1. Steps in QI

Step 1: Identifying a problem, forming a team and writing an aim statement

Step 2: Analysing the problem and measuring quality of care

Step 3: Developing and testing changes

Step 4: Sustaining improvement

2. Step 3 - Learning objectives

You will learn:
► How to come up with ideas about what to change
    to reach your aim
► how to test these changes at small scale using Plan
    Do-Study- Act (PDSA) cycles

3. Develop Changes

► Determine possible changes (interventions) that may lead
    to improvement

► Organize changes according to importance and practicality

► Test one change at one time

4. Developing Changes-Ask Your Team

► What changes will we make?

► Why will this change result in an improvement?

► How will it work?

► What improvement will we expect to see as a result
    of this change?

5. Some Categories of Changes

6. Some Categories of Changes

7. Plan the Change

► What Will Your Team Do ?

► Ask and document the details for:
    ♦ what needs to be done?
    ♦ who will do it?
    ♦ who will measure indicator?
    ♦ when will it be started
    ♦ when will result be reviewed ?

8. Testing The Change

► Test BIG changes on small scale

► Test individual changes separately when possible

► Negative results are opportunity to learn

► Think about how conditions change over time
    (monthly, seasonal patterns, external variables)

9. Test Changes

♦ Did the change lead to improvement ?

♦ Is it significant improvement ?

10. Planning

Describe:
  ♦ What change will you test
  ♦ Who will make the change
  ♦ Where they will do it
  ♦ How long they will test

11. Study And Act

After testing the change you need to think about:
  ♦ Is this feasible in our setting
  ♦ What else needs to be done so this change can happen
  ♦ Do we think it will solve the problem

After answering these questions the team will decide if they should:
  ♦ Adopt, Adapt OR Abandon

12. PDSA Cycles-What Next ?

13. Implementation

Making the change the new standard process across the  health facility (unit/department)

Specific steps taken to prevent from slipping back to the old ways of working. (Hardwiring through job descriptions, protocols etc.)

System to keep an eye on key indicators to ensure improvement is sustained

Making the successful change permanent and consistent

14. Key Tips

► Change ideas will improve care, if
  ♦ They are right idea
  ♦ Putting change in action
  ♦ Adapting it to the local context

► Testing changes as small PDSA cycles

15. Multiple Ramps of Changes Towards a Single Aim

Aim: Reduce severe hypothermia in newborn babies by 50% in 3 months

Adapted from the Institute of Healthcare Improvement (IHI)