Flow-charts. â Process ... through this process mapping that we were able to improve our system for ... American Medic
Model for Improvement: Making Changes That Result in Improvement NNHQCC Learning Session #2
Liz Dominguez Nursing Home Project Specialist MetaStar, Inc.
August 2015
Objectives
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Recognize the importance of developing a structured approach of how to identify changes that result in improvement Describe how to use various methods to identify needed changes that will result in improvement Use a method to determine where improvements can be made
MetaStar represents Wisconsin in Lake Superior Quality Innovation Network.
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Model for Improvement
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Model for Improvement What changes can we make that will result in improvement? ― ― ― ―
Flow-charts Process maps Brainstorming Review of Evidence-Based Practice
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Brainstorming • • •
Free-flowing, creative generation of ideas where all ideas are welcome Useful when you feel like your team is stuck Can be done in a structured or non-structured way
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Process Mapping • • •
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Process of creating a diagram that illustrates a business process or workflow process Allows teams to map out the actual flow or sequence of events Shows you where you are at, vs. where you need to be May reveal an issue with the process, not with a single person or department
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Flowcharting
Start/Stop
Step/Activity
Question/Decision
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Flowcharting Consider the following before you begin: •
Determine who is involved in the process
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Involve an individual who is not involved for an “outsider” perspective
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Flowcharting Constructing a Flowchart: 1. Determine the start and stop points 2. Decide the level of detail to include 3. Use brainstorming to identify all activities, inputs, outputs, and decisions 4. Arrange the steps in order
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Flowcharting: An Example
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The Nursing Home Administrator received multiple complaints from residents and families about the supper meal arriving late and being cold. She took it upon herself to learn more about the process of the supper meal service by creating a flowchart.
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Flowcharting: An Example
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Flowcharting: An Example
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Nazareth Health & Rehab Stoughton, WI “Though Nazareth had a policy and procedure in place that addressed the monitoring of Coumadin, we still noted inconsistencies in some areas of this monitoring. Knowing that quality improvement works on existing processes we needed a pictorial representation of the sequence of actions of anticoagulant monitoring within our facility. A committee was formed to review the current facility process of monitoring anticoagulants; we analyzed our current process and put it into a narrative format. It was from this narrative that we created a flow sheet. The flow sheet allowed for us to identify areas of weakness and generated ideas for improvement. It was through this process mapping that we were able to improve our system for Coumadin and INR monitoring.”
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Change Package Be a Continuous Learning Organization • Make systems thinking the norm • Include your interdisciplinary team when making improvements • Use tools that guide systems thinking when problem-solving
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Evidenced-Based Practice (EBP) EBP Includes: •
Clinical Expertise
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Best Research Evidence
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Patient Values & Preferences
Duke University Medical Center Library. "Introduction to Evidence-Based Practice." http://guides.mclibrary.duke.edu/ebmtutorial (accessed July 8, 2015).
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Evidence-Based Practice •
EBP promotes resident safety by creating more effective and efficient care Results in less variation in processes
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Use evidenced-based practice to guide your process mapping Results in less variation in processes
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Include input from you Medical Director
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Evidence-Based Practice Resources •
American Medical Directors Association (AMDA) Clinical Practice Guidelines
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INTERACT® Tools
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National Pressure Ulcer Advisory Panel (NPUAP)
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Advancing Excellence in America’s Nursing Homes
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Try This series from the Hartford Institute for Geriatric Nursing 16
Change Package Compassionate Clinical Care • Utilize evidence-based or expert-endorsed resources for common conditions • Evidence-based practices should also be used when managing conditions that can frequently contribute to re-hospitalizations
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Activity •
With your interdisciplinary team, choose and practice one of these methods to assist in choosing action steps as part of your current or next performance improvement project.
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Contact the Lake Superior Quality Innovation Network Michigan: MPRO Kathleen Lavich 248-465-7399
[email protected] Minnesota: Stratis Health Kristi Wergin 952-583-8561
[email protected] Wisconsin: MetaStar Liz Dominguez 608-441-8266
[email protected]
MetaStar represents Wisconsin in Lake Superior Quality Innovation Network.
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This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MI/MN/WI-C2-15-146 072915
