Continuous Quality Improvement

Continue Continue Continue Continue Continue Continue Continue Continue Light-Bg2.jpg Continue Continue Continue Continue Continue Continue CQI Continuous Quality Improvement (CQI) online training Welcome to Continuous Quality Improvement online training. Select each of the numbers below to review the course objectives. 3 3 3 3 2 2 1 1 1 1 Welcome option 2 Welcome to Continuous Quality Improvement online training. All imaging departments are expected to establish and maintain effective quality, safety, and performance improvement programs. This can be accomplished by using a structured, continuous quality improvement process. This is also called CQI. This course will introduce you to the specific CQI steps and tools needed to run a successful improvement project. Select each of the numbers below to review the course objectives. Objective 1: describe information gathering tools used for initiating a quality improvement project, Objective 2: list the sequential steps for implementing a quality improvement project, Objective 3: discuss the applications of various tools that may be used to analyze quality metrics. Objective 3: Discuss the applications of various tools that may be used to analyze quality metrics. Objective 2: List the sequential steps for implementing a quality improvement project. Objective 1: Describe information gathering tools used for initiating a quality improvement project. Introduction Reveal additional content Reveal additional content Reveal additional content Reveal additional content Hover over the images to review content discussed. Introduction Quality improvement efforts can facilitate continuous improvement in safety, performance and outcomes in the radiology department. Many of these efforts are now mandated by regulatory organizations. Beyond these requirements, however, practicing safe, effective value added radiology is a common goal for most practices and radiology departments must continually strive to improve their performance to stay competitive in the rapidly changing health care environment. All members of a radiology department must become familiar with the basic tools and methodology of quality improvement to achieve this goal and must be actively involved in helping achieve it. In this course we define quality improvement and briefly describe its relevance to radiology practice. Discuss the essential ingredients of a quality improvement program and introduce the sequential steps that constitute the quality improvement process. Many of these efforts are now mandated by regulatory organizations. Practicing safe, effective value added radiology is a common goal for most practices. All members of a radiology department must become familiar with the basic tools and methodology of quality improvement. Quality improvement efforts can facilitate continuous improvement in the radiology department. Quality improvement in radiology Quality improvement - the science of process management Radiology focus: to improve the performance of and processes related to diagnostic and therapeutic procedures the selection of imaging and procedural services the quality and safety of healthcare delivered the effectiveness and management of all imaging services Quality improvement in radiology Quality improvement is the science of process management. Quality improvement is intended for use by individuals, healthcare teams, or healthcare systems to improve the care delivered to patients in radiology, the focus of quality improvement is to improve the performance of and processes related to diagnostic and therapeutic procedures. The selection of imaging and procedural services, the quality and safety of healthcare delivered and the effectiveness and management of all imaging services. Essential components of a comprehensive CQI program Untitled Slide Identifying Customers Just Culture and Safety Institutional Leadership & Support Essential Components More on essential components Leadership slide layer For CQI to be successful, your institution must have support from all levels of leadership, institutional leadership, and support. Send the message that all quality related efforts are valued and constitute a central component of the institutions mission. This important message is enhanced by tangible support, the provision of human resources and acknowledgment of efforts and successes. Just Culture slide layer In addition to institutional leadership and support, a successful CQI initiative requires a just culture. David Marks introduced the phrase just culture to describe an environment in which staff members feel comfortable disclosing errors, including their own, without fear of punitive actions. Whereas many traditional healthcare cultures hold individuals accountable for all eras, a just culture recognizes that individual practitioners are not accountable for system failings over which they have no control. A just culture recognizes that even competent professionals make mistakes, but does not tolerate disregard for risks to patients or misconduct. Such a culture should minimize fear among participants. And should identify and introduce proactive rather than reactive monitoring processes. Identifying customers A spectrum of imaging services stakeholders: Referring physicians and primary care providers Trainees Technologists Nurses Administrative staff Hospital board members and chief executive officers Insurance companies and other payment sources Federal regulatory organizations Funding agencies The public and press Patients’ family and friends Industry and corporations Academic institutions - medical school administration and imaging programs Important customer interaction points: Identify and talk with customers within and outside the organization Establish processes whereby customer feedback can be collected, analyzed, and effectively managed Involve customers in quality improvement efforts and to try to gauge their needs Respond to their feedback to show that their opinions are values Stakeholders should be included in your CQI team Just culture of quality & safety A Just Culture recognizes that individual practitioners are not accountable for system failings over which they have no control recognizes that even competent professionals make mistakes but does not tolerate disregard for risks to patients or misconduct should minimize fear among participants and should identify and introduce proactive, rather than reactive, monitoring processes Marx D. Patient Safety and the Just Culture. Obstet Gynecol Clin North Am. 2019 Jun;46(2):239-245. doi: 10.1016/j.ogc.2019.01.003. PMID: 31056126. David Marx J.D., CEO Institutional leadership & support All quality-related efforts are valued and constitute a central component of the institution's mission. Enhanced by: Tangible support Provision of human resources Acknowledgment of efforts and successes Standardize, Redeploy, and Disseminate Changes Reanalyze Processes and Repeat the Steps Implement, Test, and Evaluate the Solutions Generate and Prioritize Solutions Identify Contributing Causes Select Major Contributing Root Causes Collect and Analyze Data Identify and Define the Process or Problem General steps in the quality improvement process We've covered some essential elements of a successful CQI initiative. Now let's review the general steps in the CQI process. When a quality improvement project is being initiated, a series of related and sequential steps should be followed. These steps are readily applicable to the majority of processes that exist in the radiology department and are described in detail in the following sections. Quality improvement is a continuous process and repeat it. Data analysis and cycling through these steps is usually necessary. Identify and Define the Process or Problem CQI processes – Identify & Define the process or Problem S Strengths O Opportunities T Threats W Weaknesses Customer surveys SWOT analyses Process Bottlenecks Peer review & error reporting Monitoring of compliance Brainstorming sessions Safety & environment-of-care walkabouts Identify and Define the Process or Problem The first step in the Qi process is to identify and define the process or problem analysis of many of the routine processes that take place in the radiology department offers the best opportunities for intervention and improvement and should be a routine component of a quality improvement program. Some of the more commonly used information gathering tools are customer surveys, safety and environment of care, walkabouts, process bottlenecks, peer review and error reporting, monitoring of compliance, brainstorming sessions and strength, weakness, opportunity and threat or SWAT analysis. Customer surveys, including feedback from staff and referring providers, allow benchmarking with other practices and frequently highlights improvement opportunities. A simple review of the facts surrounding specific feedback from patients is likely to identify realistic opportunities for introducing change and for satisfying and keeping a customer. Customer surveys layer Customer surveys, including feedback from staff and referring providers, allow benchmarking with other practices and frequently highlights improvement opportunities. A simple review of the facts surrounding specific feedback from patients is likely to identify realistic opportunities for introducing change and for satisfying and keeping a customer. Process bottlenecks layer Process bottlenecks affecting areas such as scheduling, access to services, patient throughput, room turnover and report turnaround time offer opportunities for further analysis and improvement of service. Mapping the process using carefully constructed flow charts or process maps facilitates the identification, quantification and analysis of such bottlenecks. Flow charts depict the sequential steps in a process and can be expanded to include decision points, inputs and outputs, time stamps and measurements. Here is an example of a flow chart. This flow chart illustrates the steps that occur between patients scheduling and completion of an interventional procedure. The diagram was constructed to analyze possible bottlenecks in patient throughput. It can be expanded to include decision points, the location of feedback loops and stages at which individual tasks are required. Additional steps can be inserted if there are specific problems. For example, if there is a need to investigate procedure room delays, attention should be focused on the numerous delays that take place between the time the patient enters the procedure suite and the time that the actual procedure begins. An example would be the timeout procedure. It is noted that I in R stands for international normalized ratio and in PO stands for nil per OS. Nothing by mouth. Peer review layer Peer review and error reporting, can provide insight into potential areas for clinical and technical improvement..... A prompt,, and thorough root cause analysis, of errors and Sentinel events, helps identify latent and active predisposing contributing factors..... Monitoring compliance layer Monitoring of compliance, with the national Patient Safety Goals highlights deficiencies,. Best practices, and areas for targeting education and improvement.... Such monitoring can be achieved through direct observation and formalized chart reviews.... These goals are updated annually and frequently include newly introduced goals. Brainstorming layer brainstorming sessions. A classical idea germinating tool, that may be facilitated by the quality management team... Allow staff at all levels to have their voices heard and thus participate in the quality improvement process... These sessions permit ideas, opportunities,, and projects, to be identified and prioritized... Brainstorming is best suited to situations, in which a broad range of creative, and original options, is desired. SWOT layer SWOT analysis allow a department or organization to identify major, internal and external stressors as well as opportunities for improvement. Internal factors to consider include the strengths and weaknesses of a product or service. External factors include possible new opportunities and any threats, limitations or competition that may exist. Sample questions for SWOT analysis can be seen here. Allow a department or organization to identify major internal and external stressors as well as opportunities for improvement. Internal factors Strengths and weaknesses of a product or service External factors Possible new opportunities and any threats, limitations, or competition that may exist Information gathering tools – Brainstorming sessions S Strengths O Opportunities T Threats W Weaknesses SWOT analyses Allow staff at all levels to have their voices heard and thus participate in the quality improvement process Best suited to situations in which a broad range of creative and original options is desired. Information gathering tools – Brainstorming sessions Brainstorming sessions Can be achieved through direct observation and formalized chart reviews Updated annually and frequently include newly introduced goals. Monitoring of compliance Information gathering tools – Monitoring of compliance Peer review & error reporting Provides insight into potential areas for clinical and technical improvement. Information gathering tools – Peer review & error reporting Process Bottlenecks Affect areas such as: scheduling access to services patient throughput room turnover report turnaround time Mapping the process using carefully constructed flow charts, or process maps, facilitates the identification, quantification, and analysis of such bottlenecks. Flow charts depict the sequential steps in a process and can be expanded to included decision points, inputs and outputs, time stamps, and measurements. Information gathering tools – Process bottlenecks Information gathering tools – Safety & environment-of- care walkabouts Information gathering tools – Customer surveys Collect and Analyze Data Identify and Define the Process or Problem Identify and Define the Process or Problem CQI Processes – Collect and analyze data Collected data categories Processes Appropriateness of studies Waiting and access times Room, equipment, and report turnaround times Adherence to protocols and guidelines Outcomes Data from peer and chart review Success and complication rates Exposure dose Diagnostic yield of biopsy samples Patient-centered measures Access to care Scheduling CQI processes - Collect and analyze data We've covered some essential elements of a successful CQI initiative. Now let's review the general steps in the CQI process. When a quality improvement project is being initiated, a series of related and sequential steps should be followed. These steps are readily applicable to the majority of processes that exist in the radiology department and are described in detail in the following sections. Quality improvement is a continuous process and repeat it. Data analysis and cycling through these steps is usually necessary. Select each tab on the left to learn more about the data analysis tools used in the collect and analyze data step of the CQI process. Control charts Control charts Control charts Control charts Pareto Pareto Pareto Pareto Cause-and-effect Cause-and-effect Cause-and-effect Cause-and-effect Check sheets Check sheets Check sheets Check sheets CQI Processes – Collect and analyze data Data analysis tools Scatter Scatter Scatter Scatter Histograms Histograms Histograms Histograms Select each tab on the left to learn more about the data analysis tools used in the collect and analyze date step of the CQI process. Cause & effect layer Cause and effect diagrams, also known as fishbone diagrams, are used to identify causes that predispose to a particular effect or problem. The structure of the diagram facilitates identification of causes by category while also providing guidance for brainstorming sessions by allowing participants to focus on ideas related to specific categories. This calls an effect diagram was constructed to identify all factors contributing to over ordering of computed tomographic scans in an emergency department. In 1950, Kaurou Ishikawa visually depicted categories of causes contributing to a problem. His fishbone or Ishikawa diagram helps capture all categories of possible causes and has become a standard in root cause analysis and six Sigma programs, basically A cause and effect Diagram. It identifies and lists possible contributing causes by categories that branch off, like the bones of a fish. The categories, which typically include materials, methods, machines, measurement, environment and people, can be modified to match the problem being addressed. Parego layer Pareto diagrams or charts are bar graphs used to quantitate data from cause and effect diagrams. A Pareto diagram may depict frequency, cost or time data and is arranged with the highest value at the top and the lowest value at the bottom, so that the major factors contributing to a particular effect are visually displayed. This Pareto chart was created to help determine whether a group of emergency department physicians were making appropriate use of imaging services. This chart helped analyze the spectrum and frequency of various indications for imaging studies to try to identify two or three opportunities for reducing the number of possibly unhelpful studies. In this case, the top three factors were responsible for 80% of overutilization. Knowing this information allowed the site to focus on these areas and making improvements. check sheets Check sheets are generic structured forms for collecting and analyzing data. They are best used when data can be observed and collected repeatedly by the same person or at the same location or when data are collected from a production process. This check sheet was created to analyze the frequency and nature of disruptive telephone calls in a CT scan reading room. Note that most calls are made on Monday mornings, when the technologists need protocols for cases or Friday afternoons when physicians want study results before the weekend begins. These data are used to identify bottlenecks and opportunities for minimizing disturbances, thereby guiding the selection of processes for possible solutions. Control charts layer Control charts, also known as statistical process control, are used to study how a process changes over time. Data are plotted over time and with use of historical data. They average upper control and lower control limits are depicted on the chart. Current data or variations in the current process are then shown to be either a consistent or stable or within the defined control limits, or B unpredictable. Falling above or below the control limits. Regular analysis of these charts allows one to identify problems and correct them as they occur. Monitor the effects of implemented solutions and confirm that processes are stable. This statistical process control chart shows the percentage of pre operative chest radiographs read within 24 hours of being obtained on the Y axis plotted against time elapsed on the X axis. The Purple Line is the defined target of what percentage of chest radiographs should be read in 24 hours of being completed. You can see at the front end of the chart on the left the process is below the defined target. Lower control limit of 90% completed within 24 hours. The purple line after an educational intervention. The dotted red line is used to improve performance. The data are back in control and the control limit defines a target control level of 95%. This minimum acceptable percent was increased because that became the new standard after the education intervention. Histograms layer Histograms are useful for analyzing the output of and changes in a process as well As for comparing outputs from different processes, and even for visually communicating the effects of a process. Analysis of the shape and of the distribution allows for the ability to see if data is normally distributed. This dual access histogram shows the actual versus budgeted total number of CT scans performed in each month in a large academic radiology department. The purple bars are the actual and the blue bars are the budgeted. The variance between actual and budgeted examinations is shown as a red run line with metrics shown on the right. Note how data points are included on the bars. Scatter Scattergrams are used to identify relationships between paired numeric data by means of the plotting of variables on different axises. Scatter diagrams are best used in an attempt to either identify factors that predispose to a particular problem, or determine whether A cause is related to one or more effects. This scatter diagram illustrates data that were collected in response to a complaint from an emergency department that CT scans performed during the day, took longer to complete than those performed at night. The diagram shows the number of hours elapsed between ordering and completion of CT scans on the Y axis versus the time of day that the study was ordered. The X axis the data demonstrate that the vast majority of scans were completed in less than 1.5 hours, with the busiest times occurring between late afternoon and midnight. Using tools is important to collect and analyze data to define the problem. Once you've defined the problem, we move on to the third step in the CQI process, identifying contributing causes. Several tools are available for identifying and prioritizing causes, contributing to a process failure, error, or adverse event. Among these previously described are cause and effect charts. Used to identify relationships between paired numeric data by means of the plotting of variables on different axes Best used in an attempt to either identify factors that predispose to a particular problem, or determine whether a cause is related to one or more effects Scatter diagrams Used to plot the frequency distribution for each value in a set of data and are best used with numeric data Useful for analyzing the output of and changes in a process, as well as for comparing outputs from different processes and even for visually communicating the effects of a process Histograms Control charts Used to study how a process changes over time. Current data (variations in the current process) are shown to be: a. Consistent or stable (within the defined control limits) b. Unpredictable (falling above or below the control limits) Regular Analysis allows: Identification of problems and correct them as they occur Monitoring of the effects of implemented solutions Confirmation that processes are stable Check sheets Generic structured forms for collecting and analyzing data Best used when data can be observed and collected repeatedly by the same person, or location Pareto diagrams Used to quantitate data from cause-and-effect diagrams May depict frequency, cost, or time data and is arranged with the highest value at the top and the lowest value at the bottom Cause-and-effect diagrams Used to identify causes that predispose to a particular effect or problem. Kaurou Ishikawa Japanese Organizational Theorist Collect and Analyze Data Identify and Define the Process or Problem Identify and Define the Process or Problem CQI Processes – Identify contributing causes Root Cause Analysis (RCA) an iterative continuous process that can help identify and correct the major contributing cause to an effect or problem Should be performed systematically, with conclusions based on collected evidence Identify Contributing Causes CQI processes - Identify contributing causes Using tools is important to collect and analyze data to define the problem. Once you've defined the problem, we move on to the third step in the CQI process, identifying contributing causes. Several tools are available for identifying and prioritizing causes, contributing to a process failure, error, or adverse event. Among these previously described are cause and effect charts. Pareto charts and flow charts root cause analysis, or RCA is an iterative, continuous process that can help identify and correct the major contributing cause to an effect or problem. Our CA incorporates many different tools and approaches and should be performed systematically with conclusions based on collected evidence. The process and analysis must establish a sequence of events or timeline to clarify the relationships between contributing factors, the root cause and the defined problem. Illustrated here is 1 method of applying an RCA, the so-called 5 why's approach. This RCA was performed with the five wise approach to investigate human factors that may have contributed to a liver lesion being missed during interpretation of a CT scan. A series of iterative questions are posed to probe further into possible contributing factors. Ultimately, it was determined that the junior Radiology resident who selected the imaging protocol had not been adequately trained to understand the differences between contrast material, enhanced options for liver imaging. Identify Contributing Causes Select Major Contributing Root Causes Collect and Analyze Data CQI process - Select major contributing root causes Identify and Define the Process or Problem The application of fishbone diagrams to a Pareto chart can be very helpful in the radiology setting Pareto "80/20" principle - only 20% of contributing factors are responsible for 80% of effects CQI process - Select major contributing root causes The 4th step in the sikuli process is to select major contributing root causes. This is important because in the next step you'll develop solutions strategies for combating these contributing factors. Several of the aforementioned tools, low major contributing factors to be identified in the complex multifactorial process. It's important to identify the those areas in which improvement will have the greatest impact. We have found that the application of fishbone diagrams to a Pareto chart can be very helpful in the radiology setting. Contributing factors are first identified with the use of a fishbone approach in a brainstorming session. The data are then collected and deployed to the Pareto chart. Which graphically displays the relative importance of each contributing factor. The Pareto or 8020 principle is then applied, which states that only 20% of contributing factors are responsible for 80% of effects, and the chart is used to identify that 20%. This 20% represents the causes that likely contribute to the majority of effects. Generate and Prioritize Solutions CQI process – Generate & Prioritize Solutions Identify Contributing Causes Select Major Contributing Root Causes Collect and Analyze Data Identify and Define the Process or Problem Consideration must be given not only to minimizing the effect or impact that introducing such solutions has on a department and its personnel, but also to defining, achieving, and maintaining a so-called preferred or ideal state. It is important to seek input from all customers The importance of team building, morale, and celebration of successes must not be underestimated It may be beneficial to identify projects with goals that are simple to achieve ("low-hanging fruit") Selecting an optimal solution requires consideration of its potential effectiveness and achievability CQI initiative Goal - Gap Statement Data-driven Should be specific in terms of timeframe and expected change Know where you are currently, where you want to go and in what timeframe Example: We will decrease patient wait time from 30 minutes to 10 minutes within 6 months. Once we determine the root causes, we move to the next step of generating and prioritizing solutions in generating solutions to an identified problem, consideration must be given not only to minimizing the effect or impact that introducing such solutions has on the department and its personnel, but also to defining, achieving, and maintaining a so called preferred or ideal state. A brainstorming session may be required to define the preferred state in defining this state. It is important to seek input from all customers once the preferred state has been defined, a strategy must be mapped out for optimal achievement of the desired goals. The decision matrix tool is designed to evaluate and prioritize identified options in an effort to identify the major contributing factor at this stage of an improvement process, the importance of team building morale and celebration of successes must not be underestimated for purposes of team building and staff engagement, it may be beneficial to identify projects with goals that are simple to achieve. We often call these low hanging fruit once both the current and preferred states have been defined, attention can be focused on bridging the gap between the two. Selecting the best tools for making the appropriate decisions and deciding how best to prioritize and implement solutions. Selecting an optimal solution we're requires consideration of its potential effectiveness and achievability. Customers and suppliers must be included in making these decisions. Their buy in and support are essential because they will be affected by the change. During this phase, we normally write a goal for the CQI initiative. It's often called a gap statement and should be data driven. This should be specific in terms of timeframe and expected change. You must know where you are currently, where you want to go and in what timeframe. An example of a goal might be we will decrease patient wait time from 30 minutes to 10 minutes within six months. It's important to have this goal statement so you can measure the effectiveness of your solution. Implement, Test, and Evaluate the Solutions Generate and Prioritize Solutions Identify Contributing Causes Select Major Contributing Root Causes Collect and Analyze Data Identify and Define the Process or Problem CQI process - Implement, test, & evaluate the solutions Implement solutions locally on a trial basis. If the selected change is successful, it can be applied more widely, although always with careful and ongoing surveillance. First consider whether the implemented solution may result in unanticipated problems or have any potential adverse human impact. Develop a timeline, assign ownership, monitor and measure the consequences and impact, and consider contingencies in case not everything goes as expected. If the solution is not working: Was the plan for implementation properly executed? Was the selected solution the correct one? Was the initial problem attributed to the wrong cause? CQI process - Implement, test, and evaluate the solutions The next step is to implement, test and evaluate the solutions. It is often most helpful to implement solutions locally on a trial basis. If the selected change is successful, it can be applied more widely, although always with careful and ongoing surveillance, it is important to first consider whether the implemented solution may result in unanticipated problems or have any potential adverse human impact. Not all staff will accept the change, especially if it impacts their work without providing any obvious benefit for them. Sharing the practical benefits of an implemented solution can aid in achieving staff buy in which as mentioned earlier, is essential for achieving and maintaining success in planning to implement change, you should develop a timeline, assign ownership monitor and measure the consequences and impact and consider contingencies in case not everything goes as expected. This planning should consider what may go wrong. Potential obstacles and the worst case scenario, should everything backfire. Get the solution is not working. It's important to consider the following questions. Was the plan for implementation properly executed? Was the selected solution the correct one? Was the initial problem attributed to the wrong cause in such a setting, one should reanalyze the initial problem, including the method that was used to collect and analyze data. The solutions that were generated and the process of implementation. In addition, it's important to consider whether the educational plan was adequate and whether all staff were adequately informed, trained, and prepared for the change. Each of these domains offers possible reasons why an implemented improvement is not having the intended consequences. As with any continuous improvement process, it should not be assumed that the process is perfect and cannot be improved upon. Standardize, Redeploy, and Disseminate Changes Implement, Test, and Evaluate the Solutions Generate and Prioritize Solutions Identify Contributing Causes Select Major Contributing Root Causes Collect and Analyze Data Identify and Define the Process or Problem CQI process - Standardize, redeploy, and disseminate changes Once it has been determined that a locally implemented change is successful, the change can be disseminated throughout a department or organization. CQI process - Implement, test, and evaluate the solutions The next step is to implement, test and evaluate the solutions. It is often most helpful to implement solutions locally on a trial basis. If the selected change is successful, it can be applied more widely, although always with careful and ongoing surveillance, it is important to first consider whether the implemented solution may result in unanticipated problems or have any potential adverse human impact. Not all staff will accept the change, especially if it impacts their work without providing any obvious benefit for them. Sharing the practical benefits of an implemented solution can aid in achieving staff buy in which as mentioned earlier, is essential for achieving and maintaining success in planning to implement change, you should develop a timeline, assign ownership monitor and measure the consequences and impact and consider contingencies in case not everything goes as expected. This planning should consider what may go wrong. Potential obstacles and the worst case scenario, should everything backfire. Get the solution is not working. It's important to consider the following questions. Was the plan for implementation properly executed? Was the selected solution the correct one? Was the initial problem attributed to the wrong cause in such a setting, one should reanalyze the initial problem, including the method that was used to collect and analyze data. The solutions that were generated and the process of implementation. In addition, it's important to consider whether the educational plan was adequate and whether all staff were adequately informed, trained, and prepared for the change. Each of these domains offers possible reasons why an implemented improvement is not having the intended consequences. As with any continuous improvement process, it should not be assumed that the process is perfect and cannot be improved upon. Standardize, Redeploy, and Disseminate Changes Reanalyze Processes and Repeat the Steps Implement, Test, and Evaluate the Solutions Generate and Prioritize Solutions Identify Contributing Causes Select Major Contributing Root Causes Collect and Analyze Data Identify and Define the Process or Problem CQI Process - Reanalyze processes & repeat the steps CQI Process - Reanalyze processes & repeat the steps We've covered some essential elements of a successful CQI initiative. Now let's review the general steps in the CQI process. When a quality improvement project is being initiated, a series of related and sequential steps should be followed. These steps are readily applicable to the majority of processes that exist in the radiology department and are described in detail in the following sections. Quality improvement is a continuous process and repeat it. Data analysis and cycling through these steps is usually necessary. A good CQI initiative has no end. ? Sample CQI Project CQI reporting template CQI reporting template CQI reporting template Sample CQI report Sample CQI report Sample CQI report CQI report Steps 1-4 CQI report Steps 1-4 CQI report Steps 1-4 Sample CQI project - part one It's important to note that when you undertake a cqi project that you should document the actions and, if applicable, results of each step you've been given a blank sample CQI reporting template before we come to the end of this course. Let's review a completed CQI reporting template. This is a CQI report for a project that devaluated film repeat rate in section one, you can see that this was completed by the radiology department. The team title was film repeat rate. The opportunity for improvement was also documented. The opportunity was for the reduction of the repeat rate for radio graphic procedures. You'll also notice that they report the reason why this opportunity was chosen. It was chosen because the repeat rate of radio graphic procedures had climbed to 14%. In addition, patient wait times were longer than the department goal. This goal was that 75% of the patients weight less than 10 minutes for their exam from the scheduled time. There was an opportunity to reduce the repeat rate, which would reduce the time the patient had to wait for the procedure to be completed, patient dose reworked for the staff and cost for department. The second section lists the team leader and members. You should notice that this team does not only include a few technologists, the team leader included a representative from the many groups of stakeholders who are affected by or impact film repeat rate. There are technologists from all shifts, a supervisor, the radiology educator, the CQI technologist, and even the radiologist. The next 8 sections of the report are where you document your actions and results, if applicable, for each of the CQI steps, you should not skip any steps as they are all critical. Sample CQI project – Part two (steps 5-8) Sample CQI project - part two After determining that the major contributing factor to repeats, was positioning errors of the chest and spine images,,, they needed to do Step 5, generate and prioritize solutions.... They documented the following solutions: monitor departmental repeat rate, provide feedback on repeat rates to technologists on a biweekly basis.. Provide in service training on positioning for error prone examinations.... Review Protocol O to determine if there was a needed change... At this point in the CQI process,, it's important to create a data drive gap statement... This statement is essentially setting a goal that can be measured.... Their gap statement was, the film repeat rate for the month of June 2017 was 14.77%... The goal was to reduce the departmental repeat rate to 5% per month or less, by December 2017... It's important that your gap statement, have a set date and clear data driven goal to be measured... Now that they had their solutions, and gap statement, they completed #6,, implement test and evaluate the solutions... note that they created a CQI action plan implementation schedule... This has the action, responsible person, completion, deadline, monitoring system, and resources needed... It's important to document these parts, to be sure to effectively monitor, the implementation of the plan... They implemented this plan, and then moved to the test, and evaluate phase... They documented their results,, and stated after implementing the plan, data indicated a drop, in the repeat rate for the months of August through December 2017... The average monthly rate was reduced to 8.47%... The next step is to standardize, redeploy, and disseminate changes... This is where the successful solutions, become protocols or policy for the department... They noted that the following have become standard.. and the department, as a result of this process improvement, monthly department repeat rates are calculated, and shared with staff... Individual repeat rates are shared by weekly with staff in service... Training is ongoing, especially related to procedures where repeat rates are high... Technical orientation of new employees includes a checklist sheet, to verify proficiency, and high repeat procedures... The information was shared with other imaging departments in the system, and the 5% repeat rate standard is being employed for all who perform diagnostic imaging procedures... The final step in the CQI process is to reanalyze processes, and repeat the steps... You'll notice that the first word in CQI is continuous... This process must be continuous... We can't change the process once we determine positive outcomes, and then never reevaluate the process again... They note how they are going to reanalyze, and repeat the process... They state the 5% repeat rate was not achieved by the December deadline... Additional Positioning training was conducted, and from January through December 2018, the average departmental repeat rate was 4.97%... Over the months, the rate continued to drop to a one month low of 3%... It was determined that the normal variation will always occur, and to repeat rate goal of 5% would be appropriate... The rate will continue to be monitored, and if it exceeds the 5% goal for three months in a row,, the CQI process will begin again... Final thoughts Describe information-gathering tools used for initiating a quality improvement project List the sequential steps for implementing a quality improvement project Discuss the applications of various tools that may be used to analyze quality metrics In closing This course has given you the specific CQI steps, along with tools to assist you in running a successful improvement initiative. The goal of quality improvement is to do the right thing in a timely fashion for every patient, every time the basic framework and tools described in this course can empire the healthcare professional to continuously improve his or her practice environment. Quality improvement is not a passive process. Rather, it requires a careful, dedicated and continuously planned effort by a number of skilled and committed team members. This process can be sustained by offering rewards and celebrating successes, with all lessons learned disseminated throughout the department or organization. You should now be able to describe information gathering tools used for initiating a quality improvement project. List the sequential steps for implementing a quality improvement project. Discuss the applications of various tools that may be used to analyze quality metrics. Assessment Assessment Welcome to the assessment. For each question, select the button to the left of your answer, and then select Submit. You will have 3 attempts to take this assessment and to successfully pass this course, you must receive a score of 80% or higher. You will receive your score when you have completed the assessment. Note: If you close the learning activity at any time before you have finished the quiz, your answers will not be saved. Select Start to begin. Start Assessment Select the best answer. ? True Question 1 of 10 Quality improvement is the science of process management. False Multiple Choice Quality improvement is the science of process management. Select the best answer. ? Institutional leadership and support All of the above Question 2 of 10 _______ is an essential component of a comprehensive CQI program. Just culture of quality and safety Identifying customers Multiple Choice Select the best answer. ? True False Question 3 of 10 Customers should be included in your CQI team. Multiple Choice Customers should be included in your CQI team. Select the best answer. ? 5 8 Question 4 of 10 There are ___ steps in the general CQI Process. 6 7 Multiple Choice There are ___ steps in the general CQI Process. Select the best answer. ? Customer surveys Peer review and error reporting Process bottlenecks Question 5 of 10 ___________ allow(s) benchmarking with other practices and frequently highlights improvement opportunities. Monitoring of compliance Multiple Choice ___________ allow(s) benchmarking with other practices and frequently highlights improvement opportunities. Select the best answer. ? Pareto diagrams Check sheets Question 6 of 10 _______ depict(s) the sequential steps in a process. Fishbone diagrams Flow charts Multiple Choice _______ depict(s) the sequential steps in a process. Select the best answer. ? Transition Therapy Question 7 of 10 The “T” in SWOT analysis stands for: Teamwork Threats Multiple Choice The “T” in SWOT analysis stands for: Select all the answers that apply. Question 8 of 10 Which of the following are essential components of a comprehensive CQI program? Institutional leadership & support Just culture Identifying customers Revenue report generating Multiple Answer Select the correct designated area, then select Submit below. Question 9 of 10 In what part of the CQI reporting template, would a root cause analysis be done? Hotspot Identify and Define First step Collect and analyze data Second step Identify contributing causes Third step Select major contributing causes Fourth step Drag each response from the right column to its corresponding item in the left column. What is the correct order of the steps in the quality improvement process? Question 10 of 10 Matching Retry Assessment Results %Quiz1.ScorePercent%% %Quiz1.PassPercent%% Continue YOUR SCORE: PASSING SCORE: Results Slide You have exceeded your number of assessment attempts. Exit You did not pass the course. Select Retry to continue. Congratulations. You passed the course. Exit To access your Certificate of Completion, select the Certificates tab from the learning activity overview page. You can also access the certificate from your PEPconnect transcript. You have completed the Continuous quality improvement online training. Completion Question Bank 1 Continuous Quality Improvement CQI workbook 1 CQI 1.1 Welcome option 1.2 Introduction 1.3 Quality improvement in radiology 1.4 Essential components of a comprehensive CQI program 1.5 More on essential components 1.6 General steps in the quality improvement process 1.7 Identify and Define the Process or Problem 1.8 CQI processes - Collect and analyze data 1.9 CQI Processes – Collect and analyze data Data analysis tools 1.10 CQI processes - Identify contributing causes 1.11 CQI process - Select major contributing root causes 1.12 CQI process – Generate & Prioritize Solutions 1.13 CQI process - Implement, test, and evaluate the solutions 1.14 CQI process - Implement, test, and evaluate the solutions 1.15 CQI Process - Reanalyze processes & repeat the steps 1.16 Sample CQI project - part one 1.17 Sample CQI project - part two 1.18 In closing 2 Assessment 2.1 Assessment 2.13 Completion