Survey staff views of current eol care 2 do analyze

Survey staff views of current EOL care
2. DO:
• Analyze survey results, identify gaps in care
• Select interventions:
• Signage when patient actively dying
• Staff communication sheet at bedside
• Standardized order set for analgesia and
sedation (after withdrawing care)
• Single room for dying patients
• Case review rounds (EOL staff education)

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3. Study:
Are the interventions ALL occurring
consistently? Why or why not?
How are staff responding to the interventions
(e.g., engaged, supportive, uninterested)?
Are the interventions sustainable?
4. Act:
Committee discusses/reviews observations
about interventions
Re-surveys staff to understand which
interventions they like, what needs to be
tailored, other recommendations
Signage and order sets now used throughout
hospital
Six Sigma
• “sigma” ( σ ) denotes standard deviation in statistics
• Six sigma is a measurement-based strategy for
process improvement done using a 5 stage process:
• DMAIC (define, measure, analyze, improve,
control)
• PDSA and Six Sigma interrelated:
PDSA Six Sigma
Plan Defining core processes &
key customer requirements
Do Measuring performance
Study Analyzing
Act Improving and Integrating
Source : Hughes, R.G. Senior Health Scientist Administrator at Agency for Healthcare Research and Quality
(AHRQ). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 44. Tools and Strategies
for Quality Improvement and Patient Safety., pg. 3-1. 2008.
Toyota Lean Manufacturing System
• Continuous improvement method, uses Six Sigma
• eliminates non-value added activities (waste)
• Kaizen Events:
• Formalized, focused rapid improvement events
• Root Cause Analysis:
• Uncovers underlying causes of an event or error
by looking at enabling factors
• Concentrates on system and process factors, not
individual factors (consistent with IOM, 1999)
• successfully used in healthcare to increase
effectiveness of patient care and decrease costs in
pathology labs, pharmacies, and blood banks
Source : Hughes, R.G. Senior Health Scientist Administrator at Agency for Healthcare Research and Quality
(AHRQ). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 44. Tools and
Strategies for Quality Improvement and Patient Safety., pg. 3-1. 2008
.

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Video: Kaizen in Healthcare
Small Group AcRvity #1
(Donabedian, FADE, PDSA)
3. Logic Models
Source : University of Wisconsin-Extension Cooperative Extension Program Development and Evaluation.
Developing a logic model: Teaching and training guide. Website: .

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Logic Models
• Antecedents and footprints of logic model
thinking are in TQM and other QI strategies
• In healthcare, often used by:
• public health organizations to design,
evaluate and improve programs
• funding agencies to understand the theory
underlying a proposed program/project and
how outcomes will be achieved
• can apply to a:
• small program
• large, multi-component program
• process
• business or organization