2016 IHI Webinar Series
Rhonda Dickman, RN, MSN, CPHQ Rhonda Dickman is a Quality Improvement Specialist with the Tennessee Hospital Association’s Tennessee Center for Patient Safety, supporting hospitals in their quality improvement work, particularly in the area of readmissions. She is also the clinical manager of the Tennessee Center for Patient Safety’s PSO (patient safety organization). Rhonda has worked in the field of hospital quality management since 2006 and has a clinical background in trauma, critical care, oncology, and organ donation. rdickman@tha.com 615-401-7404
THA Webinar Series Exclusive program for clinical leaders in hospitals that are part of the Tennessee Hospital Association Hospital Engagement Network (HEN) Focused on supporting clinical leaders who supervise front-line staff 18 webinars in total 1.5 contact hours for each webinar Transitioned to new webinar platform
4 Coming Soon- Invite your Colleagues!
Kathy Duncan, RN Kathy D. Duncan, RN, Director, Institute for Healthcare Improvement (IHI), oversees multiple areas of content, directs multiple virtual multiple learning webinar series. Currently she serves as Faculty for the AHA/HRET Hospital Engagement Network (HEN) 2.0 Improvement Leadership Fellowship Ms. Duncan also directed content development and spread expertise for IHI’s Project JOINTS, an initiative funded by the Federal Government to study adoption of evidenced-based practices. In 10 US States, Project JOINTS spread three evidence-based pre-and perioperative practices to reduce the risk of surgical site infections in patients undergoing total hip or knee replacement. Previously, she co-led the 5 Million Lives Campaign National Field Team and was faculty for the Improving Outcomes for High Risk and Critically Ill Patients Innovation Community. She has also served as a member of the Scientific Advisory Board for the American Heart Association’s Get with the Guidelines Resuscitation, NQF’s Coordination of Care Advisory Panel and NDNQI’s Pressure Ulcer Advisory Committee. Prior to joining IHI, Ms. Duncan led initiatives to decrease ICU mortality and morbidity as the Director of Critical Care, Orthopedics and Neuro for a large community hospital.
Transitions Task Force 6 Brenda Hogan- Maury Regional History – 1/2013 “Transitions Task Force, 2014 Charter signed CEO, VP of Quality, Director of AAAD, N Manager developed front line committee with local SNF Workgroup reports – 1) DC Process 2) Communication 3)Education 4)ADE/Med Safety 5) Foley Cath Currently meet every other month with focus on one topic Actions to date – Education to providers from the hospital face to face – Handoff Form – Post Discharge Order sets for SNF and HH (CHF and COPD) – “Electronic Resource Guide” – Scorecard with readmission rates and O/E for each SNF and HH
Action Period Assignment List two ideas from this session that they are putting to work in their organization/unit. – Why did you choose these two? – Why is this important to you? – What can you predict they can accomplish? Take care of Active yourself: Resiliency Constructive 3 Good Responding: Eye Things contact, Smile, Touch, Laugh
This presenter has nothing to disclose Using Measurement for Learning and Strategies to Achieve Results Kathy Duncan May 11, 2016
Session Objectives Participants will be able to: • Describe strategies for getting results in over burdened care delivery systems • Apply strategies and tools for creating an action plan to coordinate and leverage all initiatives to improve care transitions • Explain the recommended measurement strategy and rationale for using outcome, process and process measures to guide learning and assess progress
Achieving Desired Results “Results”
11 Strategies for Getting Results Building will for change Using the Model for Improvement Clarifying needs for implementation and reliability
12 Strategies for Getting Results Building will for change
13 Strategies for Getting Results Building will for change – Scoping clear aims – Focusing the aims on the Greater Good – Having the aims on the organization’ strategic plan – Clarifying the gap: reinforcing why change is important – Engaging frontline ideas and involvement – Starting with small tests of changes - PDSA
14 Engaging Frontline Clinicians Include them in: – Identifying the problems – Understanding problem from the patients’ perspectives – Testing their ideas on how to improve – Seeing the impact of changes they make – Using observations to learn the real work – Honor their work Consider the work burden of change and new processes Test potential changes well in a small unit before expanding
Seeing the Impact of Changes We Make Annotated run charts, give us feedback on the relationship between • Our theory (the changes we are making) and the • Outcomes for our patients (readmissions and overall experience)
Observing the Actual Processes • Go see the real process • Check assumptions: what really happens compared to what is described? − Observe and ask “Why?” five times to get to the root causes of current performance • Identify process failures you can change • Discuss changes that your team would like to test
17 How Do You Build Will for Change?
18 Strategies for Getting Results Using the Model for Improvement
For more information, please visit the IHI Open School Course - QI 102: The Model for Improvement: Your Engine for Change at www.IHI.org
Plan-Do-Study-Act (PDSA) Cycle A ct P lan [action-oriented • Determine • Plan 1 small change to test learning] if change(s) should be made • Predict what will happen • Plan for next test • Decide on data • Act to hold gains, to evaluate test continue to improve S tudy D o • Analyze the data • Run the test • Document • Compare results problems and to predictions observations • Summarize • Begin data what was analysis learned
Team Name: _ _________________ PDSA Worksheet Cycle start date: _________ Cycle end date: __________ PLAN: Describe the change you are testing and state the question you want this test to answer (If I do x will y happen?) What do you predict the result will be? What measure will you use to learn if this test is successful or has promise? A P Plan for change or test : who, what, when, where S D Data collection plan : who, what, when, where DO: Report what happened when you carried out the test. Describe observations, findings, problems encountered, special circumstances. STUDY: Compare your results to your predictions. What did you learn? Any surprises? ACT: Modifications or refinements for the next cycle; what will you do next?
22 Strategies for Getting Results Clarifying needs for implementation and reliability
Implementation The change is a specified part of daily work - need to develop all support infrastructure to maintain change High expectation to see improvement (Eagerness to continue testing to achieve reliability) Increased scope will lead to increased resistance (Value of evidence from successful tests)
Sequence for Improvement and Spread Spreading a Make part change to other of routine operations locations Test Implementing a under a variety of change conditions Act Plan Testing a Theory and Study Do change Prediction Developing a change Slide by Robert Lloyd
Implementation Requires . . . • PDSA: Testing implementation steps • Established buy–in & consensus building • Communication • Training • Policies & Procedure • Supportive infrastructure including assigned accountability
Tracking Progress in Changes 100% U6 U5 U4 U3 U2 CHANGES Using Teach Back Medication Reconciliation Enhanced Assessment Real-Time Handovers Scheduled Visits Follow-up Appointments 100% Coverage
# of Hospitals
Strategies and Tools 28 for Building an Action Plan Using charters Planning/tracking progress of changes Tracking/exploring connections to other initiatives Using balanced measures Specifying the measurement plan for collection, analysis and reporting for the frontline to the boardroom
Using Charters to Drive Results • Signal strategic work across the organization and attract resources • Frame and enable strategic initiatives • Keep the team focused through regular review of the aim, timeline, and measures
30 CHARTERS?
31 Include Connections to Other Initiatives
Measures to Evaluate Impact and Progress Measures directly relate to the Outcome aim of an initiative (the “So what?”) Measures reflect how well Process processes in the work get done around key changes Measures to help avoid causing detriment to another outcome or Balancing part of the system, e.g., processes, safety, satisfaction, equity, or costs
33 Examples? Outcome Measure Process Measure Balancing measure
V. System of Measures 34
V. System of Measures
V. System of Measures
V. System of Measures
V. System of Measures 38
V. System of Measures 39
V. System of Measures
Reflections • What ideas did you hear that you might apply?
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