At the end of Module 3, you will be able to:
Module 1 introduced us to the need for monitoring and evaluation as part of effective public health practice, and Module 2 taught us some of the basics of working with data in the health care setting. Building on that, in Module 3 we will explore how to use indicator data in our quality improvement efforts by learning about what makes good quality improvement (QI) and an effective QI team, what tools we can use to carry out QI tasks, and how to carry out a PDSA (plan, do, study, act) cycle to improve public health processes.
In Module 1, we were introduced to patients and healthcare workers at Mzansi Clinic and we learned about missed opportunities in care for these patients (like Andiswa and Nomzamo). These missed opportunities could be symptoms of clinic-wide problems and may represent outcomes of a system of health care that needs improvement. In many cases, the problems can be resolved or at least improved upon through better data and information management; other problems require changes or even a redesign of the system. This module will explain in detail how following a quality improvement (QI) cycle can address these problems. The missed opportunities in Module 1 are identified as problem statements in Module 3.
In this module we will look at two specific missed opportunities with regards the care of patients we met in Module 1.
Module 3 will also look at several other scenarios where improvement is needed in Mzansi Clinic. We will learn how to thoroughly analyse the issues leading to each missed opportunity, how to plan for process changes to improve upon such problems in the future, and how to use data to measure whether our changes work.
Pre-test (10 minutes)
Part 1: Quality, Quality Improvement & Continuous Quality Improvement (15 minutes)
Part 2: Teamwork (15 minutes)
Part 3: QI Tools (30 minutes)
Part 4: Testing Changes & Implementing Improvements (45 minutes)
Part 5: Run Charts (15 minutes)
Module 3 focussed on how to use data for quality improvement.
We learnt about this by first defining the terms quality, quality improvement (QI), and continuous quality improvement (CQI) in Part 1.
We then moved on to discussing the importance of teamwork, including the composition, roles, and responsibilities of a facility-based QI team, in Part 2.
In Part 3, we got into the meat of this Module by learning about various quality improvement tools we can use in our work and to assist us at each stage of the QI cycle. The main tools we discussed were the National Core Standards, process mapping/flow charts, Five-S, the Five Whys, and root-cause (fishbone) analysis.
In Part 4, we learnt about how to test changes and implement improvements through the Model for Improvement and Plan-Do-Study-Act (PDSA) cycle.
In Part 5, we learnt about run charts.
Post-test (10 minutes)
Click to open a PDF file. This PDF will open in a new screen. pdsa form.pdf
Click to open an Excel file. This Excel file will open in a new screen. Run Chart Template.xls
Click to open a PDF file. This PDF will open in a new screen. Quality Improvement Guide 2012.pdf
Data Improvement Guide: A guide to improving the quality of data. University of Kwazulu-Natal, Institute for Healthcare Improvement, 20,000+ Partnership
Guidance for Analyzing Quality Improvement Data Using Time Series Charts. USAID. Health Care Improvement Project. September 2010
Langley et al. The Improvement Guide. Institute for Healthcare Improvement, Breakthrough Series College.
Langley et al.1996. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.
Murray, Sandy. Institute for Healthcare Improvement. Measurement in Collaboratives: How Do We Know a Change is an Improvement? July, 2015.
Primary Health Care Supervision Manual (DOH 2009)
Quality Improvement Guide: Quality Improvement – The Key to Providing Improved Quality of Care. South Africa Department of Health
Silimperi DR, Miller Franco L, Veldhuyzen van Zanten T, and Mac Aulay C, “A framework for institutionalizing quality assurance,” International Journal for Quality in Health Care 14(2002)67-73
The Five Steps to Quality Improvement: A facility based guide to improving clinical outcomes and quality mentorship. Institute for Healthcare Improvement, Department of Health, University of KZN/20,000+
http://www.hrsa.gov/quality/toolbox/methodology/improvementteams/
http://asq.org/learn-about-quality/process-analysis-tools/overview/flowchart.html
http://www.cdc.gov/std/foa/aapps/driver-diagram-template.pdf
http://www.ihi.org/education/ihiopenschool/resources/Pages/Activities/GoldmannDriver.aspx
http://asq.org/learn-about-quality/process-analysis-tools/overview/fmea.html