Richard J. Banchs - The Quality Improvement Challenge

15 PART VII: ADDITIONAL THINGS YOU MAY NEED TO KNOW CHAPTER 24: How to Prepare and Conduct a Tollgate ReviewTHE TOLLGATE REVIEWS FOUR TOLLGATE REVIEWS OF A FIVE “R” PROJECT PHASE CHAPTER 25: How to Communicate Effectively to Engage the Front LineSTORIES FROM THE FRONT LINES OF HEALTHCARE: THE NICU TEAM AT ST. AGNES HOSPITAL THE IMPORTANCE OF COMMUNICATION WHY PROJECTS OFTEN FAIL PEOPLE’S BRAINS OFTEN CREATE BARRIERS TO EFFECTIVE COMMUNICATION WHAT SHOULD YOU DO TO COMMUNICATE EFFECTIVELY? TIPS FOR ONE‐ON‐ONE COMMUNICATION USE A COMMUNICATION PLANNER TO MAKE IT EASIER TIPS TO ANNOUNCING A DIFFICULT CHANGE REFERENCES CHAPTER 26: How to Lead an Effective Team MeetingSTORIES FROM THE FRONT LINES OF HEALTHCARE: BRANDON, THE AMBULATORY CLINIC MANAGER THE IMPORTANCE OF MEETINGS THE PROBLEM WITH MEETINGS ANATOMY OF A GREAT MEETING FIRST PHASE: BEFORE THE MEETING SECOND PHASE: DURING THE MEETING THIRD PHASE: AFTER THE MEETING A TEMPLATE FOR ALL YOUR MEETINGS: THE TEAM MEETING ORGANIZER TEAM MEETING GROUND RULES BRUCE TUCKMAN AND THE FOUR STAGES OF TEAM DEVELOPMENT UNDERSTANDING DIFFERENCES IN PEOPLE’S BEHAVIOR REFERENCES CHAPTER 27: How to Help Your QI Team Become a High‐Performing TeamTHE USUAL REASONS WHY WE LAUNCH A QI TEAM WHAT MAKES A TEAM, A TEAM? THE CHALLENGE FOR QI TEAMS IN HEALTHCARE FRAMEWORK FOR BUILDING A HIGH‐PERFORMING TEAM THE FIRST STEP TO HIGH PERFORMANCE THE TEAM “BUILDING BLOCKS” HIGH LEVERAGE BEHAVIORS OF HIGH‐PERFORMING TEAMS FOCUS ON THESE SIX DRIVERS TO ACHIEVE HIGH PERFORMANCE HOW TO IMPROVE TEAM COMMUNICATION WORKING WITH TEAM CONFLICT: THE KEYS TO MANAGING IT CONFLICT RESOLUTION AND THE THOMAS KILMANN INSTRUMENT REFERENCES CHAPTER 28: Steps and Strategies for Effective Decision‐MakingPROBLEM‐SOLVING VERSUS DECISION‐MAKING DECISIONS: TYPES & CONDITIONS SOURCES OF ERRORS AND BIASES IN PEOPLE’S DECISION‐MAKING PROCESS THE DECISION‐MAKING PROCESS FOUR WAYS QI TEAMS CAN MAKE DECISIONS IMPROVING THE EFFECTIVENESS OF A TEAM’S DECISION‐MAKING PROCESS REFERENCES CHAPTER 29: What Neurosciences Can Teach Us to Motivate People to ChangeSTORIES FROM THE FRONT LINES OF HEALTHCARE: “MAKE IT HAPPEN” THERE IS NO IMPROVEMENT WITHOUT CHANGE WE THINK OF CHANGE IN TERMS OF OUR OWN INTEREST THE TRADITIONAL APPROACH TO MAKING CHANGE HAPPEN TO UNDERSTAND CHANGE, WE NEED TO UNDERSTAND THE DRIVERS OF HUMAN BEHAVIOR TO UNDERSTAND CHANGE WE NEED TO UNDERSTAND THE DRIVERS OF SOCIAL BEHAVIOR CHANGE IS PSYCHOLOGICALLY PAINFUL BASIC PRINCIPLES FOR LEADING A SUCCESSFUL CHANGE INITIATIVE THE WINNING CHANGE STRATEGY FIRST, MAKE IT SAFE: REMOVE UNCERTAINTY SECOND, CREATE THE RIGHT CONDITIONS TO SAFEGUARD STATUS AND AUTONOMY THIRD, MAKE IT STICK AND INTERNALIZE THE CHANGE REFERENCES CHAPTER 30: How Does it All Fit Together? The MRI Suite at St. Mary’s HospitalSIMULATION BACKGROUND THE FIRST “R”: THE RIGHT PROJECT THE SECOND “R”: THE RIGHT PEOPLE THE THIRD “R”: THE RIGHT PROBLEM THE FOURTH “R”: THE RIGHT CAUSE THE FIFTH “R”: THE RIGHT SOLUTION

16 APPENDIX Appendix I: Common Improvement Tools and Techniques Appendix II: Glossary of Improvement Terms Additional ResourcesBOOKS ARTICLES WEBSITES

17 Index

18 End User License Agreement

1 Chapter 2 TABLE 2‐1 THE QI PROJECT STEPS CHECKLIST

2 Chapter 3 TABLE 3‐1 Template for a Project Selection Matrix

3 Chapter 6 TABLE 6‐1 Heart Medical Center Hospital Roster

4 Chapter 12TABLE 12‐1 Pros and Cons for Each Type of Data

5 Chapter 13TABLE 13‐1 A Data Collection Planner Makes Our Data Collection Process Effect...

6 Chapter 14TABLE 14‐1 Differences between research and quality improvement work.TABLE 14‐2 The Anscombe’s Quartet data set.TABLE 14‐3 The Anscombe’s Quartet summary statistics.TABLE 14‐4 Analysis of Variation: the bottom line.

7 Chapter 15TABLE 15‐1 The Run Chart Table for Interpretation of the Number of RunsTABLE 15‐2 OTR Times for STAT ABGs at Mercy HospitalTABLE 15‐3 Number of Narcotic Discrepancies at Chicago MedTABLE 15‐4 C‐section Rates at London Memorial

8 Chapter 16TABLE 16‐1 Door‐to‐Infusion Times for All Stroke Codes at Huron Medical Cente...TABLE 16‐2 Calculation of Moving Range for Door‐to‐Infusion Times at Huron Me...

9 Chapter 17TABLE 17‐1 Roadmap to Assess a Process’s PerformanceTABLE 17‐2 Process Sigma Level Conversion TableTABLE 17‐3 DVT Prophylaxis Process Sigma Levels

10 Chapter 18TABLE 18‐1 The Cause and Effect ContinuumTABLE 18‐2 The Cause and Effect Matrix

11 Chapter 20TABLE 20‐1 Paired Comparison AnalysisTABLE 20‐2 Paired Comparison Analysis ResultsTABLE 20‐3 A Pugh MatrixTABLE 20‐4 Solution Desirability Matrix Assessment CriteriaTABLE 20‐5 Solution Desirability Matrix Rank Results

12 Chapter 21TABLE 21‐1 The PDSA Cycle Template

13 Chapter 22TABLE 22‐1 The Aim of the 5S StepsTABLE 22‐2 5S Audit ChecklistTABLE 22‐3 Mistake‐Proofing Techniques

14 Chapter 23TABLE 23‐1 The Implementation Plan ChecklistTABLE 23‐2 The Impact Assessment ToolTABLE 23‐3 A Stakeholder Analysis TemplateTABLE 23‐4 Power & Influence Scores for Stakeholder Groups A to G

15 Chapter 24TABLE 24‐1 First Tollgate Review ChecklistTABLE 24‐2 Second Tollgate Review ChecklistTABLE 24‐3 THIRD TOLLGATE REVIEW CHECKLISTTABLE 24‐4 Fourth Tollgate Review Checklist

16 Chapter 25TABLE 25‐1 The Different Roles for CommunicationTABLE 25‐2 The Communication Planner

17 Chapter 26TABLE 26‐1 The QI Team Meeting Organizer Template

18 Chapter 27TABLE 27‐1 Characteristics of Teams versus Groups

19 Chapter 28TABLE 28‐1 Conditions under which We Make Decisions.

20 Chapter 30TABLE 30‐1 The QI Team Roster at St. Mary’s HospitalTABLE 30‐2 Quick Wins: Waste IdentificationTABLE 30‐3 The QI Project MetricsTABLE 30‐4 List of Ideas for ImprovementTABLE 30‐5 Summary of QI Project Results

1 Chapter 2 FIGURE 2‐1 The new quality paradigm. FIGURE 2‐2 The goal of improvement. FIGURE 2‐3 The five “Rs” of all successful QI projects. FIGURE 2‐4 The Project Roadmap.

2 Chapter 3 FIGURE 3‐1 Three main sources for project ideas. FIGURE 3‐2 Project selection steps. FIGURE 3‐3 Project types according to complexity and expected resistance.

3 Chapter 4 FIGURE 4‐1 The patient arrival‐to‐departure time at the PCP clinic.

4 Chapter 6 FIGURE 6‐1 The role of the QI team.

5 Chapter 7 FIGURE 7‐1 The SIPOC template. FIGURE 7‐2 SIPOC diagram for “prescription to medication delivery.” FIGURE 7‐3 A SIPOC diagram for “patient evaluation in the PEC clinic.”

6 Chapter 8 FIGURE 8‐1 The three types of customers in QI projects. FIGURE 8‐2 The outcome expected by the customer (VOC) is defined by attribut... FIGURE 8‐3 The CTQs are the specifications of the Voice of the Customer FIGURE 8‐4 The attributes and requirements for patient satisfaction (CTQs) a... FIGURE 8‐5 The attributes and requirements for staff and provider satisfacti...

7 Chapter 9FIGURE 9‐1 Critical Needs tree defining the requirements for optimal perform...

8 Chapter 10FIGURE 10‐1 Components of the system.FIGURE 10‐2 A process is a series of interrelated steps, actions, and decisi...FIGURE 10‐3 The Basic Process Flow map symbols.FIGURE 10‐4 Basic Process Flow map for “turnover time (TOT) in the OR.”FIGURE 10‐5 Swim Lane chart of “preoperative preparation.”FIGURE 10‐6 The three flows of a Value Stream map.FIGURE 10‐7 Current state Value Stream map for mammography at the Women’s Ce...FIGURE 10‐8 Common process metrics for the Value Stream map.

9 Chapter 11FIGURE 11‐1 TIM WOOD and the seven types of waste.FIGURE 11‐2 Spaghetti diagram: a mapping technique to identify waste.FIGURE 11‐3 Three types of process steps.FIGURE 11‐4 The opportunity flowchart: a mapping technique to identify waste...