Practical tools for practices to improve quality

Practical tools for your QI project

We have developed/adapted some practical tools to support your journey to improve quality.

List of Tools and Templates with Sources:

Please note that some of the tools are available via links to the Institute of Healthcare Improvement's (IHI) website: www.IHI.org. To access the content, an account is necessary. Click on the "register" tab in the top right hand corner of the IHI homepage and then click on the create an account link.

Name of Tool	Source of Document	Link
Project Charter	DFCM worksheets	https://www.dropbox.com/s/i0k5xz6ys6hj79g/Project%20Charter%20Template.docx?dl=0 (Links to an external site.)
Driver Diagram	IHI QI Essentials Toolkit	http://www.ihi.org/resources/Pages/Tools/Driver-Diagram.aspx (Links to an external site.)
5W2H tool instruction sheet	OH (Quality)	https://www.dropbox.com/s/ptau3xb5an5je5v/pc-5w2h-method-en.docx?dl=0 (Links to an external site.)
Problem Statement instruction sheet	OH (Quality)	https://quorum.hqontario.ca/Portals/0/QI-Tools-and-Resources/Problem-Statement-Tool.pdf (Links to an external site.)
Process Mapping instruction sheet	OH (Quality)	https://www.dropbox.com/s/tdrla63l60w80cc/qi-process-mapping-instruction-sheet-ac-en.pdf?dl=0 (Links to an external site.)
5 Whys instruction sheet	OH (Quality)	https://quorum.hqontario.ca/Portals/0/QI-Tools-and-Resources/5-Why's-Tool.pdf (Links to an external site.)
Cause and Effect instructions and fillable form	IHI QI Essentials Toolkit	http://www.ihi.org/resources/Pages/Tools/CauseandEffectDiagram.aspx (Links to an external site.)
Failure Modes and Effects Analysis instructions and fillable form	IHI QI Essentials Toolkit	http://www.ihi.org/resources/Pages/Tools/FailureModesandEffectsAnalysisTool.aspx (Links to an external site.)
Measurement Plan tool	OH (Quality)	https://quorum.hqontario.ca/Portals/0/QI-Tools-and-Resources/Measurement-Plan-Tool.pdf (Links to an external site.)
Project Measures Worksheet	IHI	https://www.dropbox.com/s/e262ixlaofgs9xu/IHITool_QIProjectMeasuresWorksheet.pdf?dl=0 (Links to an external site.)
Interpreting run chart	OH (Quality)	https://quorum.hqontario.ca/Portals/0/QI-Tools-and-Resources/Run-and-Shewart-Charts-Tool.pdf (Links to an external site.)
Change idea worksheet	DFCM worksheets	https://www.dropbox.com/s/bot6vloxfs1pbft/Worksheet%20-%20Change%20Ideas.docx?dl=0 (Links to an external site.)
PDSA Worksheet and fillable form	IHI	http://www.ihi.org/resources/Pages/Tools/PlanDoStudyActWorksheet.aspx (Links to an external site.)
PDSA fillable form	OH (Quality)	https://www.dropbox.com/s/tmow04v8xyf83ui/PDSA%20Fillable%20Form.docx?dl=0 (Links to an external site.)
Sustainability Planner	OH (Quality)	https://quorum.hqontario.ca/Portals/0/QI-Tools-and-Resources/Sustainability-Planner-Tool.pdf (Links to an external site.
Spread Planner	IHI	http://www.ihi.org/resources/Pages/Tools/SpreadPlanner.aspx (Links to an external site.)

Accessing data for your practice

HQO MyPractice Report

https://www.hqontario.ca/quality-improvement/practice-reports/primary-care

Learn even more about your practice by signing up for a confidential report that includes personalized data, along with suggestions to support you in improving care for your patients.

Screening Activity Report (SAR)

https://www.cancercareontario.ca/en/guidelines-advice/treatment-modality/primary-care/screening-activity-report

The SAR is an online tool available to primary care physicians who practice as part of a patient enrolment model, It provides screening data for breast, cervical and colorectal cancers to help physicians improve their cancer screening rates and appropriate follow-up. The report platform is interactive, allowing physicians to quickly find specific cancer screening information for each patient.

OntarioMD Dashboard

https://www.ontariomd.ca/products-and-services/insights4care/i4c-dashboard

OntarioMD has developed an EMR-integrated, actionable population health management tool that gives clinicians real-time visual representation of their EMR data using widely recognized primary care indicators each representing different preventive care and chronic disease management focus points (diabetes test results, smoking status, etc). The dashboard enables clinicians to drill down to patient-level data for each indicator and take immediate proactive steps to improve patient care. Email support@ontariomd.com to find out how to start using the dashboard in your practice

UTOPIAN - DFCM

https://www.dfcm.utoronto.ca/about-utopian

UTOPIAN can provide practices with de-identified patient data from the practice Electronic Medical Record, summarizing practice demographics and information on quality of care.

Ethics, privacy and consent

We do not need formal ethics review for local QI work that will not be published but regardless, we should always consider issues related to ethics, privacy, and consent.

Ethics

We engage in QI work to improve care for patients but sometimes our actions can have unintended harm or risk. Some of the potential harms that we think about related to efforts to improve quality include:

Privacy breaches
Opportunity costs
Patient distress resulting from interviews about a sensitive issue
Staff distress resulting from disclosure of poor performance

When designing your QI initiative, consider how to minimize potential harms and risks to patients and providers.

Privacy

When conducting your quality improvement initiative, it is important to follow strict procedures to protect patient and staff privacy including:

Storing hard copies of data in a secure location and shredding when no longer needed
Storing soft copies of data on secured drives with limited access
Limiting the amount of information collected or stored together
De-identifying data for presentations or reports (e.g. not presenting identifiable information in quotes, suppressing cell size where n<6)

Informed consent

When interviewing staff or patients for an improvement initiative, ensure they are informed about:

Why you are doing the interview
How you will use their data
Steps you are taking to protect their privacy
Opportunities to learn about how their data and your project impacted care

Disseminating your QI work

We can think creatively about ways to disseminate our results with others – from a blog, to commentaries, to presentations, to a QI report, to a more traditional peer-reviewed publication. Here are some avenues to consider.

Blogs

Share your improvement experiences with other colleagues engaged in improvement work via Quorum (hosted by Ontario Health)
Share your experience with patients through HealthyDebate
Many medical journals have associated blogs that would be good venues to share reflections

Presentations

The following conferences offer great opportunities to present primary care QI work:

Peer-reviewed publications

Full research papers can be published in a number of reputable journals. If a full research paper seems out of reach, here are some other options to consider:

QI report in BMJ Quality Open
Program Description or Commentary in Canadian Family Physician
Innovations section in CMAJ
Innovation report in Annals of Family Medicine

QI Professional Development

Maintaining knowledge and skills to improve quality is required to nurture a culture of curiosity and desire for ‘better’. There are many opportunities to continue your education in this regard:

Certificate programs:

Centre for Quality Improvement & Patient Safety https://www.cquips.ca

Institute for Health Care Improvement - Improvement Advisor http://www.ihi.org/education/InPersonTraining/improvement-advisor/Pages/default.aspx

Degree programs:

Institute for Health Care Improvement (IHI) Open School

http://www.ihi.org/education/Pages/default.aspx

University of Toronto’s Institute of Health Policy, Management and Evaluation (IHPME) Master of Science in Quality Improvement & Patient Safety

https://ihpme.utoronto.ca/academics/rd/qips-msc/

Queen’s University - Master of Science in Healthcare Quality

https://healthsci.queensu.ca/hqprograms/programs/master-science-healthcare-quality

Queen’s University - Doctor of Philosophy in Quality

https://healthsci.queensu.ca/hqprograms/programs/doctor-philosophy-health-quality

Fellowships:

VA Quality Scholars: https://www.deptmedicine.utoronto.ca/veteran-affairs-quality-scholars-vaqs

Resources for faculty

QI Publication Funding

Purpose

To help support DFCM faculty who have had peer-reviewed articles focused on improving quality accepted for publication.

Award

The DFCM will award 50% of a publication acceptance fee up to a maximum of $1,000 CAD per publication. An applicant must demonstrate availability of matching funds. Awards are based on availability of funds.

Eligibility

All faculty in the Department of Family and Community Medicine are eligible to apply. Preference will be given to Quality and Innovation Program Directors. The faculty member must be either first author or senior responsible author. Publications should relate to improving quality in primary care and summarize results of an original intervention. A maximum of one award will be granted per person per calendar year (January 1 - December 31).

Requirements

Completion of the online form.