The word and terminology used when we talk about Quality Improvement can seem overwhelming and getting to know them can feel like you are learning a new language. However here is a helpful jargon buster to assist you. The words have links to the relevant part of the QI website, so you can see where they fit in the model for improvement.
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All teach all learn:
QI is founded on the concept that there is no hierarchy of people within a QI Project Team; each person has an equally vital and valid role to play in bringing about an improvement. In this sense, everyone has something that they can teach someone and nobody has a perfect knowledge of the whole of a system or project, so everyone has potential to learn something that they do not currently know. When we use this phrase, we are referring to the need to work as a QI learning community, collaborating and openly and honestly sharing our learning with each other, regardless of our roles or position in the organisation.
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Change ideas:
Change ideas are possible ways in which you can alter your system so that you can achieve a different outcome or result and therefore improve your system. A change idea may be to alter the way staff work or the tools or processes that they use. Change ideas can vary in scope or magnitude; often small simple changes to the way that people work can have a big affect on the output of your system. You use PDSA cycles (see above) to test a change idea. Each change idea will need several PDSA cycles to test it from very small scale to the point where it can become part of normal practice.
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Data points:
A series of numbers in a set of data is each called a data point. We often refer to each point on a QI chart as a data point. The number of data points in a QI chart becomes important when we consider how to interpret the rise and fall of data over time to show whether we have achieved an improvement in our data.
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Driver Diagram:
A driver diagram is a visual display of all the factors or drivers that will contribute to the achievement of a project aim. See building a driver diagram for more details Constructing a Driver Diagram enables you to structure your thinking about how to affect your system and hence change things to make an improvement happen. It helps you to identify existing improvement initiatives that could influence the system, and to select current and future priorities for action.
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Drivers:
Drivers are descriptions of the parts of a system that affect the way the system works; the factors (items, actions or processes) that have an effect on the output or outcome of your system. We split them into primary (or major) drivers and secondary (or subsequent) drivers in a Driver Diagram. You can think of them as areas that need to change to ensure an improvement takes place; they affect or ‘drive’ other parts of your system, ultimately influencing the outcome of the aim of a QI project.
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Improvement aim / Project aim:
An improvement aim (aka project aim) is a short statement that describes the goal or objective that a QI project team would like to reach at the end of their project. It needs to be quite specific – clear that you know you where you are starting, how much you want to improve by, and the timescale that you are working to. The aim can be anything e.g. reducing the number of falls on a ward by 50% by next year.
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Improvement Journey:
We each have an improvement journey; it is the process of learning about the QI model for improvement and learning how to apply it to bring about improvements in our work. We can also refer to a collective improvement journey, such as the time a QI project team spends on achieving their improvement aim.
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Improvement Team / Project Team:
An improvement team is a term used to describe a group of patients, carers and staff that undertake a QI project.
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Measures:
Measures are collections of data which help you determine whether your system is working in the way that you want it to. There are three types of measures; outcome measures, balancing measure and process measures. Often these are presented as a set of time-series data, plotted into charts (graphs) that are used to determine if a specific change leads to an improvement over time. However, some qualitative measures may be presented in other ways, for example, word clouds, speech bubbles.
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PDSA Cycles:
PDSA stands for Plan, do, study and act. A QI project team will devise PDSA cycles to try out ideas in real work settings which they think will help reach their improvement aim.
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Primary Drivers:
Primary Drivers are the big topics and important areas that need to be addressed to achieve your QI Project Aim. They are the major factors that affect your system.
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QI:
QI is an acronym, it stands for Quality Improvement.
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Qualitative Measures:
Qualitative measures are sometimes referred to as ‘soft data’. Qualitative data refers to the character or quality of something rather than its quantity. Qualitative data might be used to gauge how people feel about the system – before, during and after our improvement work. For example, ‘the comments from service users and carers have become more positive following the introduction of our change idea’. Qualitative data may sometimes be presented in a chart. For example, survey data may use likert scales to gauge how people feel about something and this can then be quantified and displayed in a chart. It may also be used to provide more in-depth information about a situation.
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Quantitative Measures:
Quantitative measures relate to the number or quantity of something. Sometimes referred to as ‘hard data’, meaning that there is a number or set of numbers that are definite data points.
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Run chart:
A run chart is the simplest way of charting data over time. It is also a good chart to use if you don’t have many data points. A Run Chart is a line chart showing data over time, grouped around the median for that data. In this way it can help to show if there is random or non-random variation in the system – is something unusual happening over time? Are there patterns we should be aware of? Have our actions made a difference to the performance we are tracking over time?
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Secondary Drivers:
Secondary Drivers are the subsequent or contributing factors or drivers that will contribute to the achievement of a project aim. They are the lower level factors that affect your system, but are not directly affecting the outcome of the system.
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Statistical process control (SPC) charts:
SPC charts work by identifying the difference between normal and unusual variation in the data, and also whether that variation is positive or negative. This is done by charting data over time, and by investigating how the system performs within the control limits that are shown on the graph. This means that you can quickly ascertain if a change has had an impact, and whether it is statistically significant or not. In improvement work, we use SPC charts to understand how our system is working before we start our work, and to track improvements over time as a result of our interventions. You should have at least 15 data points for an SPC chart. This allows meaningful control limits to be calculated on the chart. There are a range of SPC charts to choose from depending on what you are measuring, and what you need to know.
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System:
A system is an interdependent group of items, people, or processes with a common purpose (The Improvement Guide, 2019 (G.J. Langley et al)). Think of a system as an entity that you can define, so an individual NHS service may be a system, so a team working in CNWL may be working in their own ‘system’. Often it is helpful to think about the patient journey (referral, assessment, treatment, discharge) as the ‘system’ in your service.
