2017 Mutu Sesi 10 TL Materi CQI
Continuous
us quality
improvemen
ent
TRISASI LESTARI 2017
What is Qua
uality?
Seandainya praktek
tek klinis bisa
sesederhana ini
X
Y
Pasien
konsultasi
dg Dokter
Pasien
sembuh
dan puas
Banyak faktor yang
ng mempengaruhi
X1 Usia
X4 Koordinasi
pelayanan
kesehatan
Y Outcome
pasien (sembuh,
X2 Gender
perbaikan
fungsional atau
kepuasan)
X3 Status
kesehatan
Time 1
X5 Komunikasi
Time 2
Time 3
Kenyataannya
a sseperti ini
R4
R1
X4 Koordinasi
X1 Usia
pelayanan
kesehatan
Y Outcome
R2
pasien (sembuh,
X2 Gender
perbaikan
fungsional atau
kepuasan)
R3
X3 Status
kesehatan
R5
Time 1
X5 Komunikasi
Time 2
Time 3
Mind the Gap
IDENTIFY
Y GAP
G
AND
CHALLENG
NGES
WHAT DO
OY
YOU
WANT TO CHANGE
C
WRITE YOUR ANSWER IN A PI
PIECE OF PAPER
Quality Improveme
ent
A systematic approach to analyzing (current)
performance in an organization
AND
designing, testing and monitoring interventions that
bridge the gap
The Quality Guruss
W. Edwards Deming
(1900-1993)
Walter Shewhart
(1891-1967)
Joseph M. Juran
(1904 - 2008 )
W.Edwards Deming
ing
If I had to reduce my
message for management
to just a few words, I d say
it all had to do with
reducing variation .
Quality is red
educing
variation
Dr Walter Shewhar
art
Perkembangan ilmu murni dan ilmu terapan terus
mendorong kebutuhan akan akurasi dan presisi. Akan
tetapi ilmu terapan jauh lebih membutuhkan akurasi
dan presisi dibandingkan dengan ilmu murni
Komponen Ilmu Ter
Terapan
Berfokus pada
customer
Berfokus pada
proses
Menggunakan data
untuk mengambil
keputusan
Crosby (1979)
Quality is Free
Principles of
o Quality
Improvemen
ent
Quality is everyone
ne’s business!
(W. Edwards Deming)
Quality is a team efforts
ef
Focus of improvem
ment is on process,
not individuals
QI must be data driven
dri
The QI Process is best when
based on an estab
tablished, accepted
model
Malcolm Baldrige Model
M
The QI process
must be
communicable
If you always do what you have
always done, you will always get
what you have always got!
Don Berwick
Changing Syste
stems/Changing
peo
eople
Change is threatening
Its always been done this way
Change is time-consuming
what s the point it will only disrupt the system
Change means testing out things in your own setting
some people are never happy, no matter what you do,
so what s the point
Defining the Problem
Always speak to
someone different
Didn t specify what
I wanted properly
Getting
Information
Set impossible
timescales
Am I dealing with
really urgent work?
Didn t check
often
enough
Haven t planned
time available well
Not got an
accurate
brief
Didn t give
manager
enough time
Waiting for line
managers approval
Other deadlines
Not sharing
workload
Three fundamental
al questions
q
for
improvement
( Nolan Questions )
What are we trying to achieve?
Know exactly what you are trying to do have clear aims and objectives
How will we know that change is an improvement?
Measuring processes and outcomes
What changes can we make that will result in an improvement?
What have others done? What hunches do we have? What can we learn as
we go along?
The DOING part off the
th Improvement
Model
PDSA
A Cycle
A structured approach for making small incremental changes to systems
A full cycle for planning, implementing, testing and identifying further changes
A common sense, easy to understand tool for bringing about change
A tool which can reduce anxiety to change
PLAN
Why do this?
What are the
expected results?
What are the
objectives?
Does it fit overall
mission, values,
plans?
Who needs to
participate?
What exactly will
we do?
For how long will
we engage in this
activity?
How will we
measure success?
(baseline/outcome
performance)
How will we
communicate our
results?
DO = Testing in a small
s
scale
Use interviews or calculations to test feasibility
Use volunteers or team members to do the tests
Use a small sub-population
Use one location
Conduct the test for a short period of time. Ideally over one week.
The principles off PDSAs
P
Breaks down change into manageable, bite-sized time-limited chunks
Not audits snap shots in time
A PDSA cannot be too small!!!!!!
It can be too big
Small changes can be tested without causing upheaval to the whole system
Tell others what you are doing
If it doesn t work, try something different based on your learning
Document what did/didn t work
Why test?
To learn whether the change will result in an improvement
To predict the amount of improvement possible
To learn how to adapt the change to different environments
To understand the costs and impact of change
To reduce resistance
What can we learn from
fr
testing
changes...
Taking action as a result of learning from the last tests
Planning multiple tests around each change
Thinking a couple of tests ahead
Really scaling down the size
Making sure there is agreement before testing
Source: Berwick
STUDY
Collect relevant baseline and outcome data
Analyze
compare with past performance and with external resources.
Study (past tense - outcome)
Study the outcome of your measures
What worked? Do you need to carry out another PDSA? Do you
need to involve more people?
Do you need to generate more ideas?
What didn t work and why?
Do you need to change the plan? Do you need to tweak the
original pdsa?
Analyze
Evaluate the results
Interpret
Discuss
is the new process/ strategy/improvement useful?
practical?
cost-effective?
ACT
If it works, implement, disseminate,
publicize, do training and in-service,
and maintain gains.
Act (present / future tense)
What changes are you going to make based on
your findings?
This will inform your next PDSA cycle
Document the change you are going to make and
identify future plans
Repeated use of
the PDSA cycle
Testing and
refining ideas
Bright
idea!
Implementing new
procedures & systems
- sustaining change
Create Multiple PDSA
PD
Ramps
A P
A P
A P
S D
S D
S D
A P
A P
A P
S D
S D
S D
A P
A P
A P
S D
S D
S D
A P
A P
A P
S D
S D
S D
receptionist
porters
Nurses
Diabetes (blood
dp
pressure)
Improvements wit
with PDSAs
Scottish Primary Care
Car Collaborative
Borders GP Practice
PDSAs
% of Diabetes Patients
Pa
with a BP
us quality
improvemen
ent
TRISASI LESTARI 2017
What is Qua
uality?
Seandainya praktek
tek klinis bisa
sesederhana ini
X
Y
Pasien
konsultasi
dg Dokter
Pasien
sembuh
dan puas
Banyak faktor yang
ng mempengaruhi
X1 Usia
X4 Koordinasi
pelayanan
kesehatan
Y Outcome
pasien (sembuh,
X2 Gender
perbaikan
fungsional atau
kepuasan)
X3 Status
kesehatan
Time 1
X5 Komunikasi
Time 2
Time 3
Kenyataannya
a sseperti ini
R4
R1
X4 Koordinasi
X1 Usia
pelayanan
kesehatan
Y Outcome
R2
pasien (sembuh,
X2 Gender
perbaikan
fungsional atau
kepuasan)
R3
X3 Status
kesehatan
R5
Time 1
X5 Komunikasi
Time 2
Time 3
Mind the Gap
IDENTIFY
Y GAP
G
AND
CHALLENG
NGES
WHAT DO
OY
YOU
WANT TO CHANGE
C
WRITE YOUR ANSWER IN A PI
PIECE OF PAPER
Quality Improveme
ent
A systematic approach to analyzing (current)
performance in an organization
AND
designing, testing and monitoring interventions that
bridge the gap
The Quality Guruss
W. Edwards Deming
(1900-1993)
Walter Shewhart
(1891-1967)
Joseph M. Juran
(1904 - 2008 )
W.Edwards Deming
ing
If I had to reduce my
message for management
to just a few words, I d say
it all had to do with
reducing variation .
Quality is red
educing
variation
Dr Walter Shewhar
art
Perkembangan ilmu murni dan ilmu terapan terus
mendorong kebutuhan akan akurasi dan presisi. Akan
tetapi ilmu terapan jauh lebih membutuhkan akurasi
dan presisi dibandingkan dengan ilmu murni
Komponen Ilmu Ter
Terapan
Berfokus pada
customer
Berfokus pada
proses
Menggunakan data
untuk mengambil
keputusan
Crosby (1979)
Quality is Free
Principles of
o Quality
Improvemen
ent
Quality is everyone
ne’s business!
(W. Edwards Deming)
Quality is a team efforts
ef
Focus of improvem
ment is on process,
not individuals
QI must be data driven
dri
The QI Process is best when
based on an estab
tablished, accepted
model
Malcolm Baldrige Model
M
The QI process
must be
communicable
If you always do what you have
always done, you will always get
what you have always got!
Don Berwick
Changing Syste
stems/Changing
peo
eople
Change is threatening
Its always been done this way
Change is time-consuming
what s the point it will only disrupt the system
Change means testing out things in your own setting
some people are never happy, no matter what you do,
so what s the point
Defining the Problem
Always speak to
someone different
Didn t specify what
I wanted properly
Getting
Information
Set impossible
timescales
Am I dealing with
really urgent work?
Didn t check
often
enough
Haven t planned
time available well
Not got an
accurate
brief
Didn t give
manager
enough time
Waiting for line
managers approval
Other deadlines
Not sharing
workload
Three fundamental
al questions
q
for
improvement
( Nolan Questions )
What are we trying to achieve?
Know exactly what you are trying to do have clear aims and objectives
How will we know that change is an improvement?
Measuring processes and outcomes
What changes can we make that will result in an improvement?
What have others done? What hunches do we have? What can we learn as
we go along?
The DOING part off the
th Improvement
Model
PDSA
A Cycle
A structured approach for making small incremental changes to systems
A full cycle for planning, implementing, testing and identifying further changes
A common sense, easy to understand tool for bringing about change
A tool which can reduce anxiety to change
PLAN
Why do this?
What are the
expected results?
What are the
objectives?
Does it fit overall
mission, values,
plans?
Who needs to
participate?
What exactly will
we do?
For how long will
we engage in this
activity?
How will we
measure success?
(baseline/outcome
performance)
How will we
communicate our
results?
DO = Testing in a small
s
scale
Use interviews or calculations to test feasibility
Use volunteers or team members to do the tests
Use a small sub-population
Use one location
Conduct the test for a short period of time. Ideally over one week.
The principles off PDSAs
P
Breaks down change into manageable, bite-sized time-limited chunks
Not audits snap shots in time
A PDSA cannot be too small!!!!!!
It can be too big
Small changes can be tested without causing upheaval to the whole system
Tell others what you are doing
If it doesn t work, try something different based on your learning
Document what did/didn t work
Why test?
To learn whether the change will result in an improvement
To predict the amount of improvement possible
To learn how to adapt the change to different environments
To understand the costs and impact of change
To reduce resistance
What can we learn from
fr
testing
changes...
Taking action as a result of learning from the last tests
Planning multiple tests around each change
Thinking a couple of tests ahead
Really scaling down the size
Making sure there is agreement before testing
Source: Berwick
STUDY
Collect relevant baseline and outcome data
Analyze
compare with past performance and with external resources.
Study (past tense - outcome)
Study the outcome of your measures
What worked? Do you need to carry out another PDSA? Do you
need to involve more people?
Do you need to generate more ideas?
What didn t work and why?
Do you need to change the plan? Do you need to tweak the
original pdsa?
Analyze
Evaluate the results
Interpret
Discuss
is the new process/ strategy/improvement useful?
practical?
cost-effective?
ACT
If it works, implement, disseminate,
publicize, do training and in-service,
and maintain gains.
Act (present / future tense)
What changes are you going to make based on
your findings?
This will inform your next PDSA cycle
Document the change you are going to make and
identify future plans
Repeated use of
the PDSA cycle
Testing and
refining ideas
Bright
idea!
Implementing new
procedures & systems
- sustaining change
Create Multiple PDSA
PD
Ramps
A P
A P
A P
S D
S D
S D
A P
A P
A P
S D
S D
S D
A P
A P
A P
S D
S D
S D
A P
A P
A P
S D
S D
S D
receptionist
porters
Nurses
Diabetes (blood
dp
pressure)
Improvements wit
with PDSAs
Scottish Primary Care
Car Collaborative
Borders GP Practice
PDSAs
% of Diabetes Patients
Pa
with a BP