate results and lessons learned with all stakeholders • Capturing the patient and staff perspective
Phase 4: Sustain and spread
Tool 15. After action review (AAR) Tool 16. Project checklist
Relevant to all
Tool 0. Capturing the patient and staff voice
the project. It may be led by one individual or the project lead could have a teamwork- ing on the project. Once you get approval to proceed with the project you may wish to identify a project sponsor (advocate of a project). For smaller projects, the sponsor can be your line manager/depart- ment head. For larger projects it may be a programme manager or a member of hos- pital or community healthcare organisation You may have an idea for a change that you would like to work on. At your next team, ward or clinic meeting you might like to talk about this. The toolkit could be used as a starter kit to guide you through the process of your local improvement project. Your line manager or sponsor may help in getting started and with communicating executive or management team. Opportunity to get involved
the progress of the project with key stake- holders and senior management Accessing the QI toolkit The tools and templates are avail- able to download from the website: www.qualityimprovement.ie. Maureen Flynn is the director of nursingONMSD, QI Connections Lead, HSE National Quality ImprovementTeam Acknowledgements The toolkit was developed and tested during a whole hospital QI initiative with staff of the National Rehabil- itation Hospital (NRH).We would like to acknowledge and thank members of the NRH QI Committee and the NRH Community of improvers for generously sharing learning and making the toolkit available for others to use.Particular thanks to Roisin Breen,Siobhan Reynolds and members of the National QI Team for assistance in preparing this column. References 1.HSE (2016),Framework for Improving Quality in our health service.Dublin: HSE Quality Improvement Division 2. Langley G,Moen R,Nolan K et al.(2009) The Improvement Guide: a practical approach to enhancing organisational performance.San Francisco: Jossy-Bass
The National Quality Improvement (QI) Team, led by Dr Philip Crowley, supports services to lead sustain- able improvements for safer better health care. We partner with staff and people who use our health and social care services to champion, enable and demonstrate QI achieving measurably better and safer care. Read more at: www.qualityimprovement.ie or link with us on Twitter: @NationalQI
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