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Improvement work

Improvement work. A top down or a bottom up perspective?. The true journey of discovery is not to the search for new sights and places, but to see the old, familiar with new eyes. Marcel Proust 1871- 1922. French Novelist. Sweden. Jönköping County. Jönköping. Eksjö. Värnamo. Europe.

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Improvement work

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  1. Improvement work A top down or a bottom up perspective?

  2. The true journey of discovery is not to the search for new sights and places, but to see the old, familiar with new eyes. Marcel Proust 1871- 1922. French Novelist

  3. Sweden Jönköping County Jönköping Eksjö Värnamo Europe Health care in Jönköping County: 3 hospitals, 34 primary care centers, dental care centers,9 800 employees, 330 000 inhabitants

  4. Topics for this session • Quality as business strategy in Health care • A micro system perspective • Some balanced measures including patient experiences • Example from our improvement work and how we have gone from patient focus to the patients focus. . .

  5. The success story of Jonkoping – the short version • Top 3 county councils for more than 5 years in a row – 2010 no 1. • A culture of improvement is created –value based health care • Number of study visits from sweden and abroad is increasing • Government assignments to improve quality in health care and elderly care in 2009-2010.

  6. Full scale Movement • Pursuing perfection • System measures Redesign • Leadership meeting for L/I • Diamondpicture • System thinking • Patient- • safety You can describe the historyThe future must be created • Balanced score card • Qulturum starts • Breakthrough series Processthinking • teams for patientneed • Main stay processes • Certification of laboratory Education Awareness • Esther – Health care processreeng. (HPR) • Leadership program for physician • Values based & improvement education • Swedish Malcolm Baldridge Award (QUL) • Total Quality Management • Audit for medical evaluation • Leadership development 1992 1995 1998 2000 2001 2002 2005

  7. Learning/Renewal Economy 100% 80% 60% 40% 20% 0% Improvement collaboratives, 2004Work in a smarter way! Customer/patient Process/productivity QUALITY AS A BUSINESS STRATEGY • Overall strategic aims of Jönköping County Council:With Good financing we mean activities that create values leading to satisfied customer/-patients with high quality of life. • This requires that health care... • has access. • is based on a overall view regarding patient flow and processes. • reaches/performs the best clinical • results with the best safety. • is performed to lowest possible costs. • To live up to this demand it is of necessity to have motivated and participated employees. Balanced scorecard Activities, Breakthrough series etc

  8. The vision of Jönköping County Council ”For a good life in an attractive region”

  9. IT Envir. Adm. Start with the Need and develop New Working Processes Strategic Improvement areas Learning and innova-tion Leadership AccessHow we receive Clinical improvement work Coopera-tion/flow Patient safety PreventionSelf-care Medication Good financesReliability Experimental learning Transformation broad and in depth V a l u e f o r p a t i e n t i n c r e a s e s

  10. Involving everybody – both in deep and wide

  11. Learning and doing together My self Lectures Act into new understanding Directly spread Beeing saved Goal! Result! Library Google The development of customer values My development Learning yesterday Learning focus we need more of What matters Knowledge spread The knowledge Leading by Looking for knowledge What its all about

  12. You can’t change what you can’t understand Health care was in the old days simple, safe and ineffective

  13. .. . . While it is now. . . complex, effective and potentially dangerous

  14. A day in a nurse life • 150 organizational memos • 100 guidelines for care in the department • 30 unit based guidelines • 23 357 article about COPD • 70 089 articles about Lung cancer • 30 different salary criteria's for doing a good job. No wonder it’s easy to get lost

  15. Professional knowledge • Medicine, nursing, economic . . . • Individual skills • Values ethic • Improvement knowledge • System • Variation • psychology of changes • Action based learning and improving Improvement of processes and the system in healthcare Improvement of diagnosis and treatment + Increase the value for our patients

  16. The Microsystem – Where healthcare improves

  17. Microsystem • Definition • It’s the small frontline units which provides healthcare to the community. • It is a small group of people who an a regular basis are working together to provide care to a group of patients • It has both clinical as well as financial goals, • cooperating processes, shared information and together they create results. Reference: Batalden, Godfrey, Nelson Darthmouth Medical school, NH, US.

  18. Working from within your clinical microsystem… L S Pt Perf I • Staff • Staff focus • Education & • Training • Interdependence • of care team • Leadership • Leadership • Organizational • support • Patients • Patient Focus • Community & • Market Focus • Performance • Results • Process improvement Batalden et al

  19. Which is the level of performance, intervention, measurement ? Community, Market, Social Policy System Self-care System Macro-organization System Individual professional & beneficiary System Microsystem (clinical, educational, etc.)

  20. Why do we not do what we know? Chose best plan Act locally Generell Evidensbased knowledge Measurable improvements specific setting + balanced measures over time inquire into particular identity control for context Batalden, Davidoff (2007)

  21. Will • Values • Driving forces • Ideas • on things to be better inspiration, good exempel • Methods and tools • Execution • From power points to patient values • Follow result and spread good ideas. Ref: Error today and error tomorrow Berwick D. (2003) NEJM Vol 458, no 25

  22. Feedback – publish at Qreflex. A P S G Tasks 4-6 month LS 2 LS 3 LS 4 LS 1 Start testing PDSA Measures. Posters- presentation Describe 5P Identify focus for improvement Photo-journey Base-line Fiskbone-processmap Start 5P Identify team Rolls : CM, secr, Meas-, Method Look for waste Awareness Understanding Ideas-tests Spread/learning 1.Team is in place 2. Activities No changes 4. Significant improvement 5. Outstanding resultats 3. Smaller changes

  23. How to create awareness of what is going on? • Videos • Photos • Follow a collegue and observe • Ask for stories from patients and families • Benchmark other organizations • Walk a mile in the patients shoe • Ask question. 5 P guide.

  24. Ref: Godfrey, Nelson,Batalden

  25. Poka Yota – Easy to do rightBefore … After……

  26. 5 S (Waste)Before After

  27. Improvement model Nolan, Deming m fl What to achieve? Goal! Is a change really an improvement? measure! ideas! What test do we think will lead to the goal? Act Plan PDSA-cirkeln test! Study Do

  28. Functions healthstatus Clinical Service costs Valuecompass 1. What's important for the nurses and doctors? 2.Whats important for the patient in the daily life? 3. What's important in the meeting with the healthcare system? 4. What does it cost? Which resources do we use??

  29. Value compass Hiparthros Ortopedic departmenet County council Ryhov

  30. Värdekompassen – Höftartroplastik Functional status EQ-5D Clinical status Patiensatisfaction Resources

  31. Patient experience one year follow up Kvinna -43 Kvinna -29 Kvinna -30 Kvinna -39 Kvinna -24 Kvinna -42 RA besvär flera övriga leder, Kvinna -65 Kvinna med benlängds-skillnad 2 cm Kvinna -48 Mkt aktiv man, smärtproblematik höft, Man med spinal stenos, stora svårigheter att stå och gå (090330 läkarbesök)

  32. Clinical results Infection rates after hip arthros joint operations 2003-2010 (elective) 2 ytliga infektioner t o m maj 2010 2 djupa infektioner t o m maj 2010

  33. Ekonomi/resurs Length of stay elective hip joint surgic % stayed less than 6 days Mål Fr o m jan 2009 mätning/månad Medelvårdtid 2009 = 7,3 dygn

  34. What is an improvement culture? • 30 seconds – what is the smallest improvement your organization /unit has done in the last year?

  35. LEAN exemple OP/IVA Jönköping Before… After… From 3 moment to 1 Saves 1,5 h / day

  36. Some example • Visualization

  37. The articles

  38. We also do. . . • Passion for life – elderly doing PDSA and improvements in order to have a beautiful ageing • Senior alert – the first national Quality registry for prevent falls, pressure sores and malnourish amongst elderly • From patient schools to learning café • Patient diaries for new service innovations • . . . E-health, shared care plan, care on the web. . .

  39. There is a crack, a crack in everything – that is how the lights gets in (Leonard Cohen)

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