11/14/2013 Thursday, November 14, 2013 These presenters have nothing to disclose IHI Expedition Improving Safety and Reliability for Surgical Procedures Session 1 Anthony DiGioia, MD Kathy Duncan, RN Expedition Coordinator Chris Chue, Project Coordinator at the Institute for Healthcare Improvement. Chris has worked on organizing any care transition related activities through the STate Action on Avoidable Rehospitalizations (STAAR) Initiative. He has also supported several webinars such as the Primary Care Coach Program: Wave 3, IHI’s Expedition on Reducing Readmissions, and many others. In addition, he is an avid Boston Celtics fan, go Celtics! 1
11/14/2013 WebEx Quick Reference Welcome to today’s session! Please use Chat to “All Raise your hand Participants” for questions For technology issues only, please Chat to “Host” WebEx Technical Support: 866-569-3239 Dial-in Info: Communicate / Join Teleconference (in menu) Select Chat recipient Enter Text When Chatting… Please send your message to All Participants 2
11/14/2013 Let’s Practice Using “Chat” Please take a moment to chat in your organization name and the number of people on the call with you. Ex. “ Institute for Healthcare Improvement – 2” Get unlimited access to Expeditions, two- to four- month, interactive, web-based programs designed to help front-line teams make rapid improvements. Train your middle managers to effectively lead quality improvement initiatives. Enhance your strategic planning with customized whole systems data and selected benchmarking information. . . . and much, much more for $5,000 per year! Visit www.IHI.org/passport for details To enroll, call 617-301-4800 or email info@ihi.org 3
11/14/2013 What Is an Expedition? Ex • pe • di • tion (noun) 1. an excursion, journey, or voyage made for some specific purpose 2. the group of persons engaged in such an activity 3. promptness or speed in accomplishing something Expedition Support All sessions are recorded Materials are sent one day in advance Listserv address for session communications: surgeryexpedition@ls.ihi.org – To add colleagues, email us at info@ihi.org 4
11/14/2013 Where are you joining from? Expedition Director Kathy D. Duncan, RN, Faculty, Institute for Healthcare Improvement (IHI), oversees multiple areas of content and is the clinical lead for IHI’s National Learning Network. Ms. Duncan also directs content development and provides spread expertise for IHI’s Project JOINTS as well as additional content direction for the Hospital Portfolio, directs a number of virtual learning webinar series, and manages IHI’s work in rural settings. 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. In addition to her leadership on the field team during the Campaign, Ms. Duncan was the content lead for several interventions in IHI’s 100,000 Lives and 5 Million Lives Campaigns. She also serves 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 for a large community hospital. 5
11/14/2013 Today’s Agenda Ground Rules & Introductions Safer Surgery from Start to Finish IHI’s Model for Improvement Ground Rules We learn from one another – “All teach, all learn” Why reinvent the wheel? – Steal shamelessly This is a transparent learning environment All ideas/feedback are welcome and encouraged! 6
11/14/2013 Expedition Objectives By the end of this Expedition, participants will be able to: Identify specific opportunities to improve safety and reliability during the patient’s surgical experience Improve reliability of key processes identified during each step of the surgical suite Identify and test strategies to decrease risk of surgical site infection Describe strategies to identify failures during the surgical process Expedition Schedule Session Date/Time Lead Faculty: Summary Session 2: Pre-Operative Thursday, 12/5 @ Thomas Varghese, MD, 1:00 – 2:00 PM ET Processes University of Washington Strong for Surgery Program Engaging patients long before scheduled surgery Session 3: Innovative Thursday, 12/19 @ Deborah Yokoe, MD, 1:00 – 2:00 PM ET Brigham and Women’s Hospital Strategies for Hip and Knee Surgery Pre-Op screening/decolonization process Pre-Op process for CHG bathing Session 4: Pre-Operative Thursday, 1/9 @ Gerald Healy, MD, 1:00 – 2:00 PM ET Processes Post-Admission Harvard University Medical School Sheila Barnett, MD, Beth Israel Deaconess Medical Center Standardize patient experience immediate pre-op BIDMC team discusses their best practices Session 5: Perioperative Thursday, 1/23 @ William Berry, MD Processes 1:00 – 2:00 PM ET Harvard School of Public Health Team work and communication Standardize immediate post-op process Session 6: Post-Operative Thursday, 2/6 @ William Berry, MD 1:00 – 2:00 PM ET Processes Harvard School of Public Health Post-op procedures Standardizing the end of the surgical process 7
11/14/2013 Faculty Anthony M. DiGioia III, MD is a practicing orthopaedic surgeon and an engineer by training. He developed the Patient and Family Centered Care Methodology and Practice (PFCC M/P), which is based on the “third” science for health care called the Design Sciences and builds upon traditional clinical research and process improvement efforts. PFCC M/P requires Care Givers to view all care through the eyes of patients and their families and transforms the delivery of care because care is designed for the end user. PFCC M/P is an experienced based tool that co-designs services, interactions, processes and environments by partnering with patients and families as well as health care providers. This approach improves care delivery through a full cycle of care without the need for additional resources and most importantly, develops the culture to achieve outstanding outcomes, safety, quality and waste reduction. The PFCC M/P has been adopted in over sixty different care experiences at UPMC in Pittsburgh with great success and is now being adopted nationally. Dr. DiGioia collaborates with care givers and health care leaders to export the PFCC Methodology and Practice for any care experience and any organization and is helping to develop a national PFCC Community of Practice. He is board certified in orthopaedic surgery and a Fellow of the American Academy of Orthopaedic Surgeons and the American College of Surgeons and a Faculty Member for the Institute for Healthcare Improvement (IHI). He has received numerous professional awards including the Pittsburgh History Makers Award in the area of medicine and health. Anthony M. DiGioia III, MD November 14, 2013 Tony@pfcusa.org www.pfcc.org/IHIExpedition 8
11/14/2013 Learning Objectives • Deliver value and volume by building your own Patient Focused Care Center • Use performance and process improvement tools that will improve outcomes, safety and experiences while reducing costs Value in Health Care Value = Outcomes Cost 9
11/14/2013 Deliver Value by Developing a Patient Focused Care Center • Deliver care for a specific medical condition (or health) but viewed from the patient’s and family’s perspective • Treatment for a full cycle of care by design • Reorganize and manage all resources to meet the needs of patients and families • Accountability for all outcomes and costs Developing a Hospital within a Hospital Free Standing Subspecialty Hospital Inside an Existing Hospital 10
11/14/2013 Our Journey in Developing the Bone and Joint Center • 1,600+ surgeries per year, only 2 OR’s a day and 3 FT surgeons • Over 88% of patients are discharged to home…and with lowest length of stay • Best outcomes as measured by readmission rates, transfusion rates, infection rates and SCIP compliance and functional outcomes • Lowest cost per case (real costs) BJC Annual Report and Outcomes: http://www.pfcc.org/annual-reports/ 3 Keys 1. View All Care as an Experience Through the Eyes of Patients and Families 2. Co-Design 3. Implementation 11
11/14/2013 How We Got Started… • One month post-op f/u surveys for every patient and family • Determine your Current State, care pathway and the true Touchpoints and Care Givers • Start a Patient and Family Advisory Council Patient and Family Centered Care Methodology and Practice Amazingly simple… simply amazing www.pfcc.org 12
11/14/2013 The PFCC Methodology and Practice Provides the Steps to Success Ideal Experience 6. PFCC Project Teams to Close the Gap 5. Shared Vision of the Ideal 4. Working Group thru Touchpoints 3. Shadow, Current State, Urgency 2. Guiding Council 1. Define Care Experience Current State Why a “Care Experience”? Defined through the eyes of patients and families and includes everything that impacts their journey toward wellness. Examples include outcomes, interactions with and among care providers, transitions in care, safety, costs, and everyone that touches their experience along the way. 13
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