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Leading the Best Care...Always! Campaign

Leading the Best Care...Always! Campaign. Dena van den Bergh, Michele Youngleson, Gary Kantor, Yolanda Walsh May 10 th 2011 Cape Town. Agenda. Welcome Introductions Best Care…... Always! (BCA) A framework for leading BCA Fundamentals of the QI approach Measuring for BCA

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Leading the Best Care...Always! Campaign

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  1. Leading the Best Care...Always! Campaign Dena van den Bergh, Michele Youngleson, Gary Kantor, Yolanda Walsh May 10th 2011 Cape Town

  2. Agenda • Welcome • Introductions • Best Care…... Always! (BCA) • A framework for leading BCA • Fundamentals of the QI approach • Measuring for BCA • LUNCH • QI in action • Next steps

  3. Introducing Best Care.. Always! Dena van den Bergh

  4. The BCA Quality Improvement approach • Not just protocol • Focus on the implementation gap • All learn all teach • Learning by doing

  5. 18 -24 months Repeated improvement cycles: Repeated improvement cycles: Expert Meeting and Planning Group formed Learning session 1 Learning session 2 Learning session 3 Accelerating change and improvement through networking and collaboration. Mentoring and support

  6. Framework for Leading Improvement

  7. 3,4,5: Will, Ideas and Execution Will Ideas Execution Nolan TW. Execution of Strategic Improvement Initiatives to Produce System-Level Results. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. (Available on www.IHI.org)

  8. Next Steps • Hospital visits (data) • Learning sessions • LS#1 May 25 • Monthly mentoring meetings with quality champions • More hospital visits

  9. Learning Session #2 October/November 2011 + Breakout session for CEOs • Carol R. Haraden, PhD • Vice President, Institute for Healthcare Improvement (IHI) • Lead: Safer Patients Initiative (UK) • Lead: Scottish Patient Safety Alliance • Executive lead: IHI Patient Safety Officer Executive Development Program • Institute of Medicine Committee on Engineering Approaches to Improve Health Care • Associate editor for the journal Quality and Safety in Health Care.

  10. The Burden of Healthcare-Associated Infection Prof Shaheen Mehtar UIPC, TBH & SUN Cape Town

  11. Situation Analysis of LMI countries • Rates of HAI are higher in LMI countries • IPC programmes are poorly supported • Little accountability by Health Care Workers • Clinical commitment essential - Duty of Care

  12. Comparative data- HIC and LMICBurden of endemic health care associated infection in developing countries: systematic review and meta analysis- B Allegranzi et al, Lancet, 2011, 377: 228-41 HAIs are at least 3 x more common in LMI countries

  13. Crude HAI Infection Rate: TBH. Impact of an established IPC programme

  14. Comparing TBH to meta-analysis

  15. The impact of Healthcare Associated Infections on the hospitals

  16. The impact of HAIs on the hospitals • Mortality and morbidity • Lab and pharmacy costs • Antibiotic use • Bed occupancy • Work load

  17. The impact of HAIs on your hospital • Fill in the column graphs (per hospital) • peripheral vascular catheter-associated infection (PVCAI) • central line-associated bloodstream infection (CLABSI) • ventilator-associated pneumonia (VAP) • catheter-associated urinary tract infection (CAUTI) • surgical site infection (SSI) • Fill in the scale – hand hygiene (each individual

  18. The fundamentals of the Quality Improvementapproach used in BCA

  19. Changing View of Quality We are perfect! Get rid of the bad apples NO ACTION REACTION Quality Assurance “Standards” M&M Incident reporting

  20. ...the gap between evidence and practice Patients get “recommended care” ~ 50% of the time. Adverse events occur in 10% of hospital patients. • 50% are preventable. • 7.5% of these patients die. NEJM 2003; 348:2635-2645 Qual Safety in Health Care 2008;17:216-223

  21. Changing View of Quality “Quality” Safe Effective Timely Equitable Patient-centred Efficient We are perfect! Get rid of the bad apples System thinking NO ACTION REACTION PROACTIVE Quality Improvement Quality Assurance “Standards” Process Improvement M&M Incident reporting Improvement Science

  22. Quality Improvement requires two Types of Knowledge Subject Matter Knowledge: Professional, content, evidence based knowledge. ‘What’ Subject Matter Knowledge Improvement Knowledge ‘How’ Improvement Knowledge (Deming): The interaction of the theories of systems, our ‘theory of knowledge’,variation in measurement, and psychology.

  23. Improvement Improvement: develop effective changes that lead to an improvement. Subject Matter Knowledge ‘What’ ‘Where’ Improvement Knowledge ‘How’ Langley: Improvement Guide p76

  24. Improvement Knowledge Subject Matter Knowledge Improvement Knowledge W.E. Deming (1900-1993) System of Profound Knowledge

  25. Improvement Knowledge • 4 fields of interaction • - theories of systems • - our ‘theory of knowledge’ • psychology of change • variation in measurement Subject Matter Knowledge Improvement Knowledge

  26. Complex Dynamic Systems • Step 1 – Everyone stand up • Step 2 – Without speaking; pick two people but don’t say who they are or point at them (Keep it a secret) • Step 3 - Move to be equidistant from both of the people • Step 4 – Move one person and repeat

  27. The power of the system NO Do you have a 2-digit Number? Step 1: Pick a number from 3 to 9 Step 2: Multiply your number by 9 Step 3: Add 12 to the number from step 2 YES Step 6: Convert your Number to a letter: 1=A 2=B 3=C 4=D 5=E 6=F 7=G 8=H 9 = I Step 4: Add your 2 digits together Step 5: Divide # from step 4 by 3 to get a 1 digit number Step 7: Write down the name of a city that begins with your letter Step 9: Write down the name of an animal (not bird, fish, or insect) that begins with your letter from Step 8 Step 10: Write down the color of your animal Step 8: Go to the next Letter: A to B, B to C, C to D, etc. Output: Color____________ Animal___________ City__________

  28. Understanding Systems “Every system is perfectly designed to achieve the results it gets” Paul Batalden Paul B. Batalden, MD, Professor of Pediatrics, of Community and Family Medicine The Dartmouth Institute for Health Policy and Clinical Practice at The Dartmouth Medical School.

  29. Hand washing practice in the PICU from a Report of a participative observational study done during January and March 2006 Candice Bonaconsa and Minette Coetzee Child Nurse Practice Development Initiative Prof Andrew Argent, Red Cross Hospital

  30. Calculating the % of hand washing How we did this: Actualx 100 = % Opportunity

  31. Goal 90%

  32. elsewhere in the hospital …

  33. Forces in the system keeping hand washing rates where they are A B Time Lewin K (1951) Field Theory in Social Science New York: Harper

  34. Understanding Systems “Every system is perfectly designed to achieve the results it gets” Paul Batalden “All improvement needs a change Not all change is an improvement” Paul B. Batalden, MD, Professor of Pediatrics, of Community and Family Medicine The Dartmouth Institute for Health Policy and Clinical Practice at The Dartmouth Medical School.

  35. Improvement Knowledge • 4 fields of interaction • - theories of systems • - our theory of ‘knowledge’ • psychology of change • variation in measurement Subject Matter Knowledge Improvement Knowledge

  36. Theory of knowledge Our understanding of why things are the way they are.

  37. The Implementation Gap PROBLEM EVIDENCE-BASED SOLUTION PLAN “typical” attempts to change IMPLEMENT FAIL

  38. Overcoming barriers at the frontline of care IMPLEMENT ACT DO SUCCEED/ SUSTAIN STUDY SYSTEM ANALYSIS to identify barriers to care PROBLEM GREAT IDEAS Quality Improvement Mentoring PLAN

  39. PLAN PLAN PLAN PLAN DO DO DO DO ACT ACT ACT ACT STUDY STUDY STUDY STUDY Model for Improvement What are we trying to accomplish? What can we change that will result in an improvement? How will we know that a change is an improvement?

  40. PLAN PLAN PLAN PLAN PLAN PLAN PLAN PLAN PLAN PLAN PLAN PLAN DO DO DO DO DO DO DO DO DO DO DO DO ACT ACT ACT ACT ACT ACT ACT ACT ACT ACT ACT ACT STUDY STUDY STUDY STUDY STUDY STUDY STUDY STUDY STUDY STUDY STUDY STUDY Unit 2 Improving many parts of the system at once Unit 1 Bundle 1 Bundle 2

  41. Improvement Knowledge • 4 fields of interaction • - theories of systems • our theory of ‘knowledge’ • psychology of change • variation in measurement Subject Matter Knowledge Improvement Knowledge

  42. Psychology of Change Population Late Majority Early Majority Early Adopters Traditionalists Innovators Source: E. Rogers. Diffusion of Innovation

  43. Improvement Knowledge • 4 fields of interaction • - theories of systems • - our theory of ‘knowledge’ • psychology of change • variation in measurement Subject Matter Knowledge Improvement Knowledge

  44. Understanding Variation • Walter Shewhart’s (1891-1967) • – understanding variation through • Statistical Process Control (SPC)

  45. Flip a coin

  46. ICU: Date of VAP infections 2010

  47. Measurement Common mistakes • Using bar graphs rather than run charts • Not enough data points (12 at least to understand normal variation) • Not making allowances for normal variation when interpreting data • Not measuring trends over a long enough period - cut off at year end or financial year end

  48. Reacting to Variation

  49. Measuring forBest Care….Always!

  50. Measurement • Builds will • Assesses impact • Drives improvement • Keeps the project alive • Sustains the gains

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