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HiQuiPs: Implementation Part 2 – Which Strategy to Choose: PDSA, Lean, or Six Sigma?

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PDSA, Lean, and Six Sigma are three different frameworks that can be part of your quality improvement armamentarium. Each of them can often be applied to the same quality issue. Deciding on which one to use requires an understanding of their inherent strengths and weaknesses. In our last post, we briefly introduced the theory behind Lean, Six Sigma, and PDSA cycles. Here, we will practically apply each methodology to one quality problem to …

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HiQuiPs: Implementation Part 1 – QI Implementation Methodologies

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In this two-part series, we will take a deeper dive into several QI conceptual frameworks, or ways to approach QI projects. In our previous posts, we discussed preparation strategies for QI projects; but when it comes to implementing a change, how would a team go about choosing an approach? We will start with a discussion of the variable effectiveness of different change interventions, then we will delve into an overview of some common …

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HiQuiPs: Preparation Part 3 – Root Cause Analysis

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You have just finished a monthly business meeting with your emergency department (ED) team. One of your colleagues highlighted a recurring issue of the length of time it takes from ordering blood products to administering them in your ED. There is often a long delay in administration for patients who are in acute need.   You have gathered a team to start working on this quality improvement project. The team has put a …

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HiQuiPs: Preparation Part 1 – General Considerations for ED Quality Improvement Projects

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You are in the middle of a busy night shift and you see a 73-year-old female with diffuse abdominal pain who is hemodynamically stable. You have a wide differential and order a CT scan to aid in the diagnosis as you begin empiric management. Three hours pass by and the CT has not been performed. This is the third time this week that this has happened.  In light of this, you feel strongly …

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QI Series Part 3 | Differentiating Quality Improvement and Clinical Epidemiology

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How do Quality Improvement methods differ from classical clinical research? This article is the last in a three-part series on Quality Improvement (QI) in health care. The first article, “What is Quality Improvement?”, defined this field of study and provided a brief history of its origins.  The second article defined “quality” and briefly described tools used to achieve improvement. This article seeks to differentiate QI methods and goals from those encountered in clinical …