In this course you will learn about the importance of quality in healthcare and how you can contribute by implementing a quality improvement (QI) project to improve processes of care and patient outcomes. You will learn about powerful tools to add to your QI ‘toolbox’ during short lectures and reflective exercises. You will apply these tools to the implementation of a QI project in your own practice setting or an area of personal improvement. At the completion of the course, you will have a storyboard that captures your QI project success to share with others. The QI project will be considered within the context of interprofessional teams and from a systems perspective. The objective of this course is to empower you, the working healthcare professional, to improve your knowledge and skills in the science of quality improvement so that you can take action in your own clinical setting to improve the quality of care for your patients and their families.
Guest Lecturer: Shirley Moore
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From the course by Case Western Reserve University
Take the Lead on Healthcare Quality Improvement
20 ratings
Meet the Instructors
Mary A. Dolansky, PhD, RNAssociate Professor, Frances Payne Bolton School of Nursing; Director, QSEN Institute; VA Quality Senior Nurse Fellow, Louis Stokes Cleveland VA
Shirley Moore, PhD, RN, FAANEdward J. and Louise Mellen Professor of Nursing and Associate Dean of Research
Frances Payne Bolton School of Nursing
Mamta K Singh, MD, MSPhysician Director of the Center of Excellence in Primary Care Education, Louis Stokes Cleveland VA; Associate Professor of Medicine, School of Medicine
[MUSIC]
Hi, I'm Shirley Moore a professor of nursing at
Case Western Reserve University in Cleveland, Ohio.
I've been teaching quality improvement to health profession students for
the past 20 years, and was part of a team here at Case Western Reserve,
who developed the first course in the United States on quality improvement for
health profession students.
I've been asked to discuss a key concept in process improvement:
the concept of systems thinking.
Our lives are full of systems, personal systems, such as the systems we use to
buy and prepare our food, get ready for bed, or study for this course.
We are also often part of work place systems.
In the delivery of healthcare, we have systems for admitting and
discharging patients,
for administering medications, assessing patient needs, or
just getting someone to and from X-ray.
We're also surrounded by systems of our family, our community, and
the systems in our larger society and environment.
Some are micro systems and some are macro systems.
What do we mean when we refer to systems?
Systems are comprised of a set of individual components that
are designed for a specific purpose or an aim.
In fact, every system is perfectly designed to
produce exactly the outcome it achieves, a good outcome or
a bad one, but perfectly designed to achieve that outcome.
One of the great things about systems is that they can be changed.
We can improve a system by understanding its individual components,
how those components interact within that system or
with other systems, and we can then redesign the components of the system.
We can add components, remove components, reorder them, merge them.
When you think about it, it's a very powerful idea to think that you
can have the skills and tools to change systems, and thus, change outcomes.
So what is systems thinking?
Systems thinking is ability to recognize and understand the interactions and
interdependencies in a set of components that comprise a system.
This includes the ability to recognize patterns and
repetitions in these interactions, and an understanding of how those actions and
components can reinforce or counter act each other.
These relationships and patterns occur at different dimensions.
Temporal, spacial, social, technical, or cultural.
The ability to engage in systems thinking is a key component in
a successful delivery of safe and high quality healthcare.
In fact, systems thinking may be as important as critical thinking.
How healthcare professionals experience themselves in their work,
is shaped by the structure and processes of the systems in which they work.
Most professionals provide care in healthcare organizations that are complex,
multi-level, and multi-functional.
In your day-to-day work, your ability to engage in better problem solving,
priority setting, interactions and collaborations and
decision making, is greatly influenced by your ability to understand how any
one component of your work system is related to the whole of that system.
This is particularly true for yourselves who aim to improve health care systems.
But how well do you see and understand the systems around you?
There are a set of skills to learn about, understand, and improve systems.
You'll have the opportunity in this course to learn about and
use some of these skills.
Specifically the use of flow charts and fish bone diagrams.
These tools, and
others that you'll be introduced to, can be applied to any system.
A personal one, or the ones in your workplace.
You may want to try these tools first, to change a personal system in your life.
Such as getting more sleep,
eating healthier foods at lunch,
or having some more time for leisure type reading.
I teach systems thinking in the use of these tools to school age children to
change the habits in their daily lives to be more healthy.
Habits are systems, and our daily routines are often some of the systems that
we least recognize, understand, or go about changing in a deliberate way.
I've found that children as young as ten years old are able to learn about and
use flow charting of their daily routines, in order to understand them better.
And that children also use fish bone diagrams to consider possible
influences on their routines, and discover changes in them that could be healthier,
such as eating, sleeping, and getting exercise.
These children, and their families, have been quite successful at
using the process improvement techniques to improve their healthy living habits.
But, getting back to health care organizations,
some questions associated with systems thinking that you might consider are...
How do systems drive behavior?
How do daily work routines, and momentary behavior relate to the big picture?
How and why do responses to simple work problems sometimes escalate to
big irritations?
What are the unintended consequences of shortcuts and workarounds?
Examples of skills you can learn to have better systems thinking are:
The use of feedback in individual and group interactions;
seeking, and incorporating the views of others to promote understanding and
change; and the use of tools to examine the process in greater detail.
Other skills include how to look beyond a specific event to
determine the underlying cause, or recognize recurring patterns.
Or how to analyze a problem from a system perspective.
I'm happy to report that those of you who may be interested in
measuring your level of systems thinking, or that of your students or
colleagues, we now have a valid and reliable measure of systems thinking.
With the help of an expert panel, our team here at
Case Western Reserve University has designed the systems thinking scale.
This measurement scale consists of a 20 item questionnaire, to which individuals,
such as healthcare professionals, indicate the extent to which they engage in
systems thinking regarding the quality and safety in their daily work.
If you're interested in obtaining this measure of systems thinking,
you can contact Dr. Mary Dolansky or myself at Case Western Reserve University.
So think about the systems around you that you would like to improve.
Personal systems, such as getting more exercise or getting more sleep.
Our work system,
such as how to better engage families and
patients in their care, or the safer administration of medications.
Be more alert to the components of those systems and how they might be changed in
order to improve the system, and thus improve the outcome of that system.
I'd suggest that you'd start with a small system.
Engage a team of others to help you.
Use some of the new tools that you've been introduced to in this course
on quality improvement.
Seeing systems and engaging in systems thinking is a powerful way to
learn about and improve the quality and safety of healthcare.
I hope you enjoy changing systems as much as I do.
[MUSIC]
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