Improvement in newborn care through increased compliance with the Neonatal Resuscitation Program: sustaining improvement Dr Adele Harrison; Island Health Jessica Belle, Shaun van Pel, Ashley Jewett; Island Medical Program
Disclosure • I have no affiliation with any commercial or industry interest in relation to this presentation. • Adele Harrison is a Neonatal Resuscitation Program (NRP) instructor and regional instructor-trainer. 2
Neonatal Resuscitation Program 3
Key Measure • Percentage of resuscitations in which there is accurate documentation of correctly performed resuscitation as characterized by correct use of oxygen and correct use of ventilation pressures according to NRP. • Target: 100%. 4
Methods • A multidisciplinary working group of healthcare providers who were involved in teaching and clinical delivery of NRP was established. • Hospital charts of up to 5 newborns admitted to the Neonatal Intensive Care Unit were audited every 2 weeks from April 2012 to May 2013 and from November 2013 to February 2014. • Plan-Do-Study-Act cycles were utilized to evaluate change ideas 5
Planning for Success: DICE Methodology • Duration of project • Integrity of project team • Commitment of top management • Commitment of employees affected • Effort over and above usual work – DICE Score =12 “Win Zone” (7 to 14) Hal Sirkin, Perry Keenan and Alan Jackson. The Hard Side of Change Management, 6 October 2005, Harvard Business Review .
Early findings Healthcare professionals like doing, not charting! 7
Strategy for Change Design Changes/Interventions Key Drivers Develop VIHA “program” of NRP Knowledge/skills of courses NRP Teach resuscitation record Specific Aim Completion of completion to NRP instructors Resuscitation Record Improve compliance with NRP to 100% by Implement checklist for Correct equipment March 2013 resuscitation equipment available Optimize team structure at Team composition deliveries Team functionality Develop recommendations for course content for different HCPs Develop multidisciplinary NRP courses 8
Quality Forum 2013 9
Newborn extended resuscitation records initiated 100 90 Percentage of records initiated 80 70 60 50 40 30 20 10 0 median Newborn extended resuscitation records completed 100 Percentage of records completed 90 80 70 60 50 40 30 20 10 0 10
Correct use of pulse oximeter and oxygen documented 100 Percentage of records completed 90 80 70 60 50 40 30 20 10 0 median Correct use of pressures documented 100 Percentage of records completed 90 80 70 60 50 40 30 20 10 0 11
Sustainability Radar Chart Sustainability Benefits 16 Infrastructure Credibility of evidence 12 8 Fit with goals and culture Adaptability 4 0 Clinical leaders Monitoring Progress Senior leaders Involvement and training Behaviours Source: NHS Institute for Innovation and Improvement. Sustainability Model and Guide. 2010. Adapted by BC Patient Safety Quality Council 12
Key Factors in Sustainability Strengths Challenges Benefits Efficiency Credibility of benefits Evidence-based Communication Adaptability of process System change Ability to monitor progress Ongoing Staff involvement/training From the beginning Behaviours towards change Some buy-in QI not part of the culture Senior leadership support Engaged Not visible Clinical leadership support Engaged and involved Strategic aims and culture Clear goals Culture Infrastructure Adapted environment 13
Summary • Visualize success • Articulating clear goals and sharing the data helped drive positive change • Get everyone on board • Including multidisciplinary clinical staff in the process positively impacted sustainable change. • Make it child’s play • Environmental modifications and system changes were powerful drivers of behaviour and promote sustainability. 14
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