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Utilizing Systems Theory for Successful Quality Improvement Projects

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Utilizing Systems Theory for Successful Quality Improvement Projects 2019 QI PROJEC T GUIDE SUPPLEMENT Utilizing Systems Theory for Successful Quality Improvement Projects June 2019 2019 QI Project Guide Supplement Utilizing Systems Theory for Successful Quality Improvement Projects Society for Vascular Surgery Patient Safety Organization Table of Contents Section Content Page 1 Introduction/Overview 1 2 Acknowledgements 3 3 Systems Theory and the SVS PSO 4 4 Systems Theory at the CENTER Level 5 4.1 Case Study – Iowa Heart Center Claims Validation Audit: Return on Investment 5 4.2 Failure Modes and Effects Analysis (FMEA) 6 4.3 Plan-Do-Check-Act (PDCA/PDSA) 8 5 Systems Theory at the ORGANIZATION Level (Regional) 11 5.1 Using the #Hashtag for a regional QI project 11 5.2 #Hashtag for a contrast-induced nephropathy project 12 5.3 #Hashtag for a frailty project 13 6 Systems Theory at the ENVIRONMENT Level (National) 15 6.1 Resources 16 6.2 Long-Term Follow-Up table 17 7 Quality Improvement and the Participation Awards 18 2019 QI Project Guide Supplement Utilizing Systems Theory for Successful Quality Improvement Projects Society for Vascular Surgery Patient Safety Organization 1. Introduction/Overview The Society for Vascular Surgery’s Patient Safety Organization is a system of 18 regional groups consisting of over 565 centers, 4,100+ physicians and vascular providers, and over 110 data abstractors/managers and quality personnel with the vascular patient at the center. The original 2016 QI Project Guide provided step-by-step strategies and tools that guided members through a successful QI Project; from initiating a QI project, implementing processes, and evaluating improvement. The 2018 supplement contained information specifically selected to help VQI members improve prescribing rates for AP/ statins at discharge and improving EVAR LTFU imaging rates using tools provided by the SVS PSO and real-life case studies from members. This 2019 supplement will assist you, the VQI member, in initiating a quality improvement project at the center, regional, and national level while utilizing tools that other centers and regions have successfully implemented and have willingly shared to help our VQI system. The 2016 QI Project Guide and 2018 Supplement can be found at https://www.vqi.org/national-data/qi-project-management/ and https://www.vqi.org/wp- content/uploads/Member-Guide-v-June-2018.pdf, respectfully. Implementing an organizational change does not take place in a silo. A multi-, inter-disciplinary approach is needed to accomplish this feat. Getting all appropriate stakeholders involved in the process as early as possible is a must for a successful system level project. It is known in Systems Theory, that a microsystem is part of a macrosystem. According to Nelson, Batalden, & Godfrey (2007), a clinical microsystem is formed at the first exchange between a patient and a health care provider. Clinical microsystems are embedded in smaller systems which are embedded in larger systems.1 1 General Systems Theory (GST) was initially introduced in the 1930s by Karl Ludwig von Bertalanffy who stated:” The whole is more than the sum of its parts”. Systems Theory works on the premise of “No man is an island” and “It takes a village” ideology. Quality improvement (QI) necessitates an investment of time and resources at every level of the health system, and the VQI registry data provides the foundation for this work. All of us benefit from learning about each other’s QI successes and sharing ways of overcoming challenges. The purpose of this 2019 supplement is to take all of those isolated villages and islands (healthcare centers) and demonstrate through real-life case studies that the VQI membership can collaborate to create a strong platform for better patient outcomes and demonstrate a positive financial impact to SVS PSO healthcare centers. 1 Nelson, E., Batalden, P., & Godfrey, M. (2007). Quality by design: A clinical microsystems approach. San Francisco, CA: Jossey-Bass. Page 1 2019 QI Project Guide Supplement Utilizing Systems Theory for Successful Quality Improvement Projects Society for Vascular Surgery Patient Safety Organization The SVS PSO will continue to provide QI resources by providing: • Focus group discussions • Webinars on the QI initiatives • Monthly newsletters • More reports showing your data • Discussions at regional QI meetings • Increased communications with members and key stakeholders Cheryl Jackson, DNP, MS, RN, CNOR, CPHQ SVS PSO Director of Quality Page 2 2019 QI Project Guide Supplement Utilizing Systems Theory for Successful Quality Improvement Projects Society for Vascular Surgery Patient Safety Organization 2. Acknowledgements The SVS PSO would like to thank staff from the following VQI centers for their invaluable contributions. Their ability to successfully complete QI projects and their willingness to share their stories have helped the SVS PSO create a QI Project Guide Supplement that is practical and relevant to other VQI centers. Iowa Heart Center / Mercy Medical Center (Des Moines, IA) • Cynthia A. Bik, RN, BSN • David Chew, MD • David Ebaugh, MD Rocky Mountain Vascular Quality Initiative • Julie Beckstrom, RN, MSN, RN, CCRC • Ben Brooke, MD, PhD Participating Centers: • University of Utah • St. Luke’s Regional Medical Center (Boise, ID) • St. Vincent Healthcare (Billings, MT) • Carondelet Heart & Vascular Institute (Tucson, AZ) • Penrose St. Francis (Colorado Springs) • St. Patrick Hospital (Missoula, MT) Peter Munk Cardiac Centre (Toronto, Canada) • Naomi Eisenberg, PT, MEd, CCRP SVS PSO Contributors and Reviewers Carrie Bosela, RN, Director of Clinical Operations Jens Eldrup-Jorgensen, MD, Chief Medical Officer Nancy Heatley, Education and Research Projects Manager Cheryl Jackson, RN, Quality Director Dan Neal, Analytics Director James Wadzinski, Senior Director Yuanyuan Zhao, Statistician Page 3 2019 QI Project Guide Supplement Utilizing Systems Theory for Successful Quality Improvement Projects Society for Vascular Surgery Patient Safety Organization 3. Systems Theory and the SVS PSO The patient is the focal point of a healthcare system as shown in Figure 1 below. Figure 1 (Adapted from https://www.ncbi.nlm.nih.gov/books/NBK22878/, A Framework for a Systems Approach to Health Care Delivery) (Health Care professionals, family, data managers/abstractors, Health Care Centers, IT) Regional Groups Society for Vascular Surgery Patient Safety Organization VQI Page 4 2019 QI Project Guide Supplement Utilizing Systems Theory for Successful Quality Improvement Projects Society for Vascular Surgery Patient Safety Organization 4. Systems Theory at the CENTER Level The Care Team includes vascular providers (surgeons, cardiologists, radiologists, APNs, PAs), the family, data abstractors/managers, and all departments of a health center, including Informatics. (Figure 1, page 4) Although separate entities, they all need to work together to provide continuity in care with the goal of an optimal outcome for the patient. 4.1 Iowa Heart Center Case Study Iowa Heart Center (IHC) joined the SVS VQI in July 2012 and went through their second claims validation audit in the Fall of 2017, which covered cases performed in 2015. Every center participating in VQI is required to participate in the claims validation process to ensure consecutive procedure entry of appropriate cases and to eliminate inconsistencies between claims data and procedures entered into VQI. The purpose of the audit is to eliminate selection bias from the dataset by ensuring 100% of the eligible procedures are entered into the registry. Validation is accomplished by comparing procedures entered into the VQI registry with claims data provided by VQI participants and rectifying any inconsistencies between the two data sources. All new centers, who began collecting procedures in the prior calendar year, will be required to participate in the annual claims audit occurring the following year. A random number of previously reporting VQI centers will be selected annually to participate in the claims audit. Many QI tools were used by IHC: Swiss Cheese Model, Failure Modes and Effects Analysis (FMEA), Plan- Do-Check-Act (PDCA), and perseverance. After completing the validation audit, IHC discovered they had 12 unbilled patients. “The VQI Claims Validation Audit provided our practice with some incredible insight into our scheduling and billing processes we may never have discovered otherwise.” Cynthia Bik, RN Page 5 2019 QI Project Guide Supplement Utilizing Systems Theory for Successful Quality Improvement Projects Society for Vascular Surgery Patient Safety Organization What fell through the holes? • Emergencies • Add-on cases in the hospital • Bedside procedures • Hospital consults QI Tools used to facilitate a successful QI project: “I had recently watched a Webinar from the SVS PSO and thought I should give it a try.” C. Bik, RN “Starting a QI Project” https://drive.google.com/a/m2s.com/file/d/1e7ks3ugQ2-FM8HZSD6lmtKXSrn- R7J0s/view?usp=sharing 4.2 Failure Modes and Effects Analysis (FMEA) The Failure Mode and Effects Analysis is a structured approach to discover potential failures that may exist within a design or process. Developed in the 1950s, FMEA was one of the earliest structured reliability improvement methods. Today, it is still a highly effective method of lowering the possibility of failure. • Failure modes are the ways a process can fail. • Effects are the ways these failures lead to poor outcomes. • Effects analysis refers to studying the consequences of those failures or outcomes. • Define the FMEA topic
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