Choosing a Quality Improvement Project
January 21, 2016
Key Agenda Points
• Some things to consider when choosing an area of
concern for improvement
• Narrowing the choice
• Brainstorm for an appropriate intervention
 Determine the cause
 Strategize for a fix
• Data and measurement
 Data driving the project
 Data suggesting intervention tweaks
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Things to Consider
• Relevance
 Which projects might align best with your
mission/vision/purpose/goals?
 Which best address your funder’s priorities (RW Part)?
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Things to Consider
• Think both locally and globally
 Response to NHAS and the HAB Performance
Measures
 Regional or statewide activities
 Local or city wide activities
 Agency level priorities
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Things to Consider
• Can you get buy-in/support from:
 Senior management
 Clinical providers
 CM and SW providers
 Data or QM staff
 Front desk and support staff
 Patients
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Things to Consider
• Resources
 Staff
• Who needs to participate, how many staff will be involved, and
which type?
 Time
• How much time will they need to set aside
 Energy
• Can we generate the spark and keep it lit?
 Dollars
• Will it cost anything? If so, are funds available?
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Things to Consider
• Skill Sets Available?
 Is training needed?
• Is there someone to provide it
 Is there in-house expertise?
 Do you need to rely on external
partners?
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Things to Consider
• Data Availability
 Can you establish a firm baseline
 Is your data as clean and comprehensive as you
can get it?
 Can you collect ongoing data
• Are data generated on site?
• Do you need to rely on outside partners for your data?
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Things to Consider
• Feasibility
 How possible will it be to experience success?
 Consider all that you have in place and all that you
need to acquire. Can you get what you need?
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Things to Consider
• Patient Impact – Weigh:
 How many patients will be impacted/experience
benefit?
• Would this QIP involve the whole clinic, a major
subpopulation or a small number of patients?
 What will the patient impact be?
• A health outcome?
• An increase in screens or tests?
• Better adherence to appts or meds?
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Try a Simple Priority Matrix
Potential
Projects
How
important
is it?
VLS
Retention
Perinatal
trans.
Dental
These can be scored via scale.
“10” is the most positive response,
“1” is the least positive response.
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Do you
have the
data?
What is the
Can you
Is it
potential influence it? reasonably
impact?
achievable?
Sample Exercise (There is NO right answer!)
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Sample Exercise (There still is NO right answer!)
Poll
Annual Paps
Annual Syphilis Screen
TB Screen
HCV Screen
Dental Visit
Pregnant Women on ART
VL Suppressed (under 200)
Four 6-month visits in 2 years
2 VL tests 3 months apart
AIDS patients on HAART
PCP Prophylaxis
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Sample Exercise (There still is NO right answer!)
Below are just a few additional data pieces collected from your database. Does any of this
new information change how you would prioritize your selections?
• 70% of the women without a Pap are all from the same culture. (You have heard these
women mention their same misgivings about seeking Gyn care)
• The positivity rate for those who were screened for Syphilis was 18%......if you are sharing
Syphilis, you may also be sharing HIV.
• 50% of the patients without a dental screen are 18 years of age or less.
• All 5 of the pregnant women not on ART also have mental health and substance abuse
problems.
• Your clinic has 4 providers (or as the grantee, you have 4 subcontractors). 70% of the
virally unsuppressed are from one provider.
• The VL screening rate history in your clinic is as follows:
2010 - 97%, 2011 - 95%, 2012 - 92%, 2013 - 90%
Are there OTHER questions you want to ask of your database?
Anything else you want to know?
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Next Steps
You have just selected an area of concern that
lends itself to improvement activities. Next:
• Strategize to develop an intervention (we have lots of
tools for this!)
• Measure and re-measure
• Refine intervention
• Measure again
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Intervention Development
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Choosing the Right Tool
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Some Commonalities of Strategizing
•
•
•
•
•
•
•
•
•
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Gathering a diverse group
Listening to all positions/aspects/opinions
Thinking about the cause of the problem
Backing up the “thoughts” with data
Mapping/writing/diagramming the options
Voting, heeding consensus
Small, incremental tests of change
Measuring and re-measuring
“Making a wise choice of many alternatives”
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Data and Measurement
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And I miss you too!!
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Data Measurement and Improvement
What’s the Connection?
• Separate what you think is happening from what is really
happening
• Establishing a baseline and allowing for periodic
monitoring
• Determining whether changes lead to improvements
• Comparing performance with others
• Linking performance data to quality improvement
activities
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How Do I Know on What to Focus?
Example
A clinic has had traditionally bad rates for Gyn exams for female patients.
When questioned at quarterly quality meetings, the staff said that patients did
not show up for referrals or would refuse the exam.
The new medical director had heard this reason for 2 consecutive meetings
and decided to investigate further.
The next slide illustrates the findings.
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What action
steps
should you
take once
data are
collected?
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Review
The prior slide illustrated 2 things:
• The importance of defining the problem by
studious inquiry
• The value in the graphical display of data
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Summary of Using Data to Guide your
Improvement Work
Look at the data
Decide how to act
on the data
Begin
improvement work
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• Doing well, or not?
• Performance stable, or a trend?
• Compared to other grantees?
• Which areas need improvement?
• What are our priorities for
improvement?
• Identify project team
• Define improvement goal
Common Pitfalls
• Picking projects that are too easy or too hard.
• Picking projects that grantors care about but staff and clients
don’t.
• Not using your data to drive the quality improvement project
(QIP).
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Common Pitfalls
• Picking projects that don’t align with the larger home
institution’s quality priorities.
• Thinking that you need to address your entire
population; you can target:
•
•
•
•
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a specific age group
a certain race, ethnicity or culture
a gender
other appropriate subpopulation as identified by your
data!
Final Message!
Target your efforts, time,
and resources effectively so
that you are not taking
stabs in the dark, but rather
aiming towards the
intervention that will be
most fruitful in a measure
that will have great patient
impact. Remember to let
data be your guide!
Good luck!
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Questions?
Nanette Brey-Magnani
[email protected]
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Link to recording
To access the recording of the webinar, please go to:
https://meetny.webex.com/meetny/lsr.php?RCID=6435cbac0
08b420596de91b09a559792
To download the slides
http://www.nationalqualitycenter.org/resources/choosing-aquality-improvement-project-2016/
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