Quality Improvement Models
QI Training 1
Enabling Objectives
By the end of this session, participants will be able
to:
Discuss the rational for using quality improvement models
Identify some commonly used quality improvement
models in Health care setting.
Describe quality improvement models adopted in Ethiopia
Explain application of the adopted models.
Designed by Alemu
Kejela Feb 2021
Outline
• Introduction
• Why are QI models used?
• Commonly used QI models in Health care
setting
• Quality improvement models in Ethiopia and
their application
• Summary
Designed by Alemu
Kejela Feb 2021
Larger group discussions
• Reflection questions
Why are quality improvement (QI) models used?
What are some commonly used QI models in
healthcare?
List the QI models approved in Ethiopia?
• Time: 10 minutes
Designed by Alemu
Kejela Feb 2021
Why are QI Models used?
• are frameworks or roadmaps used to organize the
work of improvement initiatives or activities
• They encourage planning based on theory
• They empower people in the organization/facility to
take action
• They facilitate use of team work
• emphasize and encourage interactive learning
Designed by Alemu
Kejela Feb 2021
Commonly used QI Models in HC
Kaizen Model for
Improvement
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Commonly used QI Models in HC
(Cont’d)
Six Lean Challenge
Sigma
SBM-R Lean Six Sigma
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Small Group Exercise
• In a group made up of 4 to 6 participants
• Discuss among yourselves the QI models you
have used
Have you applied QI models to develop and execute
Improvement project?
What was the aim of the project?
What lessons did you learn?
• Time: 5 minutes discussion
Designed by Alemu
Kejela Feb 2021
Commonly Used QI Models (… Cont’d)
• Several overlapping and complementary QI models exist
All stem from Science of Improvement
Starts with an aim
Develops innovative ideas and tests towards improvement
Some provide framework to improve patient care
Care Model
Lean Model
Some focus on processes that monitor the results of measures
Six Sigma Model
FADE (Focus, Analyze, Develop, Execute)
Designed by Alemu
Kejela Feb 2021
MFI (Model for Improvement)
QI Models – Ethiopian Context
“They all have an essentially similar set of QI
None is superior ideas and methods under different names
over the other and terminology with a different approach
of implementation.”
Ethiopian • KAIZEN’S 5S Methodology
NHQSS-II • MODEL FOR IMPROVEMENT
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Reflection Question
Why Ethiopia Selected the two models?
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Kejela Feb 2021 QI Training January 17, 2025 11
KAIZEN’S 5S Methodology
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KAIZEN Contd..
• Guiding principles
Good processes bring good results.
Go see for yourself to grasp the current situation.
Speak with data, manage by facts.
Take action to contain and correct root causes of
problems.
Work as a team.
It is everybody’s business.
Designed by Alemu
Kejela Feb 2021
Kaizen’s 5S Framework
Way of organizing and managing the
workspace and work flow with the
intent to improve efficiency of work
by
• eliminating waste
• improve the work environment
and efficiency
• Preventing Errors
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Benefit Of 5S
• Identify Abnormalities • Improve productivities
• Identify wastes, and • lower cost
reduce the wastes • High quality
• Promote everyone’s • on time delivery
participation/business
• Better customer
• Improve safety by service
reducing errors, injuries
• Strengthen Teamwork
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Kejela Feb 2021 QI Training January 17, 2025 15
Individual Exercise Instruction
• Instruction:
You have 60 seconds to circle or strike out the numbers 1 to 49 in
sequential order (e.g.: 1, 2, 3, …)
The facilitator will tell you when to start and when the 60 seconds is over
s/he will ask you to stop.
Each sheet/page is to be faced down until you are told to turn/flip to a
particular page.
Each person should be prepared to call out his/her score at the end of
each exercise.
Annex: Module 3: KAIZEN 5S Exercise
• Time: 5 minutes (1 minute per page) + 15 minutes discussion
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Sample of Sheet/Page 1
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Sample of Sheet/Page 2
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Sample of Sheet/Page 3
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Sample of Sheet/Page 4
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Sample of Sheet/Page 5
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Reflection Questions
• What difference did you notice between sheets/pages 1
and 2?
• What difference did you notice between sheets/pages 2
and 3?
• What difference did you notice between sheets/pages 3
and 4?
• What difference did you notice between sheets/pages 4
and 5? Designed by Alemu
Kejela Feb 2021
KAIZEN: 5S as an entry point for all QI works
• SORT (SEIRI )- remove unused stuff
(unnecessary / may or may not be necessary /
necessary)
• SET (SEITON )- proper orderliness
• SHINE (SEISO) – cleanliness
• STANDARDIZE (SEIKETSU) - set up norms &
equalization
• SUSTAIN (SHITSUKE) – consistent practice of
5S
Designed by Alemu
Kejela Feb 2021
5S….. Sort (seri):
• Remove unused stuff from working
place by:
Categorizing and color code the items.
Have criteria for discarding.
Developing inventory list for all
categorized items.
Storing (keep) “may be needed” items.
Regularly sorting of unused items.
Developing culture of returning items to
where they belong.
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5S…. Set in order(seiton):
• organize all necessary items in proper order for easy services
provision (proper orderliness) by:
Have a consensus where items should be kept
Consider work flow while arranging items
Organizing cabinets with labeling/numbering.
Keeping items at their respective areas and label them
accordingly.
Directional arrows leading to services areas.
Labeling of service rooms.
Updating stock/equipment inventories.
Designed by Alemu
Kejela Feb 2021
5S…….Shine (seiso):
• Maintain high standards of cleanness.
Everyone should participate
Routine cleaning campaign - Daily, weekly, monthly
and quarterly “Shine” time schedule.
Clean not only the place that comes into your view
but also behind, under furniture or equipment.
Clean and attractive environment will be appreciated
by internal and external clients.
Cleaning tools, cleaning tool renewal, tool storage,
space arrangement and provision better uniform for
cleaning staff are also important particularly for the
cleaners.
Designed by Alemu
Kejela Feb 2021
5S……Standardize (seiketsu):
• The first three components set the
stage for the facility to develop and
implement standard operating
procedure to maintain good working
environment.
Set up the sort, set and shine as a norm
in every section of the health facility.
Work instruction.
Standard operating procedures (SOPs).
Standard and regulation for both
administrative and technical staff.
Designed by Alemu
Kejela Feb 2021
5S ….. Sustain (shitsuke):
• Train and maintain discipline of the health care
workers engaged (consistent practice of 5S).
To train and maintain discipline of the health
workers engaged.
Apply regular self-assessment.
Create a competing environment.
The award champions the best practicing units
Designed by Alemu
Kejela Feb 2021
Importance of 5S
• The workplace gets cleaned and better organized.
• Facility system become easier and safer
• Mistakes and risks will be reduced
• Results are visible to everyone
• Visible results enhance the generation of more and new ideas.
• People will be proud about their clean and organized workplace
• Create a positive attitude for improvement of quality among
frontline workforces.
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Kejela Feb 2021
Example of 5S activities in Medical Records Room
Before 5S After 5S
Source: Dialah Clinic, Nimba County, Liberia
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Health Center
Before 5 S Application After 5 S application
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MCH Mini Store
After
BEFORE
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How Can You Implement 5S in Your Facility
IMPLEMENT SUSTAIN
PREPARE INTRODUCE IMPLEMENT
Share progressprogress Refresher
Share
Advocacy with Train QIT on of 5S activities
of 5S activities
trainings
5S
health facility to other areas
to other areas
managers
Standardize
Staff training
Practice 5S at activities and Regular
conduct facility on 5S
selected unit regularly monitoring &
assessment and monitoring evaluation
selection target area(s)
for 5S Recognition
Standardize
and
activities and
encouragement
regularly
monitoring
Designed by Alemu
Kejela Feb 2021
5S Tools
• These are tools needed to apply the 5S
practice
Red tag
Useful for “S1” when you cannot decide whether an item is
“necessary” or “not necessary”
Alignment
Useful for S2 “SET” activities. It is useful for organizing files,
and equipment in order to improve orderliness and
beautification
Designed by Alemu
Kejela Feb 2021
5S Tools Contd..
Labeling
Useful for S2 “SET” activity. It is useful to reduce time
wasted looking for necessary items
Color coding
Useful for S2 “SET” activities. It is for clear
identification of items. It is useful to increase
productivity and mistake proofing .
Designed by Alemu
Kejela Feb 2021
5S Tools Contd..
Numbering/alphabetical coding
Useful for S2 “SET” activities. This is to organize
files and other items numerically or alphabetically. It
helps users to find necessary items quickly and for
practicing the “Can See-Can Take Out – Can Return”
principle.
Zone
Useful for S2 “SET” and S4 “STANDARDIZE”
activities. It is dedicate a specific area for specific
item. It shortens the time lapsed looking for
necessary items thereby increasing productivity.
Designed by Alemu
Kejela Feb 2021
5S Tools Contd..
Safety signs
Useful for S2 “SET” and S4 “STANDARDISE”
activities. It is notify the presence of hazardous item
or material. It is useful to assure safety of staff,
clients and family.
Sign board
Useful for S2 “SET”” activity. Putting clear and
informative signs to direct to easily find the clients
and staff to service area or places they want to go. It
increases productivity by creating a modality for an
easy communication.
Designed by Alemu
Kejela Feb 2021
5S Tools Contd..
Symbol
Useful for S2 “SET” activities. Putting marks or
symbols to communicate visually.
XY axis on notice board
Useful for S2 “SET” and S4 “STANDARDIZE”
activities. Useful to keep orderliness and
arrangement of posters and papers on notice board.
Designed by Alemu
Kejela Feb 2021
5S Tools Contd..
Symbol
Useful for S2 “SET” activities. Putting marks or symbols
to communicate visually.
XY axis on notice board
Useful for S2 “SET” and S4 “STANDARDIZE” activities.
Useful to keep orderliness and arrangement of posters
and papers on notice board.
Designed by Alemu
Kejela Feb 2021
Group Exercise
• GROUP EXERCISE
Discuss the finding from your assessment of
department/unit’s work area using 5S audit checklist
• Time: 15 minutes discussion
Designed by Alemu
Kejela Feb 2021
Model For Improvement
The model comprises three
basic questions and a fourth
element that describes a PDSA
cycle for testing innovations
The four simple steps are:
Set aims
Find promising ideas for
change
Define measurements and
Test those ideas/changes
on a small scale in real
work settings
Designed by Alemu
Kejela Feb 2021
MFI-Driving all QI initiatives
Components of Model for Improvement
1. Three Fundamental Questions 2. PDSA cycle
a. What are we trying to Framework for an efficient trial-
accomplish? and-learning methodology
Used for
b. What changes can we make that
Learning
will result in an improvement?
Developing a change
c. How will we know that a change
Testing a change
is an improvement?
Implementing a change
Designed by Alemu
Kejela Feb 2021
Summary
• Different QI models exist but all with the same
concepts.
• Ethiopia had adopted two of the QI models:
Kaizen’s 5S methodology: an entry point for all QI
activities.
Model for Improvement: key tool providing structure for
QI initiatives. Small scale, multiple and rapid tests of
changes are at the heart of Model for Improvement that
leads to process improvement
Designed by Alemu
Kejela Feb 2021
Thank you!
Designed by Alemu
Kejela Feb 2021 QI Training January 17, 2025 44