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Rhetoric to Reality

Rhetoric to Reality. Creating and Sustaining Culture Change. The Execution “Bundle”. If evidenced based practice can be bundled and effective in the clinical arena, then why not on the management side?

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Rhetoric to Reality

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  1. Rhetoric to Reality Creating and Sustaining Culture Change

  2. The Execution “Bundle” • If evidenced based practice can be bundled and effective in the clinical arena, then why not on the management side? • What are the principles that when consistently applied over time generate positive, sustainable change? • When do you use a sledgehammer and when do you use a scalpel?

  3. Can I Give You Some A.D.V.I.C.E.? • Assess • Design • Validate • Innovate • Confront • Eliminate

  4. Assess • Facility values – what is important to the stakeholders? • Do they value change? • Prefer status quo? • What are the social norms • Who are the pivotal characters • Who or what are the obstacles

  5. Design • Physician Orientation to set the expectations • Medical Staff Leadership Education • Medical Staff Documents that support the values • Mandatory protocol use • “Opt out” vs. “Opt in” language • Physician Conduct Policy with progressive discipline • OPPE that reflects individual, specialty specific, performance • Let the standards work for you

  6. Validate • Administrative Walk Arounds • Town Hall Meetings • “Lemonade Stand” • Daily Dose • The Buzz • The Leader • Patient Safety Climate Surveys

  7. Innovate • Resource Center Concept • Concurrent Data Collection – • Multidisciplinary CHF Rounds • PI Specialist stationed in PACU • Canopy list of all vaccine patients • Canopy list of possible POA Patients • Glycemic Control Team • Mobility Team • Crew Resource Management Projects • Psychiatric Crisis Center

  8. Confront • Obsolete institutional belief systems • Rumors and innuendo • Informal Leaders • Convoluted Processes • Unsafe Practice

  9. Eliminate • Disruptive Behavior • Physicians • Staff • Contractors • Negative Influence • Informal Leaders • “Naysayers” • Waste • Lean Principles • “6S”

  10. ICU Length of Stay

  11. Ventilator-Associated Pneumonia

  12. Central Line BSI’s

  13. Sepsis Management Bundle

  14. Severe Sepsis/Septic Shock Mortality Protocol Patients

  15. All Severe Sepsis/Septic Shock with at least one day in ICU, excluding palliative care * Severe Sepsis/Septic Shock Protocol Orders and Bundles based on Surviving Sepsis Campaign guidelines implemented

  16. Glucose Control Nurse driven policy to initiate Insulin drip protocol for two BG >150 mg/dL Revised policy to Institute Insulin Drip Protocol for oneBG >150 mg/dL

  17. ICU Mortality FY02 – FY08 ICU Collaborative October 2003

  18. ICU 6 Year Outcomes FY03-FY08 4.5 • 40% reduction in ICU LOS • 41% decrease in vent length of stay • 57% reduction in VAP rate (3.34 to1.48).  • 41% drop in BSI rate (4.07 to 2.41).   • 40% decrease in sepsis mortality  • ICU glycemic control between 60- 150 mg/dL was averaging around mid 50% levels and improved to around 68-70%. • 42% reduction in ICU mortality

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