Quality Improvement Tools and Techniques

The adoption of systems-focused risk assessment techniques has not led to measurable improvement in the rate of patient harm. Why? In part, because these tools focus solely on understanding problems, and provide no direct support for designing and managing solutions (i.e., risk control). This second installment of a 2-part series on rebalancing risk management describes a structured approach to bridging this gap: The Active Risk Control (ARC) Toolkit. A pilot study is presented to show how ARC Toolkit can improve the quality of risk management practice.

Risk assessment, by itself, does nothing to reduce risk or improve safety. It can only change outcomes by informing the design and management of effective risk control interventions. But current practice in healthcare risk management suffers from an almost complete lack of support for risk control. This first installment of a 2-part series on rebalancing risk management describes a new framework to guide risk control practice: The Process for Active Risk Control.

BACKGROUND: Fishbone diagrams have been widely promoted as a systems-focused hazard analysis tool for use in root cause analysis, but they suffer from a number of structural weaknesses, including a unidirectional structure that only takes into account forces that promote an accident (ignoring those that make the accident less likely or less severe) and a means of displaying these forces that does not convey any difference in strength of influence. In a separate but related issue, many healthcare organizations suffer from a lack of change management expertise.

PROPOSED SOLUTION: To address these concerns, I present a novel technique, the Lovebug diagram, which draws from both Fishbone diagrams and force-field analysis (an approach to analyzing planned change). This new technique adds value to both its progenitor methods, while retaining their key strengths and ease of use. It can be used both prospectively, to assess planned changes, and retrospectively to assess unplanned (accidental) departures from the status quo.

DISCUSSION: The Lovebug diagram is a more powerful analytical tool than its progenitor methods; however, overall adoption of systems-focused tools for root cause analysis remains suboptimal. Additional research is needed to determine how best to promote a truly systems-focused approach to healthcare root cause analysis. Beyond this retrospective use of the technique, it represents a simple tool to assist healthcare organizations with prospective change management.

Available from: http://cri.sagepub.com/content/early/2013/10/25/1356262213510855.abstract

Current practice in healthcare risk management is supported by many tools for risk assessment (understanding problems), but none for risk control (solving problems).  The results: a failure to improve safety, and a waste of the investment made in risk assessment.  The Active Risk Control (ARC) Toolkit, available for free, fills this void with a systematic, structured approach to risk control.

INTRODUCTION
Quality improvement (QI) methods have
been introduced to healthcare to support
the delivery of care that is safe, timely,
effective, efficient, equitable and cost
effective. Of the many QI tools and
methods, the Plan-Do-Study-Act (PDSA)
cycle is one of the few that focuses on
the crux of change, the translation of
ideas and intentions into action. As such,
the PDSA cycle and the concept of iterative
tests of change are central to many
QI approaches, including the model for
improvement,1 lean,2 six sigma3 and total
quality management.4

PDSA provides a structured experimental
learning approach to testing changes.
Previously, concerns have been raised
regarding the fidelity of application of
PDSA method, which may undermine
learning efforts,5 the complexity of its
use in practice5 6 and as to the appropriateness
of the PDSA method to address
the significant challenges of healthcare
improvement.7

This article presents our reflections on
the full potential of using PDSA in
healthcare, but in doing so we explore
the inherent complexity and multiple
challenges of executing PDSA well.
Ultimately, we argue that the problem
with PDSA is the oversimplification of
the method as it has been translated into
healthcare and the failure to invest in a
rigorous and tailored application of the
approach.

The main objective of this research is to measure the level of knowledge, understanding, and implementation of quality management tools in a sample of the industrial sector in Saudi Arabia, and to monitor the different policies to implement the quality strategies and the extent of their integration into the industrial management systems in general. A questionnaire to cover key elements, including knowledge and understanding of the various quality management (QM) approaches and the accompanying tools, is implemented. The impact of using each QM approach on the level of actual growth of the industrial organisations is verified, along with the impact of the executive method of management and its compatibility with the proper implementation of quality tools. The results of the study indicate that different visions of QM strategies and policies are still adopted by industrial companies participating in the survey. In addition, there is a difference in the levels of understanding and implementation of QM tools and techniques. OPSOMMING Die doel van hierdie navorsing is om die vlak van kennis, begrip en implementering van gehaltebestuurgereedskap binne ʼn monster van die industriële sektor in Saoedi-Arabië te meet. Verder word die verskillende beleide om gehaltestrategieë te implementeer en die omvang van hul integrasie in industriële bestuurstelsels gemonitor. ʼn Vraelys wat sleutelelemente dek, insluitend kennis en begrip van die verskeie gehaltebestuur benaderings en die gepaardgaande gereedskap, is geïmplementeer. Die impak van die gebruik van elke gehaltebestuur benadering op die vlak van werklike groei van die organisasie is geverifieer saam met die impak van die uitvoerende bestuurstyl en die verenigbaarheid daarvan met die behoorlike implementering van gehaltebestuurgereedskap. Die resultate van die studie dui daarop dat verskillende visies van gehaltebestuurstrategieë en beleide nog in die proses is om aangeneem te word deur die maatskappye wat in die peiling deelgeneem het. Verder is daar ʼn verskil in die vlakke van begrip en implementering van gehaltebestuurgereedskap en tegnieke.