Quality Improvement: Why and How. Michael L. Rinke, MD March 9 th, 2013
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1 Quality Improvement: Why and How Michael L. Rinke, MD March 9 th, 2013
2 Disclosures I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation
3 Objectives Explain the importance of quality improvement work in practice Understand and reflect on the determinants of QI success
4 Presentation Importance of QI Determinants of QI Success QI Theory to Use in Practice
5 Why do you care about quality improvement? On average, children in the study received 46% of the indicated care. They received 68% of the indicated care for acute medical problems, 53% of the indicated care for chronic medical conditions, and 41% of the indicated preventive care. Quality varied according to the clinical area, with the rate of adherence to indicated care ranging from 92% for upper respiratory tract infections to 34% for preventive services.
6 Overestimating Performance Preventive Service Rates Percent Up to Date Immunizations Anemia Screen Lead Screen TB Screen Estimated Actual Randolph, Fried, Loeding, Margolis, Keyes, Lannon: Pediatrics, 2005.
7 Variation in Performance Randolph, Fried, Loeding, Margolis, Keyes, Lannon. Pediatrics, 2005.
8 How many deaths?
9
10 In the last decade, the National Highway Traffic Safety Administration has received complaints of 34 fatalities related to sudden acceleration of Toyota vehicles, far more than for any other automaker. At least 22 additional deaths related to Toyota acceleration problems have been alleged in lawsuits and police reports.
11 More Fail On average, 5% to 20% of US residents get the flu annually, and more than 200,000 persons are hospitalized for flu related complications each year. About 36,000 Americans die on average per year from flu complications.
12 The math Toyota: 56 deaths in 10 years 1 death every 2 months Flu: 36,000 deaths per year 1 death every 15 minutes (in a good year)
13 How Hazardous Is Health Care? (derived from Leape & Amalberti) Total lives lost per year 100,000 10,000 1, DANGEROUS (>1/1000) HealthCare Mountain Climbing Bungee Jumping REGULATED Driving Chemical Manufacturing Chartered Flights ,000 10, ,000 1,000,000 10,000,000 Number of encounters for each fatality ULTRA-SAFE (<1/100K) Scheduled Airlines European Railroads Nuclear Power
14 44,000 98,000 Deaths per Year (At Least)
15 Determinants of QI Success
16 MUSIQ: Model for Understanding Success in Quality
17 Kaplan H C et al. BMJ Qual Saf 2012;21:13-20 Copyright BMJ Publishing Group Ltd and the Health Foundation. All rights reserved.
18 An exploratory analysis of the Model for Understanding Success in Quality Kaplan et. al Surveyed 74 QI projects at multiple centers 302 Respondents Which MUSIQ factors were present in your QI Project? How Successful was your Project?
19 Kaplan H C et al. BMJ Qual Saf 2012;21:13-20 Copyright BMJ Publishing Group Ltd and the Health Foundation. All rights reserved.
20 There is nothing so practical as a good theory Kurt Lewin
21 Influencer Motivation Ability Personal Social Structural
22 Influencer
23 Influencer
24 Influencer Personal Motivation Make the Undesirable Desirable Ability Surpass Your Limits Social Structural Harness Peer Pressure Design Rewards and Demand Accountability Find Strength in Numbers Change the Environment
25 Conclusions Quality Improvement is IMPORTANT! MUSIQ: Influencer Resource Availability QI Team Skill QI Team Leadership Microsystem: Motivation, QI Culture, QI Capability Personal Social Structural Motivation/Ability
26 The first idea is rarely the best idea
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