108 4.2.4 Quality Improvement Steps

Step 1: Get Started

• Identify the problem
• Ask – who can help me with this?
• Decide how big the change will be – one area or whole home?

Step 2: Get People on Board

• Determine who will be project lead (clinical and/or administrative)
• Build your project team
• Talk to your stakeholders (staff, residents, family members)
• Build awareness of your project in the home

Step 3: Take a Deeper Dive

• Identify the root causes of the problem (Ask the 5 Whys)
• Ask – Are we ready to make a change?
• Ask – What can help us? What can block us?

Step 4: Prepare for the Change

• Aim: What are we trying to accomplish?
  • Pick an issue that is important to those involved
  • Make your aim specific, measurable, actionable, relevant, time-limited (SMART)
• Measures: How will we know a change is an improvement?
  • Process Measures = Are we doing the right things to get there?
  • Outcome Measures = Where are we ultimately trying to go?
  • Balancing Measures = Has the change led to any unintended consequences (whether good or bad)?
• Changes: What changes can we make that will result in improvement?
  • Improve patient/provider interaction
  • Eliminate waste
  • Improve workflow
  • Change the work environment
  • Manage time
  • Reduce errors

Step 5: Plan, Do, Study, Act

• A Plan-Do-Study-Act (PDSA) Cycle is a useful tool for documenting &  testing out change ideas.
  1. Plan: Start by planning how to test a change.
  2. Do: Implement your plan and pilot the change. Collect data — keep it simple, this is not research!
  3. Study: Analyze what happened when the change was implemented. Summarize what you learned.
  4. Act: Determine whether this is a change worth maintaining or if modifications are needed (adopt, adapt or abandon).

Step 6: Celebrate, Sustain, and Spread