1. Application of Quality
Improvement Tools:
In the face of a diarrhea outbreak
within a hospital in Viet Nam
Thuy Trang Nguyen Thi
Hloliphani Juta
Jasmine Paul
Lara Kesteloo
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2. Fishbone Analysis: Exploring
Cause and Effect
Methods People
Machines
Staff: Health
Hand washing, Equipment, Care Team,
Cleaning, PPE, Central Cleaning,
Isolation Cleaning Patients, Types
Procedures of Admissions
Beds, Data Hospital, bed
Bathrooms, Collection, sharing, frequent
IV’s, Infection disasters,
Commodes, Prevention underdeveloped
Bedpans, and Control medical system
Materials Measurement Environment
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4. Discarded Tools
3. Adverse Drug Effect Trigger tool
“Triggers” used to identify level of hard that the medical care causes.
4. STAR Separateness
Talking and Action
listening
Reason to
work together
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6. 5 P Tool Application
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7. References
Cleary, B. A. (1995). Supporting empowerment with Deming′s PDSA cycle. Empowerment in Organizations, 3(2), 34-39.
doi:10.1108/09684899510089310
Consultative Group to Assist the Poor. (2007). The STAR tool: Analyzing funders’ effectiveness and defining comparative
advantage. Retrieved April 22, 2012, from http://www.cgap.org/gm/document-1.9.2277/StarTool.pdf
Gill, M., & Gray, M. (2006). Using Clinical Microsystems and Mesosystems as enablers for service improvement in mental
health services. Retrieved from http://www.lj.se/info_files/infosida31595/micro_mesosystems_mjg_mdg.pdf
George, M.L. (2003). Learn six sigma for service: How to use lean speed and six sigma quality to improve sciences and
transactions. NY, NY: McGraw-Hill
Godfrey, M. M., Nelson, E. C., Batalden, P. B., Wasson, J. H., Mohr, J. J., Huber, T., & Headrisk, L. (2004). Clinical
microsystem action guide: Improving health care by improving your microsystem [Action Guide 2.1]. Retrieved from
Microsystem Academy: http://clinicalmicrosystem.org/materials/workbooks/action_guide/CMAG040104.pdf
Harris, J. L., & Roussel, L. (2010). Initiating and sustaining the clinical nurse leader role: A practical guide. Sudbury, MA:
Jones and Bartlett.
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8. References
Institute for Healthcare Improvement. (2012). Institute for healthcare improvement outpatient adverse event trigger tool.
Retrieved April 22, 2012, from http://www.ihi.org/knowledge/Pages/Tools/OutpatientAdverseEventTriggerTool.aspx
Institute for Healthcare Improvement. (2012). SBAR technique for communication: A situational briefing model. Retrieved
April 22, 2012, from
http://www.ihi.org/knowledge/Pages/Tools/SBARTechniqueforCommunicationASituationalBriefingModel.aspx
Li, S., & Lee, L. (2011). Using fishbone analysis to improve the quality of proposals for science and technology programs.
Research Evaluation, 20(4), 275-282. doi:10.3152/095820211X13176484436050
Nelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement
action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.
PATH. (2010). Keeping a focus on diarrhea disease control in Viet Nam [PDF]. Retrieved from
http://healthmarketinnovations.org/sites/healthmarketinnovations.org/files/VAC_ddc_vietnam_fs[1].pdf
To, K. G., Graves, N., Huynh, V. N., & Le, A. T. (2011). Structure of infection control and prevention in Cho Ray hospital:
An analysis of the current situation. International Journal of Infection Control, 8(1), 14-20. doi:10.3396/ijic.v8i1.004.12
Weber, J. R., & Kelley, J. (2011). Health assessment in nursing (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
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9. Search Process
• Utilized previous presentation slides from Slide share to research current
tools for quality improvement
• Researched the tools further through scholarly databases such as CINAHL
and Google scholar to make an accurate judgement towards application and
non application of tools to health issue chosen
• Used research on Vietnam from previous presentations
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10. Collaboration
• Critically analyzed and further developed health issue from first two
presentations as a group
• Ensured each individual understood her task and gave each other guidance
through communication tools (via person-person, email, Facebook etc).
• Sought out and shared scholarly information when needed
• Each partner had an opportunity to look over the finished product to provide
feedback and error identification.
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Editor's Notes
References Gill, M., & Gray, M. (2006). Using Clinical Microsystems and Mesosystems as enablers for service improvement in mental health services. Retrieved from http://www.lj.se/info_files/infosida31595/micro_mesosystems_mjg_mdg.pdf Godfrey, M. M., Nelson, E. C., Batalden, P. B., Wasson, J. H., Mohr, J. J., Huber, T., & Headrisk, L. (2004). Clinical microsystem action guide: Improving health care by improving your microsystem [Action Guide 2.1]. Retrieved from Microsystem Academy: http://clinicalmicrosystem.org/materials/workbooks/action_guide/CMAG040104.pdf Li, S., & Lee, L. (2011). Using fishbone analysis to improve the quality of proposals for science and technology programs. Research Evaluation , 20 (4), 275- 282. doi:10.3152/095820211X13176484436050 Nelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.
The pick Chart explains how to prioritize and evaluate ideas for improvement to determine which intervention will be most useful. The drawback to this tool is that in the case of our health issue (infectious disease control), although it may be suitable for a small outbreak in the Western world, obtaining supplies (e.g. gloves, gowns, masks) and even negative pressure rooms for isolation may be too costly and therefore “hard to do” and may have a low impact as transmission rates are so high outside hospital walls. The SBAR tool provides a framework for communication between interdisciplinary members about a patient's condition. SBAR is easy-to-remember, but the barrier it faces towards application of our health issue is that a large population of patients have diarrhea and therefore will already be receiving similar treatment (e.g. oral supplement, rehydration salts, IV therapy etc) and it will become redundant to communicate with other health professionals regarding symptoms and assessments. References George, M.L. (2003). Learn six sigma for service: How to use lean speed and six sigma quality to improve sciences and transactions. NY, NY: McGraw-Hill Institute for Healthcare Improvement. (2012). SBAR technique for communication: A situational briefing model. Retrieved April 22, 2012, from http://www.ihi.org/knowledge/Pages/Tools/SBARTechniqueforCommunicationASituationalBriefingModel.aspx
The adverse drug effect tool can be very helpful because it measures the level of harm that medical care causes to an individual. Improper hand washing, breaks in asepsis, and unsafe practice can all be triggers contributing to adverse events. However, the Healthcare Improvement (2012) notes that using this tool is limited to a single inpatient experience and is both time and exposure limited, meaning the healthcare professional using this tool must be able to identify triggers efficiently and effectively. The STAR tool is a self-assessment tool that helps healthcare professionals evaluate their effectiveness in providing effective care. It allows workers to identify their strengths and weaknesses in order to improve the way they work, coordinate more effectively, and achieve a better division of labor. This has the potential to be an effective tool, especially with infection control as the issue and lack of collaboration as the weakness. Yet this tool also requires action, and because relationships between doctors and nurses, as well as nurses and nursing students in Viet Nam are not strong, admitting weaknesses and working together to make change may become difficult and instead “blaming the system” for weaknesses may result. References Consultative Group to Assist the Poor. (2007). The STAR tool: Analyzing funders’ effectiveness and defining comparative advantage. Retrieved April 22, 2012, from http://www.cgap.org/gm/document-1.9.2277/StarTool.pdf Institute for Healthcare Improvement. (2012). Institute for healthcare improvement outpatient adverse event trigger tool. Retrieved April 22, 2012, from http://www.ihi.org/knowledge/Pages/Tools/OutpatientAdverseEventTriggerTool.aspx
References Cleary, B. A. (1995). Supporting empowerment with Deming′s PDSA cycle. Empowerment in Organizations , 3 (2), 34-39. doi:10.1108/09684899510089310 Nelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.). Oakbrook Terrace, Illinois: Joint Commission Resources.
References Harris, J. L., & Roussel, L. (2010). Initiating and sustaining the clinical nurse leader role: A practical guide . Sudbury, MA: Jones and Bartlett. PATH. (2010). Keeping a focus on diarrhea disease control in Viet Nam [PDF]. Retrieved from http://healthmarketinnovations.org/sites/healthmarketinnovations.org/files/VAC_ddc_vietnam_fs[1].pdf To, K. G., Graves, N., Huynh, V. N., & Le, A. T. (2011). Structure of infection control and prevention in Cho Ray hospital: An analysis of the current situation. International Journal of Infection Control , 8 (1), 14-20. doi:10.3396/ijic.v8i1.004.12 Weber, J. R., & Kelley, J. (2011). Health assessment in nursing (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
