How are QI projects structured?

What do I want to improve?

• Define your goal with an AIM statement that follows the SMART guidelines. Using a project charter as a guide can help define and organize your project for all team members.

Do I need to get approval prior to starting?

• Performing quality improvement projects does not require traditional IRB approval, however IRB approval is always recommended and is required if you plan to disseminate your quality improvement project as a presentation, poster, or publication. The IRB approval process for quality improvement is typically different from the process for research. If you are even considering disseminating your project, it is important to submit your project to the appropriate review body so they can deem it a quality improvement project and provide approval. Local hospitals will also require approval for QI projects taking place in their institutions.

Where are we starting/what should I change?

• RedCap can help compile data obtained during manual chart review or survey. It is a free resource available to KUMC students, residents, and faculty.
• Flowchart/Process Map: A flowchart or process map is a visual representation of the sequence of steps in a process. Understanding the process as it currently operates is an important step in developing ideas about how to improve.
• Fishbone/Ishikawa Diagram (also known as Cause and Effect diagram): A fishbone diagram is an educational tool that helps teams explore and display the many causes contributing to a certain effect or outcome. It graphically displays the relationship of the causes to the effect and to each other, helping teams identify areas for improvement.
• Pareto Analysis: A Pareto chart is a type of bar chart in which the various factors that contribute to an overall effect are arranged in order from the largest to the smallest contribution to the effect. This ordering helps identify the "vital few" (the factors that have the largest contribution to the effect and warrant the most attention).

Is change an improvement?

• Run Chart: A run chart is a graph of data over time. Run charts are the most basic form of graphical outcome data to include with a quality improvement project and should be included in every project with rare exceptions. They help improvement teams decide how well (or poorly) a process is performing, understand the value of a particular change, and begin to distinguish between common and special causes of variation. Tools for analyzing run charts to identify if change is happening as a result of the project (special cause variation) can be found here.
• Control Chart: A control chart is similar to a run chart but includes an upper control limit and a lower control limit. It goes further to help teams distinguish between common and special causes of variation within a process. Use a control chart when you have more than 15 data points and/or want more insight into your data and/or are monitoring a process for deviations from expected outcomes.
• Common vs. Special Cause Variation: Common cause variation is random and inherent to the process; no process, particularly processes involving humans, performs exactly the same way every time. Special cause variation is non-random and suggests that a change is occurring. Those changes could be intentional (i.e., part of a project with an aim to produce change) or unintentional (i.e., something new, but unplanned is happening in your process). When used in conjunction with active quality improvement projects, identifying special cause variation within your run charts and control charts will confirm whether or not you have made a true change. How to identify special cause variation on run charts (by identifying shifts, trends, runs) can be found here.

What other online resources are available?

• The Institute for Healthcare Improvement provides a free resource via the IHI Open School Curriculum.
  • Sign up for an account here.
  • Basic QI concepts are discussed in QI 101, QI 102, QI 103, QI 104, QI 105.
• Stanford's RITE Tutorials provide short video lectures on common QI topics.