Course: Quality Improvement

[M] QI 1: Introduction to Improvement and Implementation Science

[M] QI 1: Introduction to Improvement and

Implementation Science Module
[W] Implementation Science with Professor Nick Sevdalis
[W] QI Mod 1: Moving Beyond QI Projects: Safer Care
Victoria's Journey to Creating Whole System Quality

[C] QI Mod 1: Introduction to Improvement and

Implementation Science
1. If the design of the intervention had considered the awareness and training of
the units separately from the work groups and within their work unit, it might
not have had the same effect. Simultaneous training and awareness sessions
for different levels of staff can create a shared understanding and
commitment to change, fostering a cohesive approach to improvement.
However, tailoring the intervention to the specific needs and roles of each
group is also important to ensure relevance and engagement.
2. The eight steps proposed by Kotter are indeed relevant when trying to
achieve change within an organization. Kotter's model provides a structured
approach to organizational change, emphasizing the importance of creating a
sense of urgency, building a guiding coalition, and empowering broad-based
action. These steps are valuable in navigating the complexities of change
management and can help ensure that change efforts are comprehensive and
sustainable.
3. The eight steps of Kotter remain valid in initiating an intervention prioritizing
patient safety, as they provide a solid framework for managing organizational
change. However, in the current environment, additional emphasis on data-
driven decision-making, continuous learning, and adaptability could be
beneficial. Factors such as regulatory requirements, cultural norms, resource
availability, and stakeholder engagement are crucial variables to consider
 when initiating an organizational change that prioritizes patient safety.
Adapting the change process to the specific context and needs of the
healthcare environment is essential for successful implementation.

*[P] QI Mod 1: Introduction to Improvement and Implementation Science

[M] QI 3: Collaboratives to improve care

M] QI 3: Collaboratives to improve care Module

[W] Collaboratives - what is the evidence? How do you design
one? with Tricia Woodhead

[W] Troubleshooting Tips for Collaboratives with John

Brennan and Tricia Woodhead
*[C] QI Mod 3: The National COPD Improvement
Collaborative, Ireland
1. This collaborative facilitated different hospital sites in improving the quality
problems most important to them by providing a flexible framework that
allowed each site to identify and prioritize their own quality improvement
goals. By engaging frontline staff and leadership in the process, the
collaborative created a sense of ownership and accountability for
improvement efforts, which helped ensure that the goals were relevant and
achievable. Additionally, the collaborative provided opportunities for sharing
best practices and learning from each other, which helped accelerate the pace
of improvement across all sites.
2. The patient perspective and voice were included in several ways during this
collaborative. First, patients were involved in the design and implementation
of quality improvement initiatives, providing valuable insights into their
experiences and needs. Second, patient feedback was collected and used to
inform improvement efforts, helping to ensure that the initiatives were aligned
with patient priorities. Finally, patient representatives were included in the
collaborative governance structure, providing a direct voice in decision-
making and ensuring that patient perspectives were represented at all levels.
3. The positive aspects of how data was used to drive the improvement process
during this collaborative included the ability to track progress and identify
areas for improvement, as well as the ability to share data across sites and
learn from each other's experiences. However, there were also negative
aspects, such as the potential for data overload or misinterpretation, and the
risk of focusing too narrowly on quantitative measures at the expense of other
important aspects of quality improvement, such as patient experience and
staff engagement. To mitigate these risks, it's important to use a balanced set
of measures that reflect the full range of quality improvement goals, and to
ensure that data is used in a transparent and collaborative manner that
engages all stakeholders.
*[P] QI Mod 3: Collaboratives to improve care

[M] QI 4: Quality Improvement Update

W] The Value of Accreditation in Health Care Quality:

Translating Standards in Today’s World with Dr Kathryn
Leonhardt
[W] Redefining Quality Improvement with Dr Peter Lachman

*[C] QI Mod 4: How the use of collaborative improvement

narrows the gap of missing TB cases in Cambodia
1. To assess current screening practices in public health facilities, it would be
important to review existing guidelines and protocols, as well as to collect
data on screening rates, patient outcomes, and patient satisfaction.
Additionally, conducting surveys or focus groups with patients and healthcare
providers could provide valuable insights into the barriers and facilitators of
screening practices and their impact on patients.
2. The barriers to performing systematic and routine TB screening at public
health facilities include limited resources, lack of awareness or training among
healthcare providers, and stigma or fear associated with TB. Enabling factors
include the availability of screening tools and resources, support from
leadership and management, and engagement of patients and communities
in the screening process.
3. The QI methodology played a critical role in driving change among healthcare
providers by providing a structured approach to identifying and addressing
barriers to screening. By engaging frontline staff and leadership in the QI
process, the methodology helped create a sense of ownership and
accountability for improvement efforts, which helped ensure that the changes
were sustainable and effective.
4. Each stakeholder played a critical role in this improvement effort. Patients and
communities provided valuable insights into their experiences and needs,
which helped inform the design and implementation of screening initiatives.
Healthcare providers were responsible for implementing the changes and
 ensuring that they were integrated into routine practice. Leadership and
management provided support and resources for the improvement effort, and
were responsible for creating a culture of continuous improvement.
5. Recommendations for EQHA for future work could include expanding the
scope of the improvement effort to other public health facilities, engaging
additional stakeholders such as policymakers and funders, and incorporating a
broader range of quality improvement goals beyond TB screening.
Additionally, EQHA could consider incorporating technology and data
analytics to enhance the effectiveness and efficiency of screening practices,
and could explore opportunities for collaboration and knowledge-sharing
with other organizations and initiatives.

*[P] QI Mod 4: Quality Improvement Update

*[P2] QI Mod 5: Advanced Performance Improvement - Publication 2

*[P3] QI Mod 5: Advanced Performance Improvement

[M] QI 2: Best practice in Quality Improvement
W] Managing Change in Clinical Quality Improvement with
Dr Ulfat Shaikh

[W] Scaling best practices in high risk industries - The case of

OPENPediatrics with Dr Traci Wolbrink
[C] QI Mod 2: Broadening Staff Awareness of Patient Safety
Issues
1. In the areas in which I work, I might want to observe patient safety incidents
related to medication administration, falls, pressure ulcers, and hospital-
acquired infections. These incidents could be analyzed to identify broader
themes and risks related to these areas, such as medication errors, inadequate
staffing, or inadequate infection control measures.
2. Yes, I have identified key themes or repeated incidents in my clinical unit that
suggest the need for a broader review of safety risks. One theme that
characterizes repeated incidents is communication breakdowns between
healthcare providers, which can lead to delays in care, medication errors, and
other adverse events.
3. Staff in my clinical unit might say in response to these questions that care has
been safe in the past, but there have been some incidents that suggest the
need for improvement. They might also say that clinical systems and
processes are generally reliable, but there are some areas where
improvements could be made, such as communication and documentation. In
terms of whether care is safe today, staff might say that they are vigilant and
proactive in identifying and addressing safety risks, but there is always room
for improvement. Finally, staff might say that they are committed to ensuring
that care will be safe in the future, and that they are actively engaged in
ongoing quality improvement efforts to achieve this goal.

[P] QI Mod 2: Best practice in Quality Improvement

[M] QI 5: Advanced Performance Improvement

[W] Yellowbelt in Continuous QI with Dr Richard G.

Greenhill

W] Prioritization in Quality Management and Continuous

Improvement with Richard Greenhill
*[C] QI Mod 5: Value Stream Mapping
1. Possible barriers to applying the methodology in my own setting could
include resistance to change from healthcare providers, limited resources, and
competing priorities. Other obstacles could include a lack of buy-in from
senior leaders, inadequate training and support for staff, and difficulty in
collecting and analyzing data.
2. Applying LEAN principles to patient-centered processes adds significant value
to both patients and healthcare workers. For patients, LEAN improves the flow
of care, reduces wait times, and enhances overall patient satisfaction. For
healthcare workers, LEAN promotes job enrichment, increases motivation, and
helps build a stronger team culture.
3. Key lessons from the case study that I will apply in my own setting include:
a. Engage frontline staff and leadership in the improvement process to ensure buy-in
and sustainability.
b. Use data to drive improvement efforts and to evaluate the effectiveness of
interventions.
c. Focus on small, incremental improvements to build momentum and generate
quick wins.
d. Foster a culture of continuous improvement and learning.
e. Address barriers to change, such as resistance to innovation, limited resources, and
competing priorities.
f. Collaborate with other teams and organizations to leverage collective wisdom and
expertise.
g. Prioritize patient-centeredness throughout the improvement process to ensure
that patient needs are met.
h. Celebrate successes and milestones to keep staff motivated and engaged.
i. Continuously seek feedback from patients and staff to refine improvement efforts
and to ensure that they align with evolving needs and priorities.
*[P1] QI Mod 5: Advanced Performance Improvement