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GHA Hospital Engagement Network HAC Learning Collaborative

GHA Hospital Engagement Network HAC Learning Collaborative. Webinar ~ September 19, 2012 Kelley Dotson, GHA Freya Gilbert, Hughston Hospital Meryl Montgomery, MCCG. Follow-Up from 8/28 Evaluations. Technical Issues with Webinar Screen and volume Transcript with handouts

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GHA Hospital Engagement Network HAC Learning Collaborative

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  1. GHA Hospital Engagement Network HAC Learning Collaborative Webinar ~ September 19, 2012 Kelley Dotson, GHA Freya Gilbert, Hughston Hospital Meryl Montgomery, MCCG

  2. Follow-Up from 8/28 Evaluations • Technical Issues with Webinar • Screen and volume • Transcript with handouts • View the presenters • Webinar Material Availability • Agenda emailed with links • Materials posted to GHA website • Participation in Sharing and Learning • Allow participant to submit questions/requests prior to webinar • Open forum during webinar to allow sharing • Small group meetings with similar hospitals • Subscribe to the list serve at HealthcareCommunities.org (exchange info-EBP, Examples) • Application of Reliability Concepts • Hospitals examples through presentations • Open forum for exchange of information

  3. Learning Objectives • Review concepts of the Reliability Theory used at specific hospitals • Discuss improvement work for reliable design concepts • Share struggles and ideas related to using concepts of the Reliability Theory

  4. Reliability Theory Concepts in PracticeMed Rec - Hughston Hospital Freya Gilbert, RN Administrative Director of Quality & Clinical Practice Hughston Hospital

  5. Analyzing Testing & ImplementingQuestion the Connection

  6. Analyzing Testing & ImplementingQuestion the Design Strategy

  7. How to Measure Human Factor How to Measure the Human Factor Human Factor Tests of Study the Design Process  Identify Human Factor Tests of Change & Resulting Defects  Develop Process to Resolve Defects

  8. Analyzing Testing & ImplementingQuestion SEGMENTATION

  9. Segmentation -Enables control of some variables -Defines boundaries success of sequential expectations -Tests validity rather than addressing the barriers -Forces understanding of the differences among segment -Fosters deeper understanding of design complexity -Allows the formation of predictable timelines • Finding the FIRST Segment • MUST represent a reasonable volume • Should have clearly defined boundaries • Involve willing participants to avoid barrier of agreeing • Allows neutralization of key variables or barriers • Establishes a design theme • Identifying OTHER Segments • Total segment topics not to exceed 4-5 • Segment follows design theme (type of admission, physician, etc.) • Segments differ by a distinct design feature • Adjustment of the initial segment division as the design develops • Segments cover the population involved in the topic

  10. Testing & ImplementingQuestion STANDARDIZATION vs STANDARD WORK

  11. Standardization - Standard Work *KEY LEARNING POINT* A standardized process design using knowledge of human factors & acceptable science is superior to varied processes • Allows training of new employees & enables testing of current employees • Provide the appropriate infrastructure (the how, what, where, who & when) • The “what”we are standardizing is based on scientificevidence • Initial standardized protocol requires little time when testing a very small scale • Changes to the protocol in the initial stages should be required and encouraged • The “how”is based on systems knowledge and does not require scientific evidence • Defects are studied and used to redesign the process Successful description of a process by 5 front line process users  likely to achieve 95% performance & to sustain the performance over time

  12. Analyzing Testing & ImplementingQuestion the DESIGN METHODOLOGY

  13. Three Step Design for Reliability • Points to Remember • - Perfection is the enemy of DESIGN - Constant testing of observed defects • - The design is designed by the people who use the design - Segmentation tests the design

  14. Analyzing Testing & ImplementingQuestion the SMALL, RAPID CYCLE TESTS

  15. How to Evaluate Are testing cycles being used on an acceptable basis? Are huddles occurring after the tests for quick redesign? Are records being kept of the tests? Do all team members have test responsibilities?

  16. Analyzing Testing & ImplementingQuestion COLLECTION & MEASUREMENT

  17. Design Measurement = Process Measures Using Failure Modes in Process ReDesign • Assess defects in the current design (Process Failure) • Prioritize failure modes in terms of overall affect on the reliability of the process • Establish process measures based on the prioritized failure modes • Incorporate established measurement into the INITIAL design • Evaluate process improvement using small samples over time Using Measurement to Evaluate Design / ReDesign (Process Measures) • Data collected by the team using established process measures • Data collection strictly follows a define tempo / schedule • Data can initially be collected for segments PROCESS Measurement vs OUTCOME Measurement • Process measures are collected by the primary team • Process Measure Goals set at 95% (10-2) • Outcome measures are NOT collected by the primary team • Outcome measures goals set at 0 / 100%

  18. Reliability Theory Concepts in Practice:HITTING THE WALL - MCCG Meryl Montgomery, RN, MSN Nursing QI Coordinator, Magnet Program Director Medical Center of Central Georgia

  19. Testing Implementation and SpreadHitting the Wall **Key Question** What do we do when the team just seems stuck? • Use the 7 Question Analysis • Check the rules of engagement • Use the spread analysis

  20. Hitting the wallProcesses to Improve Outcomes

  21. HITTING THE WALLMore Processes to Improve Outcomes

  22. PROCESSES - EBP Bundle

  23. LOTS of processes, hard work and diligence

  24. Results: Leading Indicator: use of prevention strategies

  25. HAPU vs. POA- going in the right direction

  26. HAPU prevalence rates 3Q10-2Q12

  27. Stepping Back to Move Beyond the WallReview the 7 Questions to Analyze Testing & Implementing

  28. Hitting THE WALL in 2012 • Sustain HAPU rate just under <5% • Prevention strategy utilization >70% • Underperform compared to >500 beds and Magnet hospitals • Focus on education, expectation, engagement, encouragement, RCA, report out • Join GHA HEN HAC- RCA, process flow, small tests of change Stepping back- where we are with reliable process design strategies?

  29. Stepping Back to Move Beyond the WallReview the Rules of Engagement Engage Team Members Using the 4 E’s2 How does this make the world a better place? Engage (adaptive) Senior leaders Educate (technical) What do we need to know? Team leaders What do we need to do? What can we do with our resources and culture? Execute (adaptive) Staff Evaluate (technical) How do we know we improved safety? www.ahrq.gov/cusptoolkit/2assembleteam/assembleteam.pptx

  30. Stepping Back to Move Beyond the WallReview the Stages of Engagement Engaged Apathy Aversion Uninvolved www.ahrq.gov/cusptoolkit/2assembleteam/assembleteam.pptx Engagement: “To involve oneself or become occupied; to participate fully and deeply” Active support of the project

  31. Stepping Back to Move Beyond the WallKey Questions To Analyze Spread

  32. Stepping Back to Move Beyond the WallUtilize the Spread Analysis IHI Science of Improvement Tools • A Framework for Spread: From Local Improvements to System-Wide Change • A key factor in closing the gap between best practice and common practice is the ability of health care providers and their organizations to rapidly spread innovations and new ideas. • Spread Planner • The Spread Planner is a set of questions designed to assist organizations in identifying the key actions they can take to turn a local success into a system-wide improvement. http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementSpreadingChanges.aspx

  33. Moving past the “nag and snitch”*climbing over & going around THE WALL

  34. BEFORE attempting the MOVE…What have others done when you hit the wall? • Present • Stepping back to move forward • EXCHANGE ideas • Future • Ideas implemented • Beyond the WALL

  35. Exchange Ideas to Prevent HACsFalls – Med Rec – Pressure Ulcers - VTEs Possible Topics for Discussion among Participants • Tips for doing Small Tests using “1” • Results from Data Collection/Analysis • Successful interventions for each HAC • Beneficial Tools and/or Frameworks • Evidence Based Practice (EBP) guides/tools • Supportive research findings • Policy / Procedure development **Remember to email questions/requests to kdotson@gha.org if preference is to anonymously initiate a discussion**

  36. To-Do List • Submit process data • Collect data using the worksheet • Email data to kdotson@gha.org • Current collection should be the 3rd month of process data collection and submission • Complete the electronic evaluation • Remember…complete & send the sign-in sheet if listening to the recording • Join the Georgia HEN Community of Practice on the HealthcareCommunities.org website • List Serve is excellent way for hospitals to share information • List serve is excellent way for HEN to provide information

  37. Educational TELNET/Webinars • 3rd Wednesday every month • October 17, 2012 • 11:00 am – 12:00 pm Next Telnet/Webinar

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