Tag Archive for: QMS

The Plan Do Check Act (PDCA) cycle: a model for continuous improvement

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You’ve identified which problem or opportunity to work on, but what next? How do you make sure you spend the little time you have available to do this quality improvement in the best way possible? In this how-to guide, we’ll walk you through a systematic approach called the PDCA cycle, to guarantee you run the project like a pro!

What is It?

The PDCA cycle is a popular model used for quality improvement and change. It consists of four key phases: Plan, Do, Check, and Act, which are completed in a step-wise manner. The sequence can be repeated, promoting ongoing refinement of a solution and a culture of continuous improvement amongst the team. 

Healthcare teams often add a foundation stage to the cycle in which the problem is defined and measures are established.

Why use it?

The PDCA cycle is a straightforward and versatile approach for all staff to use. It encourages the benefits of testing and learning, avoiding the extremes of over planning and rushed, ineffective changes.

How’s it used?

Step 1: Foundation

Start by identifying and defining the problem you want to solve. Find a measure that will tell you if your changes are working and baseline it. Do a root cause analysis and come up with some creative countermeasures. 

Step 2: Plan

Decide on one solution to test and get everything ready to start testing it. This might involve voting on the solutions you previously identified and quickly coming up with a protocol for staff to test.

Step 3: Do

Put the chosen solution into action on a small scale. This might mean running it for a few days or with a few patients. Make sure you collect the data to indicate whether its working as you go along. 

Step 4: Check 

Analyse the data from the trial to determine if it’s working as expected. This might involve looking at numbers or getting feedback from staff or customers. Reflect on the results and decide whether it’s been successful, needs adjustments or you should try a different solution.

Step 5: Act

Based on what you’ve learned, take action. If the change is successful, roll it out as a new way of working. If it needs adjustments then update the protocol and validate them. If it didn’t work, prepare for the next improvement cycle. 

Example

A surgical team decides it’s taking too long to get operations started every morning. They use the time between their shift starting and the induction of the first patient as the measure. They take a baseline measure of 60 minutes. They do a root-cause analysis and identify several solutions to trial.

CyclePlanDoCheckAct
1The team vote on changing the pre-meds they use so they’re faster acting. They agree on the new drugs and doses and select a week to pilot them.They use a different pre-med protocol for one week and record the induction times on a post-it note by the anaesthetic machine each day.Following the pilot they review the data. The average time is now 45 minutes. They discuss the results and decide to roll out the change.To roll the change out they create a new pre-med chart for the wall and discuss it at their monthly vet and nurse meeting.

Top Tips

  1. Set a specific timeframe to complete the cycles, like 4 weeks, in order to maintain focus on delivery.
  2. Involve front-line staff in the test phase as it will reduce the barriers to any final changes you roll out. 
  3. Balance your time evenly across different areas of the cycle, avoid jumping the test or planning phase.

In summary, the PDCA cycle provides a simple and versatile model for you to use to make sure your QI project stays on track. If you need more support in getting started, or have a particularly complex problem you need help with, contact Contact VetQI

Where to begin on your quality improvement journey in practice

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Are you eager to do some quality improvements but find the sheer number of potential improvement opportunities overwhelming?

In this blog article, we’ll identify six key areas to begin your improvement project, complete with practical examples. By the end, you’ll feel confident and ready to embark on your journey.

Aligning with Strategy 

When diving into your improvement project, remember that quality goes beyond the shop floor. Companies that value quality also have big-picture strategies that dictate where staff should be prioritising their time. If you want to get noticed by ‘higher-up’, align your project with your practice or company’s plan.

For instance, let’s take the practice’s goal to increase high-value procedure sales. Karen, a new nursing team leader, noticed her new employer isn’t doing as many dental X-rays as her previous practice, despite having all the equipment and a similar caseload. Karen teamed up with the practice manager to test a new pricing model that bundles together dental procedures and X-rays. She closely watched how this impacted sales.

Profit and Loss

Most organisations, including charities, are concerned with understanding their costs and how well they cover them with sales. So, any improvement project that targets these areas is a smart choice and is easy to demonstrate results. Don’t let financial metrics intimidate you; it’s all about finding ways to cut costs or sell more in the same time.

Consider Sally, the surgery nurse. She noticed that the practice was using costly 1ml syringes when the larger cheaper variety would do. She added clear signage to the drawers, encouraging her team to ‘think twice’ when grabbing a syringe. She monitors the number of syringes ordered and compares it to previous months.

Reducing Defects 

In the veterinary world, “defects” can be seen as things that didn’t go as planned. A common example includes significant events, animal mortality, avoidable morbidity, and resulting client complaints. When these occur, the impact can be significant. A quality-driven team seizes this opportunity to investigate what went wrong in a blame-free environment and works on improvements to prevent such incidents from happening again.

For instance, consider Martin, the in-patient nurse. He takes over a shift and notices that a cat with an indwelling urinary catheter is in pain and the bladder isn’t draining properly. After the team resolve the situation, Martin conducts a root cause analysis with the team. Together, they develop a new standard operating procedure (SOP) for managing blocked cats, which involves doing an additional check on the bladder every 4hours.

Listening to the Voice of the Customer (VoC)

Maintaining a strong relationship with our customers is crucial in making sure our patients get the treatment we reccomend at home and also supporting the practice financially. Customers interpret quality in different ways so its important to research and understand what your customer value.

In the example above, Karen introduced a new pricing model, bundling all dental X-rays into dental procedures as a value-added package. After conducting a client survey, she found that some customers didn’t fully appreciate this change. In response, she piloted a new way of work in which the team sends the dental X-rays to the customer after the procedures in order for them to see what was done. She repeated the survey 6 months later. 

Listening to the Voice of the Employee (VoE)

The practice team are close to the action and can provide valuable “bottom-up” perspectives on opportunities for improvement. But listening to all their suggestions and effectively managing their ideas is a skill in itself. It’s important to develop this skill to develop a culture of ‘continuous improvement’ amongst the team.

Consider Chloe, the practice manager. She regularly receives improvement requests from her staff but finds it challenging to handle them all. In a quality improvement effort, she created a closed suggestion box and provided template cards for her team to submit suggestions. On a monthly basis, she shortlisted the ideas that aligned with the practice’s strategy and presented them to the team for voting on the “quickest win.”

Pareto Principle (80/20 Rule)

The Pareto Principle, often referred to as the 80/20 rule, suggests that 80% of the effects come from 20% of causes. This principle is a valuable tool in quality management as even small or margin improvements in the 20% will result in substantial results.

Sandy, the receptionist, realises the team leaves the desk on average every 15 minutes. Half of the time they are going to the printer. She does an improvement project which moves the printer within safe reach of the desk. She compares the number of time the team leave the desk before and after. 

Deciding the right opportunities to work on when you have so little time can be tough, but by using the above themes you can rationalise your decisions and get your project off to a confident start. These themes can also be used to help facilitate a meeting where you collect idea’s within the team. 

If you need any support in making quality improvements, Contact VetQI—we’re here to help.

Setting the standard for excellence: crafting effective policies for your veterinary practice

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As a veterinary practice, you are responsible for providing high-quality care to your patients and clients. But with the many complex and challenging situations that can arise in the course of daily operations, it can be tough. That’s where policies come in. By providing clear guidelines and parameters for behaviour and actions, policies help to support decision-making, maintain quality of care, and promote a culture of excellence in your practice.

What is a policy?

A policy is a statement that conveys the values, culture, philosophies, goals, and limits of your organization. It helps in decision-making and serves as a link between your organization’s vision, values, and daily operations. Procedures, also known as standard operating procedures (SOPs), are detailed instructions that provide specific steps to execute a policy. They are a part of policies but are more specific and detailed.

Why are policies useful for vet practices?

Key benefits of having policies in place include:

  • Set guidelines and parameters for employees to successfully reach their goals with confidence
  • Increase compliance with regulatory and professional standards
  • Improve the quality of the care being delivered to patients and clients
  • Support decision-making during difficult or complex situations to avoid a crisis

What policies should a vet practice have?

As a veterinary practice, there are specific policies that you should have in place. These policies include:

  • Health and Safety Policy
  • Code of Conduct Policy
  • Complaints Policy
  • Data Protection Policy
  • Waste Management Policy
  • Biosecurity Policy
  • Staff Training and Development Policy

Who should be involved in making policies?

Responsibility for policy-making can vary depending on the type of policy and the size or structure of the company. In a small company, it might be the business owner, while in a corporation, it could be the head office. For specialist services or offerings, it might be the departments themselves. It’s important to involve subject matter experts and conduct research to reflect the latest regulations and standards. 

How should policies be structured?

A policy document should include the following:

  • Document control: Who created and approved the document, who edited last and what version is it?
  • Purpose: What is the policy about?
  • Statement: This is the core of the document. What is the policy statement of your organization specific to the topic? 
  • Procedures: What procedures might sit within this policy?

In the statement, consider the what, why, when, who, and basic how (this will be elaborated on in each procedure that comes out of it). It may be important to lay out the responsibilities for certain roles in this area in some detail. Further useful reading on writing a specific sustainability policy can be found here by the BVA.

Top tips for creating policies

  • To make it easier to read, use simple, easy to understand language and have a set structure to each policy
  • Think about what you want to achieve with your policy and ask yourself ‘what if’ to see if it covers the most common eventualities 
  • Learn about what needs changing by piloting it as quickly as possible with operational teams 

When should policies be reviewed?

Policies are not changed very often (unlike procedures), and when they are, will involve many stakeholders from across the company. Policies should be reviewed periodically to ensure that they remain current and relevant. Examples of when you might want to review and update policies include:

  • Existing policies are not robust enough.
  • Outdated policies with new technologies, systems or services offered.
  • Changes in regulations and professional standards.

In conclusion, having policies in place is essential for the success of your veterinary practice. They provide clarity around how to run the practice within the context of the organisation (e.g., values, mission), regulatory requirements (e.g., health and safety), and professional standards (e.g., code of conduct). For more help withe reviewing or crafting your own policies, Contact VetQI.