Continuous
improvemen
improvemen
TRISASI LESTARI 2017
us quality
ent
What is Qua
Seandainya praktek
sesederhana ini
X
Pasien
konsultasi dg Dokter
X
Pasien
konsultasi dg Dokter
tek klinis bisa
Y
Pasien sembuh dan puas
Y
Banyak faktor yang
X1
UsiaX2
GenderX4
Koordinasi pelayanankesehatan
X2
GenderX3
Statuskesehatan
X5
KomunikasiTime 1 Time 2
ng mempengaruhi
X4
Koordinasi pelayanankesehatan
Y
Outcome pasien (sembuh, perbaikanfungsional atau kepuasan)
X5
KomunikasiY
Outcome pasien (sembuh, perbaikanfungsional atau kepuasan)
Kenyataannya s
X1
UsiaX4
Koordinasipelayanan kesehatan R1 R2 R4
X2
GenderX3
Statuskesehatan
X5
KomunikasiTime 1 Time 2
R3
R5
a seperti ini
X4
Koordinasi pelayanankesehatan
Y
Outcome pasien (sembuh, perbaikanfungsional atau kepuasan)
X5
KomunikasiY
Outcome pasien (sembuh, perbaikanfungsional atau kepuasan)
IDENTIFY G
CHALLENG
CHALLENG
Y GAP AND
NGES
WHAT DO Y
WANT TO C
WANT TO C
WRITE YOUR ANSWER IN A PI
O YOU
CHANGE
CHANGE
Quality Improveme
A systematic approach to analyzing (current)
performance in an organization
AND
designing, testing and monitoring interventions that
bridge the gap
A systematic approach to analyzing (current)
performance in an organization
AND
designing, testing and monitoring interventions that
bridge the gap
ent
A systematic approach to analyzing (current)
performance in an organization
AND
designing, testing and monitoring interventions that
bridge the gap
A systematic approach to analyzing (current)
performance in an organization
AND
designing, testing and monitoring interventions that
The Quality Gurus
W. Edwards Deming (1900-1993)
Walter Shewhart (1891-1967)
s
Walter Shewhart (1891-1967)
W.Edwards Deming
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
.
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
.
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
.
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
.
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
.
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
.
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
.
If I had to reduce my
message for management
to just a few words, I d say
it all had to do with
Quality is red
variation
Dr Walter Shewhar
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
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
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
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
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
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
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
Perkembangan ilmu murni dan ilmu terapan terus
mendorong kebutuhan akan akurasi dan presisi. Akan
Crosby (1979)
Principles o
Improvemen
Improvemen
of Quality
ent
Quality is everyone
(W. Edwards Deming)
Focus of improvem
not individuals
The QI Process is
based on an estab
model
is best when
The QI process
must be
communicable
must be
If you always do what you have
always done, you will always get
what you have always got!
Don Berwick
If you always do what you have
always done, you will always get
what you have always got!
Don Berwick
If you always do what you have
always done, you will always get
what you have always got!
Don Berwick
If you always do what you have
always done, you will always get
what you have always got!
Changing Syste
peo
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
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
stems/Changing
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
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
Always speak to
someone different Didn t specify whatI wanted properly
Getting Getting Information Information Set impossible timescales
Defining the Problem
Set impossible timescales
Am I dealing with really urgent work?
Other deadlines Other deadlines
Haven t planned time available well
Not sharing workload
Didn t specify what I wanted properly
Didn t check often enough
Not got an accurate
brief
Defining the Problem
Haven t planned time available well
Didn t check often enough
Waiting for line Waiting for line managers approval managers approval
Not got an accurate
brief
Three fundamental q
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? 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?
al questions for
)
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? How will we know that change is an improvement?
What changes can we make that will result in an improvement?
The DOING part of th
Model
PDSA
A structured approach for making small incremental changes to systems
A full cycle for planning, implementing, testing and identifying further changes 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
A Cycle
A structured approach for making small incremental changes to systems
A full cycle for planning, implementing, testing and identifying further changes A full cycle for planning, implementing, testing and identifying further changes A common sense, easy to understand tool for bringing about change
PLAN
Why do this? What are the
objectives?
What are the expected results?
What exactly will we do?
How will we communicate our
results?
Does it fit overall mission, values,
plans?
Who needs to participate? For how long will
we engage in this activity?
How will we measure success? (baseline/outcome
performance) For how long will
we engage in this activity?
How will we measure success? (baseline/outcome
performance) How will we
DO = Testing in a s
Use interviews or calculations to test feasibility Use interviews or calculations to test feasibility Use volunteers or team members to do the tests Use volunteers or team members to do the tests Use volunteers or team members to do the tests Use a small sub-population
Use a small sub-population Use one location
Use one location
Conduct the test for a short period of time. Ideally over one week. Conduct the test for a short period of time. Ideally over one week.
small scale
Use interviews or calculations to test feasibility Use interviews or calculations to test feasibility Use volunteers or team members to do the tests Use volunteers or team members to do the tests Use volunteers or team members to do the tests Use a small sub-population
Use one location
The principles of 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
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
f PDSAs
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
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
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
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
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
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
What can we learn fr
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
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
from testing
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
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
STUDY
Collect relevant baseline and outcome data Collect relevant baseline and outcome data
Analyze Analyze
compare with past performance and with external resources. compare with past performance and with external resources. Collect relevant baseline and outcome data
Collect relevant baseline and outcome data
Analyze
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?
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?
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?
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?
Analyze
Evaluate the results
Interpret
Discuss
is the new process/ strategy/improvement useful?
practical?
cost-effective?
Evaluate the results
Interpret
Discuss
is the new process/ strategy/improvement useful?
practical?
cost-effective?
Evaluate the results
Interpret
Discuss
is the new process/ strategy/improvement useful?
practical?
cost-effective?
Evaluate the results
Interpret
Discuss
is the new process/ strategy/improvement useful?
practical?
ACT
If it works, implement, disseminate,
publicize, do training and in-service,
and maintain gains.
If it works, implement, disseminate,
publicize, do training and in-service,
and maintain gains.
If it works, implement, disseminate,
publicize, do training and in-service,
and maintain gains.
If it works, implement, disseminate,
publicize, do training and in-service,
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
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
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
What changes are you going to make based on your findings?
This will inform your next PDSA cycle
Repeated use of
the PDSA cycle
Testing and refining ideas
Implementing new procedures & systems - sustaining change
Bright idea!
Create Multiple PD
P D S A P D S A S A P D S A P D S A D S P D S A P D S A Sreceptionist porters Nurses
Scottish Primary Car Borders GP
70 80 90
% of Diabetes Pa
Diabetes (blood p
Improvements wit
PDSAs to improve shared diabetes information with
Secondary Care PDSAs to Validate Diabetes Register 0 10 20 30 40 50 60 Base line Mon th 1
Mon th 2
Mon th 3
Mon th 4
Mon th 5
Mon th 6
Mon th 7
Mon th 8
Mon th 9
Mon th 1
0
Mon th 1
1
Mon th 1
% o f P e o p le w it h Di a b e te s
PDSAs to improve shared diabetes information with
Secondary Care
PDSA to contact all Patients who have not had
a BP check in the last year PDSAs to Validate Diabetes Register Care Collaborative GP Practice
Patients with a BP<140/80
d pressure)
with PDSAs
PDSAs to improve shared diabetes information with
Secondary Care
PDSAs
PDSAs PDSAs
PDSAs to improve current patient recall
system
onth 12
Mon th 1
3
Mon th 1
4
Mon th 1
5
Mon th 1
6
Mon th 1
7
Mon th 1
8
Mon th 1
9
Mon th 2
0
Mon th 2
1
Mon th 2
2
Mon th 2
3
Mon th 2
4
PDSAs to improve shared diabetes information with
Secondary Care
PDSA to contact all Patients who have not had
a BP check in the last year
PDSAs to improve current patient recall
“If you always
have always d
always get wh
always
always
Don Be
ys do what you
s done, you will
what you have
ys got!”
ys got!”
Quality Impro
means CHAN
all changes a
improvement
improvement
provement
ANGE but not
s are
Pertanyaan 2: Ba
tahu bahwa perub
terjadi adalah sua
agaimana kita
rubahan yang
Sulitnya mengukur
Makan waktu, menambah pekerjaan Makan waktu, menambah pekerjaan
Harus memastikan akurasi data dan konsistensi metode pengambilan data Harus memastikan akurasi data dan konsistensi metode pengambilan data
Terlalu banyak indikator, tapi bukan indikator yang tepat Terlalu banyak indikator, tapi bukan indikator yang tepat Terlalu banyak indikator, tapi bukan indikator yang tepat Terlalu banyak indikator, tapi bukan indikator yang tepat
Indikator terima jadi, tanpa ada proses diskusi Indikator terima jadi, tanpa ada proses diskusi
Bagaimana menggunakan data yg sudah dikumpulkan Bagaimana menggunakan data yg sudah dikumpulkan
Pengumpulan data manual atau otomatis Pengumpulan data manual atau otomatis
Hasil analisis tidak sesuai dengan pendapat manajemen Hasil analisis tidak sesuai dengan pendapat manajemen
ur mutu
Makan waktu, menambah pekerjaan
Harus memastikan akurasi data dan konsistensi metode pengambilan data Harus memastikan akurasi data dan konsistensi metode pengambilan data
Terlalu banyak indikator, tapi bukan indikator yang tepat Terlalu banyak indikator, tapi bukan indikator yang tepat Terlalu banyak indikator, tapi bukan indikator yang tepat Terlalu banyak indikator, tapi bukan indikator yang tepat
Indikator terima jadi, tanpa ada proses diskusi Indikator terima jadi, tanpa ada proses diskusi
Bagaimana menggunakan data yg sudah dikumpulkan Bagaimana menggunakan data yg sudah dikumpulkan
Pengumpulan data manual atau otomatis
The more effort you put into understanding
and utilizing data, the more you will be
rewarded in terms of solving the right
problem in the right way .
(The Victorian Quality Council Safety and Quality in Health)
The more effort you put into understanding
and utilizing data, the more you will be
rewarded in terms of solving the right
problem in the right way .
(The Victorian Quality Council Safety and Quality in Health)
The more effort you put into understanding
and utilizing data, the more you will be
rewarded in terms of solving the right
problem in the right way .
(The Victorian Quality Council Safety and Quality in Health)
The more effort you put into understanding
and utilizing data, the more you will be
rewarded in terms of solving the right
problem in the right way .
Useful links
Institute of Healthcare Improvement
www.ihi.org
A Guide to Service Improvement
www.scotland.gov.uk
Improvement & Support Team Toolkit
http://member.goodpractice.net/ContinuousImprovementToolkit/Welco me.gp
Improvement Leaders Guides
www.modern.nhs.uk/improvementguides
Institute of Healthcare Improvement
www.ihi.org
A Guide to Service Improvement
www.scotland.gov.uk
Improvement & Support Team Toolkit
http://member.goodpractice.net/ContinuousImprovementToolkit/Welco me.gp
Improvement Leaders Guides
www.modern.nhs.uk/improvementguides
Institute of Healthcare Improvement
www.ihi.org
A Guide to Service Improvement
www.scotland.gov.uk
Improvement & Support Team Toolkit
http://member.goodpractice.net/ContinuousImprovementToolkit/Welco me.gp
Improvement Leaders Guides
www.modern.nhs.uk/improvementguides
Institute of Healthcare Improvement
www.ihi.org
A Guide to Service Improvement
www.scotland.gov.uk
Improvement & Support Team Toolkit
http://member.goodpractice.net/ContinuousImprovementToolkit/Welco me.gp
Improvement Leaders Guides
