Quality Improvement in Healthcare
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- เผยแพร่เมื่อ 27 ก.ย. 2024
- Thanks to St. Michael's Hospital www.stmichaelsh..., Health Quality Ontario www.hqontario.ca, and Institute for Healthcare Improvement www.ihi.org
Check out our new website www.evanshealth...
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Dr. Mike Evans is a staff physician at St. Michael's Hospital and an Associate Professor of Family Medicine. He is a Scientist at the Li Ka Shing Knowledge Institute and has an endowed Chair in Patient Engagement and Childhood Nutrition at the University of Toronto.
Written, Narrated and Produced by Dr. Mike Evans
Illustrations by Liisa Sorsa
Directed and Photographed by Mark Ellam
Produced by Nick De Pencier
Editor, David Schmidt
Story/Graphic Facilitator, Disa Kauk
Production Assistant, Chris Niesing
Director of Operations, Mike Heinrich
©2014 Michael Evans and Reframe Health Films Inc.
Watched this for a class and woah did I learn a lot. This is the most helpful and clear video on QI I've seen to date. Thank you so much. The lessons and wisdom you share can be applied to so much more than healthcare. I even took parenting and general life lessons from here. Than you, really.
I love the connection made between motivational interviewing with quality improvement.
A very insightful video and applicable to more than just the healthcare system. The methods discussed can be used in people's day to day lives to achieve personal goals, as well as to improve business productivity, and processes involved in specific industries. It seems a huge problem we have is to focus on the problems but we forget that we have the power to change them. It may not be possibly to implement a quick fix to rectify an issue, however, with small steps that lead to a planned goal, change can be implemented.
Oh, and I found the 'video within a video' quite appealing and thought it was beneficial to put a quote from another thinker in there.
Wanted an overview that wasn’t the rambling 58 minute uploaded lecture that got straight to the point without a ton of tangents, thanks for making this.
Being a system thinker is definitely useful in QI initiatives. Constant curiosity and asking how we can improve makes us better leaders. Quality Improvement is a continuous process. Always finding ways how we can do things better.
Thanks Dr Evans for making it easy to understand QI and how to apply PDSA in practice
Fantastic presentation. Will share with my nursing students.
Watching for my QI in healthcare class in 2017, still relevant, glad I found it!! Thank you!
This gave me a better understanding of QI and the processes involved to bring about change. I highly recommend this to everyone, not just those who are working in healthcare, but those in other industries working towards making them better.
OMG!!!- your introduction to QI ia faaaaantastic. Its just what I was looking for. A breif intervention for QI ludites. EVERYONE should watch it.
I was mesmerized by the drawings...I think the content really stuck more because I was so fascinated!
I saw this 4 years ago and it really helped me, and I just watched it today, and its still very good information. Thank-you, and I like the video in the clip it does make it better.
1. Aim 2. measure for improvement 3. test one change PDSA 4. adapt/adopt/dischard
I agree with this video. If doctors and physicians expect their patients to adjust their daily life, patients should be able to expect health care professionals to do the same. There is a difference between recognizing something is wrong in healthcare, compared to knowing how to prevent it. Seemingly small behaviors such as improving hand washing technique can have a positive ripple effect throughout the healthcare system. Healthcare needs to be able to measure if changes actually lead to improvement. In the video they discussed the PDSA cycle and I highly agree with it. However, I feel that most hospitals either disregard or slack when it comes to this cycle. If hospitals are motivated enough to see improved they will do this cycle of planning a change, doing the change, study the change results, then act on those results. Health care professionals need to adapt, adopt, or discard the results of these changes. I believe hospitals and their employees need to view this video and learn more about quality improvement.
"Some is not a number and soon is not a time."
Enjoyed your Video!!! I'm a visual learner. The concepts and images you used created a mental picture of what continuous quality improvement means.Good Job!
I love this, simple and understandable thank you
so touching for an excellent video
A career in this field would be amazing!
The videos are perfect to reach a wide audience. Thank you for these.
Great video! The illustrations were wonderful and kept it interesting - thanks for the encouragement!
Great, succinct, engaging video
amazing video, current mhs student specializing in leadership. very helpful video, alot of insight!
Loved the video! As a Public Health student studying for an upcoming exam on quality of care, hearing about quality improvement in an easily understandable way is quite helpful. :)
I find it of the upmost importance to ensure that healthcare improves. Many people are killed or injured from simple error of healthcare professionals. I understand some mistakes can simply not be avoided and we are indeed human, but many mistakes are just careless error and I find this unacceptable. I believe healthcare workers should always make quality healthcare their first priority, and do their best to leave their personal lives 'at the door' as they walk into work. I found it astonishing that one study showed that 247 deaths happen each day from hospital infections in the US from inadequate hand washing. This is an area that can easily be fixed by paying close attention to basic standards of healthcare. I agree with the videos three standards of change. Simple practices such as documenting hand washing can make a huge difference in the future. I also agree with how difficult it may be to get people to change. With collaboration and time, I believe it can get done. One study showed the importance of patient centered care, and how it increased quality improvement in healthcare. As a future OT, client centered practice is one area that we always focus on. My professors always stress the importance of making the treatment meaningful to the individual for maximal benefit. I am glad to see that other practices are adopting this mindset as well.
this was great, very thought provoking and interesting!
Appreciate the video. A lot covered with use of the drawings. Starting simple is best. Making small incremental steps is what many of us overlook. Thanks for reminding me of what is necessary to be a change agent. keep them coming.
Still absolutely relevent, and a great summary of quality improvement.
Thank you Dr. Mike that was wonderful!
This is also applicable to animal medicine as well. Great information here! Thanks!
thanks, this helped with my HIT course
Dr Mike;
An excellent and "good news" presentation. Some of the improvements obtained were really amazing. The dropped-in video was a very good idea. It lets us see the human face of improvement.
One comment about quality improvement and control. In industry, the word quality means making sure that the standards and procedures are followed exactly.But when this word gets it out of its cage and into the hands of non technical and or non business types like medical practitioners, its meaning changes. This is no surprise, the general population thinks of quality as well designed, effective, reliable and even beautiful.
What you are really talking about with these improvements, as Deming would say, is "continuous improvement" of a delivery system, or "kaizen" in Japanese. As examples, quality control of handwashing is making sure that doctors and nurses do this exactly as instructed. Quality improvement and continuous improvement gets more interesting. Now you ask are they all using enough soap and washing long enough? Do all the dispensers contain the same soap? Are the ingredients really anti-bacterial?
Are there better, more expensive ingredients that are much more effective? Some harmful ingredients were removed from the dispensers in hospitals last year. There are no signs or recordings warning people with colds to wear masks as they enter the hospital !!
Now when we come to continuous improvement, you touched on this in your video, when you said we must be sure that the handwashing really works. A systems approach would look at all factors that cause illness in the hospital setting. This gets back to what you did in your 23-1/2 hour video. Viruses are very common causes of diseases in emergency rooms. Why don't doctors and nurses wear masks when they themselves are breathing the air around patients and carrying the viruses from room to room? Why are old bandages, pads and syringes often seen on the floor of emergency rooms? Are the rooms really cleaned thoroughly? What are the most effective ways to really scrub C. Diffficile and other nasty viruses from rooms? Hydrogen peroxide? Irradiation of rooms? What about the air filtration systems in hospitals?
Yes, it gets very complicated and expensive quickly. But some of the low hanging fruit is not being plucked. Doctors and nurses do not wear masks all the time, probably because they don't wearing them. When they tried to force nurses who didn't get the flu shot to wear masks, this was more about forcing everyone to comply and support the drug industry than help patients.The chemicals used to wash floors and walls do not appear to be especially effective. Like you say, it's actually very fascinating, not boring.
Congrats! This video was very instructional and fun at the same time. I find the way you included the video was great: short, right to the point and it felt like it belonged with the drawings.
A retired nurse here ~Just as an aside: while it's necessary to have "thinkers" (i.e. in boardrooms & on their laptop computers)...can someone not get a warm blanket for those seniors on stretchers awaiting care? or stop to ensure they are sipping a drink (flds)? or just bending over to make eye contact with them & offer a warm smile? "Doing the right thing" isn't just about systemic changes, it's about patient-focused practical care. And that starts with ME and it starts with YOU. But yes, please sanitize or wash your hands before giving any care; & wear a mask as appropriate; & get inoculated to protect others & just live what you preach by example. 👍
Very interesting approach .
I think it would be good to include videos into your videos. Just make sure there are not too many and they're kept short. I still want to see your drawings!
I second this
While it may seem that both the pros and cons of screening seem almost hand in hand, the choice to do annual screening tests. Even though sometimes these test can be a little misleading and not as black and white as we hope. But some knowledge is better than no knowledge. Also even though some of the test that are run are not very beneficial for those who are not at risk, it does help those who are. By getting screened for certain diseases the general knowledge of the overall health of people can be better looked upon. With some of the test creating false advertising of a patient's health, I believe that it is worth the time and effort. If I am misdiagnosed with something that I do not have, is definitely better than not taking the chance to even knowing where my health is even at. As far as being misdiagnosed with nothing when actually there is something wrong, that is just the something that comes with life. No one is ever perfect, and most diseases are hard to catch to begin with. It is just the chance that you are willing to take if you are willing to benefit and further your knowledge of your own personal health.
This was good. Wow some pretty crazy statistics in this video. Got me thinking
I liked the video and the illustrations are fantastic. Very informative.
Loved this video - really simplifies and takes the mystery out of QI . Thought the video inside the video was great example of mixed media
A wonderful video with a great message. Thank you, Dr. Mike! I will be sharing this and your other videos with my healthcare students in the future.
Love this!!! Will use all that I learn from this on my nursing licensure exam, and in my day to day activities!
Excellent simple video, thank you!...wish this could be the intro to the QI concept in medical school and residency as this is so much more engaging than that with which we're usually presented!
this has helped me in my meeting as I suggest improvements in workflow!
Thanks for this intro to QI in healthcare, a nice overview
You are very easy to listen to.
Great presentation. Very practical & effective.
Tragically, many deaths happen in hospitals that are completely preventable. Many things need to improve which include implementing strategies found in this video which all have to do with improving the quality of the health care system. In this video, it is explained that a staggering number of deaths in hospitals could have been prevented if patients and healthcare providers were not subject to the broken system of the hospitals they work in. I argue that there are many areas of improvement in the healthcare system and the first one is creating and implementing patient safety better protocols in hospitals. Some strategies of patient safety protocols include more in-depth patient identification (much of which includes being informed of different medical issues various races and cultures face), infection control, hand hygiene, and medical safety. Secondly, hospitals need to adopt an environment of safety as they have and live by a mission statement where there are shared attitudes, beliefs, and goals that shape each employee’s behavior and ultimately the behavior of the organization and system in which they work. What does this mean? Having a culture of safety involves making it a safe place to report and learn from mistakes and having honest and meaningful relationships with superiors and patients. Systemic work needs to be involved in changing the results of hospitals as the goal is to save lives. We must make simple, measurable, meaningful goals as healthcare professionals that are doable among employees. This video emphasizes the importance of making small tweaks regularly that can lead to amazing systemic results. It is important to note among hospitals that one small change can have a rippling effect on the hospital. One bad case that leads to a lawsuit can change every future case in the hospital. Its time to implore preventative medicine. It is essential to have a protocol that is well-known, and concise, yet open to change among employees so that it can be as effective and quality focused as possible.
Great, very helpful for my healthcare project 👍🏻 thanks
I enjoyed watching and learning from your video. The drawings along with the words and narration made it very easy to understand and apply the knowledge. Thanks!
Thanks Dr. Evans for making an entertaining and very educational and thought provoking video. This has change my attitude about QI and it was a delight to learn through your fun presentation. Love the drawings :-) God bless you and your team. Que Dieu vous benisse... ;-)
What a great video. The ideas to adapt into practice simple and realistic and I feel would be very effective, will be adapting my practice to include these ideas.
The video definitely helps. Thanks
This video is priceless. Thank you
Great video and videos overall. Topics that make one think and superbly presented. Embedded videos are fine as long as they contextual snippets kept at a reasonable length.
Good video.
i really liked the video within the video to help clarify!!! plus your voice is so soothing thank you so much for that clarification
I know this is a little late...but I liked the video in a video. Helps put pieces together as I've used some IHI stuff before. Thanks!
This is great! thank you!
Many of us look for our doctors to take care of our every dying need, for them to make sure we healthy. When in all actuality it starts with us. We have to make sure we improve ourselves, in our daily lives. Making sure we eat right, don’t smoke, and just making sure we are taking the right steps in order to make less visits to our doctors. When they say it’s in our attitude that is very much true, because having a negative attitude about things will not make anything better for the situation. It is a good thing for you to keep trying if one thing doesn't work. It’s a process of trial and error, just as long as you make it to whatever works for you. And once you find that one thing stick to it until you need to switch to another strategy. Don Berwick was one to realize that he could learn from the kids he saw in his clinic, which is a god thing because even the young ones can teach you some new things. The system thinker is one who is always curious, who doesn't know the whole answer but take the proper steps to get to the next step. Children are by nature System thinkers by Berwick. By changing the way we live our lives could decrease the negative outcomes of health care.
Thank you I really enjoyed this. It was fast paced (I had to press pause a few times to make notes !!) but that wasn't a problem and the cartoons provided energy. I thought a video within this video worked well.
very good presentation. thx
Thank you for the information. I am looking for information on the Donebedian model and found this. You make the process a little easier to understand. Just need more input at this time. P.S. The vid-in-vid is a nice touch.
A very thought provoking and engaging video! Thank you!
thank you!
Very informative video, thank you
Great video with great concepts and illustrations. Video in video was fine - I enjoyed putting a face with a name. I appreciated that you highlighted the potential for innovation fatigue. As an RN, I am often "overloaded with requests for practice change" as you mentioned. I would venture to guess that innovation fatigue is directly related to nurse fatigue... I guess I have my next quality improvement project. :)
Thank you, awesome video, on target with message.
Great video as always! Do you happen to have a link to the study you mentioned (at 5:35) regarding a handwashing poster creating a 1/3 improvement in handwashing over a 2 week period?
i have a 10 powerpoint presentation in university, I have to think of a service improvement and talk about it... so worried as i have no idea; especially since i havent had any experience...
Here is an entertaining video on Quality Improvement
Great talk. I was a bit dizzy after watching that though.
How does the pain scale continue to be mandated by the VA and The Joint Commission even though Opioid Crisis started around the same time as the initiation of the pain scale requirement? I think the pendulum swung too hard on this QI. There are so many regulations are not continued to be monitored for desired affecting wasting physician time and risking patient's health as well.
I love this video! It also led me to IHI
im deaf but not blind... thanks to you you add letters :)
very good, thanks a lot
There are a lot of improvements that can be made to our healthcare system, starting with the amount of patients killed due to doctors mistakes. When it comes to being a doctor it is about treating people and even saving lives, some are the careless mistakes made as the video mentions cost so many individuals their life. Something like hand washing causing 247 each day should not be happening. It is sad to think that there are so many infections caused simply because doctors are not properly washing their hands. By changing the system we can lower the amount of negative outcomes in the healthcare field. By making changes and measuring the improvement, there can be a positive impact on patient care. The number of deaths caused by easily avoidable mistakes should be much lower and can be reduced to improve the quality of healthcare people receive.
thank you for your awesome advice that is very important for our parents anyway, Dr, who's have had a decision as a surgery don't make mistakes before not to be a complete of the patients survey past the situation similarly incident the case,
Is hanging a different handwashing sign really something that gives a sustained effect, or is that a short-term "Hawthorne Effect" at work? Dr. Deming would have taught to look at data over time, not just a two data point comparison of before and after.
+Mark Graban... 'sustained effect' only matters if you are eager to eliminate the cost of Logo Writers and Poster Painters. But re the video, I suspect "regularly changing the hand-washing sign" is the intervention.
It is absolutely startling that 44,000-98,000 people in the U.S. are dying from preventable errors every year. Health Care Management companies, such as Blue Cross & Blue Shield, have made dramatic improvements in cost due to enforced policies with their members. By creating financial incentives (or financial penalties) to encourage people to exercise or quit smoking, wellness incentives have become the norm in health care management. What previously was considered intrusive by employees, has become the norm in corporate America. It seems the time is right to use these same types of incentives with providers to reduce errors and improve outcomes. This could include financial surcharges on providers or health systems if certain metrics are not met, or financial bonuses if the metrics are exceeded.
Great Video. Very Informative.
great effort
I hate doing group project
Great video!
The vid dropped in was good :-)
It TOTAL this was a great presentation 😀👍🏾
can i get a reference list this is really excellent
What kinds of Software did you use to make this animation video sir?
So fantastic !
Hi Doctor, IATF: 16949 or AS9100 are QMS standards widely known in Auto and Aero industry. Can you name similar level stds in healthcare for me to read further.
Is there a way to review the study you reference about the hospital in Timmins? I am working toward my MPH and writing a piece on using the Donebedian Model to improve patient outcomes. Thank you for your help.
Nice video!!
Some CARE... “On April 30, 2021, Ontario’s physician licensing body, the College of Physicians and Surgeons of Ontario (CPSO), issued a statement forbidding physicians from questioning or debating any or all of the official measures imposed in response to COVID-19.”
Interesting video, it does make me think what we can do as nurses (the little guys) in big corporations. Yes, we are the heart of the hospitals BUT if we brought up a QI potential observation for improvement would it really be heard, or is the source usually just coming from the numbers where saving money can be accomplished instead of lives...
Everyday we try to improve something about ourselves or the way we go about things. Some improvements are so minuscule that we do not even notice them. However, something we can all appreciate is the quality improvement of healthcare. Some errors are over looked and do not even come into discussion where we can improve. Take the washing hand statistic. 44,000-98,000 people in the U.S. die from preventable errors every year. We do not need to flip the entire system, but the objective is to become more efficient in what we do in the healthcare field. With improvement comes change and not everyone is okay with change. As Dr. Evans stated "people can become overwhelmed with change." As humans we like to be set in routines that go smoothly. Any bump in the road can steer us in the wrong direction and become lost. Small changes can be good and overtime can accumulate into something greater. Take the study of fractured hip patients in St. Micheal's Hospital. The tweak in the system of getting to the patients in the ER bumped the percentage of patients receiving surgery in a 48 hour period from 66% to 90%. Even though not every change will make that big of an impact it is still a goal to improve.
Om pure and simple and
The American health care system has serious problems with quality and safety. Ethical issues arise in QI because attempts to improve the quality of care for some patients may sometimes inadvertently cause harm, or may benefit some patients at the expense of others, or may waste limited health-care resources. Ethical issues also arise because some activities aimed at improvement have been interpreted as a form of medical research in which patients are used as subjects. Is this the most effective and reasonable way to regulate QI to ensure that it is carried out in an ethical fashion?
Definitely improved your messaging. Life tools. Perpetual curiosity...I think Benjamin Franklin and Thomas Jefferson to begin with.. were as such.
completed by LP
nice drawings!!
@DocMikeEvans i am Dyslexic and enjoy your videos very much. For me personally i rather not to see a person as this extra stimuli is a little distracting.
let me explain
When i see characters I rather them to be neutral if possible (without gender, features) kind of like a cartoon or shaded character. I did find that i was paying more attention to what Dr Don was wearing and his hair trying even trying to figure out his cultural identity.
a quick suggestion alternative to a visual video maybe using audio only instead would be meeting you part way.
just a thought but i wonder if others also felt or did the same.
:)
Systems help… humans matter.
If I am supposed to be doing quality improvement as back broken clinician.....what the fuck are CEO's managers and quality improvement technocrats meant to be doing.....!!? My QIP is to schedule work for the managers and CEO by the hour and appraise them on ROI ....their annual appraisal shoudl be based on QALY saved or money saved by their quality improvement ideas....I am not a peasant and they are not my landlords.