Characteristics of Successful QI Teams

1. Characteristics of Successful QI Teams Mirek Skrypak Associate Director for Quality and Development @MirekSkr @HQIP

2. Safe Timely Efficient Equitable Effective Patient-centered Teams working on quality improvement address the following: http://www.nap.edu/books/0309072808/html/ @MirekSkr @HQIP

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4. Simplicity X Y Patient sees doctor Healthy and productive member of the community @MirekSkr @HQIP

5. Complexity @MirekSkr @HQIP

6. The NHS 133 People to take care of the patient The Patient @MirekSkr @HQIP

7. Complex systems @MirekSkr @HQIP

8. Some key questions to ask as a team… Do we know how good we are? Do we know where we stand relative to the best? Over time, where are the gaps in our practice that indicate a need for change (i.e. improvement)? In our efforts to improve, what’s working? Do we know/understand where variation exists in our organisation? @MirekSkr @HQIP

9. Don’t get lost in improvement approaches @MirekSkr @HQIP

10. Break out Exercise • Get into groups of 5,6,7,8: • Assign a time keeper/ball drop counter • Assign a number to each of the other people at your table, starting with the number 1 and continuing until you run out of people @MirekSkr @HQIP

11. Break out Exercise • Your current process involves tossing the tennis ball (provided) from person to person, following the sequence provided on the next slide • Practice your process one time • Time keeper please: • Time how long the team takes to complete the process (in seconds) • The number of times they drop the tennis ball @MirekSkr @HQIP

12. Exercise Sequence 8 people 7 people 5 people 1 1 1 1 4 4 3 4 7 5 8 6 3 3 2 3 4 7 5 6 1 2 5 2 5 1 2 6 1 1 @MirekSkr @HQIP 6 people

13. Time? Drops? @MirekSkr @HQIP

14. Break out Exercise • Team Aim: We aim to reduce the time taken for every person to touch the ball in sequence. • We also aim to reduce our ball drops • Rules: • The initial sequence as provided must be adhered to • You may only test one change idea at a time • Record the time and ball drops after each change @MirekSkr @HQIP

15. Exercise Sequence 8 people 7 people 5 people 1 1 1 1 4 4 3 4 7 5 8 6 3 3 2 3 4 7 5 6 1 2 5 2 5 1 2 6 1 1 @MirekSkr @HQIP 6 people

16. How did you get on ?Fastest Time ? Breakthrough Changes? @MirekSkr @HQIP

17. PDSA Learning Cycle “A goal without a plan is just a wish” “It’s not the plan that’s important, it’s the planning.” Antoine de Saint-Exupery Dr. Graeme Edwards Langley et. al @MirekSkr @HQIP

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21. Why are we measuring? @MirekSkr @HQIP

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23. A personal view from John Welch clinical lead (sepsis) regional QI collaborative • Clinicians and patients to set the agenda • Clarity, simplicity; ambition with realism • Exemplars, information, feedback (“how we’re doing”) that feels current and relevant at the local level • Do-ers as well as “leaders” - and credible leaders who get their hands dirty • Robust critique - allowing doubters to voice their concerns and to shape what’s done; and change if new evidence or new information emerges • Recognition that sometimes a place or team or time just isn’t right @MirekSkr @HQIP

24. Model at least these 5 behaviours by…Santana et al 2011 J Hosp Med, Behaviors of Successful Interdisciplinary Hospital Quality Improvement Teams • motivating involved hospital staff toward a shared goal • creating opportunities for learning and problem-solving • addressing the impact of changes to care processes on staff • protecting the integrity of the new care processes • representing each involved clinical discipline effectively. @MirekSkr @HQIP

25. The Four Habits of High-Value Health Care Organizations NEJM 2011 Bhomer Specification and planning Infrastructure design Measurement and oversight Self-study “Learn from the patient of today, to improve the care for the patient of tomorrow” • Learn from mistakes • Be creative • Capitalise on User Experience and Feedback (including your own team members) @MirekSkr @HQIP

26. The Value of “Failed” Tests “I did not fail one thousand times; I found one thousand ways how not to make a light bulb.” Thomas Edison 26 @MirekSkr @HQIP

27. Learning from mistakes to increase P.A.C.E of QI • Probe • ‘Doctor, what other options are you considering if we can’t get the tube in’ • Alert • ‘Doctor, O2 is at 40% and still dropping, the tube not going in, what about a tracheostomy kit?’ • Challenge • ‘Doctor, we need to conduct a tracheostomy now or we will loose the patient’ • Emergency • ‘I’m alerting the resuscitation team to do the tracheostomy’ @MirekSkr @HQIP

28. "Creativity is seeing what everyone else has seen, and thinking what no one else has thought" ~ Einstein @MirekSkr @HQIP

29. Design versus user experience and what could happen when you respond to user feedback via @chrisarsenault@MattStibbs @MirekSkr @HQIP

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31. Words of wisdom…. • 1)Control the controllables • 2)Football is like a bank, the more you put in the more you will get out • 3)You are only as good as your last game @MirekSkr @HQIP

32. THANK YOU Mirek Skrypak Associate Director for Quality and Development mirek.skrypak@hqip.org.uk @MirekSkr