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Collaborative and Improvement Models

Collaborative and Improvement Models. Maryland Perinatal Patient Safety Collaborative Lead Workshop January 25, 2007 Jennifer Ustianov. Framework Models. The Breakthrough Series Collaborative Model The Model for Improvement. Objectives.

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Collaborative and Improvement Models

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  1. Collaborative and Improvement Models Maryland Perinatal Patient Safety Collaborative Lead Workshop January 25, 2007 Jennifer Ustianov

  2. Framework Models The Breakthrough Series Collaborative Model The Model for Improvement

  3. Objectives • Understand the components of the Breakthrough Series Collaborative Model and the Model for Improvement and how these models with frame our improvement work. • Understand how to use PDSA cycles to implement sustainable improvements in the delivery of high quality healthcare. • Describe the importance of leadership engagement and support for initiative aimed at improved patient safety outcomes

  4. Maryland Perinatal Patient Safety Breakthrough SeriesCollaborative Select Topic Participants Expert Panel Identify Change Concepts Time for setting aims, allocating resources, preparing baseline data leading to the first 2 day meeting. Pre-work P P A D A D S S Planning Group LS 1 LS 2 LS 3 Lead Workshop Policy & beyond AP 3 AP 1 AP 2 E-mail/Listserv Supports Site Visits Monthly Conference Calls Senior Leader Reports

  5. Works of Wisdom “Every system is perfectly designed to get the results it gets” Don Berwick, IHI

  6. Three Fundamental Questions for Improvement • What are we trying to accomplish? • How will we know that a change is an improvement? • What changes can we make that will result in improvement?

  7. What Changes Can We Make That Will Result in Improvement? • The collaborative “change package” contains the key elements of high performing system • Use the change package to identify the changes you want/need to make to your system to achieve your aim

  8. What Changes Can We Make That Will Lead to Improvement? • Change Concept: a general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement.

  9. Model for Improvement What are we trying to Aim accomplish? How will we know thata Measures change is an improvement? What change can we make that Ideas will result in improvement? Act Plan Study Do From: Associates in Process Improvement

  10. The PDSA Cycle Plan, Do, Study, Act Act Plan • Also known as: • Shewhart Cycle • Deming Cycle • Learning and Improvement Cycle • The “continuous scientific method” Study Do Source: Improvement Guide, p 7

  11. P-D-S-A Cycles • A way to turn Ideas into Action (P D) • A way to connect Action to Learning (S A)

  12. The PDSA Cycle for Learning and Improvement Plan Act • What changes • are to be • made? • Next cycle? • Objective • Questions and • predictions • Plan to carry out • the cycle (who, • what, where, when) Study Do • Complete analysis of data • Compare data to • predictions • Reflect on what was learned • Carry out the plan • Document problems • and unexpected • observations

  13. Model for Improvement Aim Improve process and efficiency Of Critical Emergency Events What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that MEASURE - Improve time from call for Emerg C/S to skin incision - Improve efficiency of Teamwork during s. dystocia will result in improvement? Testing Ideas Simulation Drills Debriefs Tracking Times

  14. Why Test? • Increase the belief that the change will result in improvement • Predict how much improvement can be expected from the change • Learn how to adapt the change to conditions in the local environment • Evaluate costs and side-effects of the change • Minimize resistance upon implementation

  15. A P S D D S P A A P S D A P S D Repeated Use of the PDSA Cycle Changes That Result in Improvement Learning from DATA Implementation of Change Wide-Scale Tests of Change Follow-up Tests Hunches Theories Ideas Very Small Scale Test

  16. Use the PDSA Cycle for: • Helping to answer the first two questions – aim, measures • Developing a change • Testing or adapting a change idea • Implementing a change • Spreading the changes to the rest of your system

  17. A PDSA for Improved Efficiency??

  18. Clarification of Terms • Task: An activity that needs to be completed or something that needs to get done, i.e. create a Pitocin Induction Audit Tool, inform staff council of Pitocin bundles, identify first physician to test. • Test: Trying a change on a small scale to see if the change results in improvement. A test of change involves complete Plan-Do-Study-Act cycles, including a question and a prediction. The specific change idea is being used in the clinic on a temporary basis. (Collecting baseline data, meeting, brainstorming, and/or planning to change are not tests of change. These are examples of getting ready to test or planning to test.)

  19. Years Quarters Months Weeks Days Hours Minutes Drop down next “two levels” to plan Test Cycle Decrease the Time Frame for Early PDSA Test Cycles

  20. Tips for Success • Improvement occurs in small steps • Repeated attempts needed to test and implement new ideas • Assess regularly to improve plan • Failed changes = learning opportunities • Plan communication • Engage leadership support

  21. Key Elements of Breakthrough Improvement • Will to do what it takes to change to a new system • Ideas on which to base the design of the new system • Execution of the ideas

  22. “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” Charles Darwin

  23. The Role of Leadership

  24. Visionary Motivating Respectful Honest and Ethical Communicative Consistent Collaborative Optimistic Action oriented decision maker Institutionally centered Cultivates relationships Approachable Tunnel vision Fire-fighter Paranoid Petty Poor decision making skills Unfair Doesn’t delegate Conflict generating / avoiding Embarrassing Inadaptable Sneaky and distrustful Miser Womanizer Leadership CharacteristicsWhere is breakthrough improvement likely? STRONG LEADER WEAK LEADER Taken from Class Discussion: HCM 706 Physician Leadership Class, HSPH, 2005 Courtesy Jim Conway, Senior VP, Institute for Healthcare Improvement

  25. Framework: Leadership for Improvement Making the future attractive Changing the old Setting Direction: Mission, Vision and Strategy PULL PUSH Ideas Execution Will Establish the Foundation

  26. Net Backward Energy - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - What We Can’t Do What We Can Do + + + + + + + + + + + + More Negatives Than Positives

  27. Net Forward Energy + + + + + + + + + + + + + + + + + + + + + + + + + + - - - - - - - - - - - - - - - + + + + + + + - - - - - - - - - + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + More Positives Than Negatives

  28. Kotter’s 8 Reasons Why Attempts at Change Fail • Not establishing a great enough sense of urgency. • Not creating a powerful enough guiding coalition. • Lacking a clear vision. • Under-communicating the vision by a factor of ten. • Not removing obstacles to the new vision. • Not systematically planning for and creating short-term wins. • Declaring victory too soon. • Not anchoring changes in the corporate culture.

  29. Thinking about your team—and your organization… • Team: • How can you increase the sense of urgency? • What are 3 ways to communicate your program’s vision (that are not now being done)? • What ways can you make the vision “come alive”? • Are the right parties at the table? Whom do you need to add? • Organization • Are you using improvement methods as your coalition’s organizational strategy? How are you measuring your own performance (as it relates to the vision)? • What can you do to generate more forward movement in your organization? Early wins?

  30. Where to begin? • “Quality improvement begins with love and vision.Love of your patientsLove of your workIf you begin with technique, improvement won’t be achieved.” • A. Donabedian, M.D

  31. References • The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. G. Langley, K. Nolan, T. Nolan, C. Norman, L. Provost. Jossey-Bass Publishers., San Francisco, 1996. • Quality Improvement Through Planned Experimentation. 2nd edition. R. Moen, T. Nolan, L. Provost, McGraw-Hill, NY, 1998. • “Understanding Variation”, Quality Progress, Vol. 13, No. 5, T. W. Nolan and L. P. Provost, May, 1990. • A Primer on Leading the Improvement of Systems,” Don M. Berwick, BMJ, 312: pp 619-622, 1996. • “Accelerating the Pace of Improvement - An Interview with Thomas Nolan,” Journal of Quality Improvement, Volume 23, No. 4, The Joint Commission, April, 1997.

  32. Jennifer R Ustianov BSN RN IBCLC National Initiative for Children’s Healthcare Quality (NICHQ)jennifer.ustianov@uvm.edu 802-847-1805

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