putz falls improvement collaborative

PowerPoint PresentationNational Quality Improvement Team
Welcome
National Quality Improvement Team Strategic Plan 2020 - 2024
Our purpose is to support and enable lasting improvements across our health service.
We aim to:
1. use our leadership, knowledge and skills to support services to innovate and sustainably improve quality of care and practice
2. support a co-ordinated and prioritised approach to improvement work within the CCO.
CHAMPION EDUCATE PARTNER ENABLE www.qualityimprovement.ie @NationalQI
Chief Clinical Officer
Our programme of work
National QI team programmes of work
Core Elements to develop a safety culture and QI Focused Health Service
1. Develop real partnerships with people 2. Collaborate and share learning across our system 3. Invest in QI and create QI posts in all our organisations 4. Commit to QI training for all staff 5. Work on relationships and culture so that staff feel valued and their input is encouraged 6. Work with our managers to create a work environment where staff are enabled to work on improving care 7. Use measurement for improvement approaches to understand our data better 8. Ensure we have quality at the centre of our management and governance of health care 9. Work to integrate services 10. Partner with communities so that we contribute to improving the social issues that profoundly affect health outcomes
Some National QI Safety Achievements
Pressure Ulcers to Zero (PUTZ)
Collaborative: Phase 1 (2014): 21 Teams -
73% reduction Phase 2 (2015): 26 Teams -
49% reduction Phase 3 (2017 -2018): 23 teams - 67.5% reduction
Medication safety Intensive training course
provided to 100 acute hospital staff.
Know check ask medication safety
campaign
Established Patients for Patient Safety Ireland and the National
Patient Forum. Recruited 61 members for the
National Patient Representative Panel.
prevention (from median 61% to 81%
Decontamination Programme
primary care dental, QI masterclasses to 420
participants)
Clinical audit training to 1,858
staff in 3 years National clinical audits and QI programmes in major trauma, ICU, hip fracture, orthopaedics hospital mortality, GI endoscopy, radiology and histopathology
Leadership skills for staff
Leadership Skills for Engaging Staff in Improving Quality Toolkit
Schwartz rounds - 22 teams
Reduction in broad
spectrum antibiotic use from 45% to 16.8% in Out of Hour
GP co-operative in Cork
Frail older person care pathway redesign. Median
length of stay reduced from 12.6 days to 9.7 days yearly
saving €3 million
• Enablers
• When combined together create the environment and acceleration for sustained improvement
HSE Framework for Improving Quality
Roisin Breen
Share with us:
PUTZ or Falls?
Twitter: @NationalQI
Web: www.qualityimprovement.ie
GDPR
Eileen Tormey
Speed networking
Outcome types and examples
• Improved staff / service user engagement
• Improved decision- making skills
• Better use of evidence to inform QI initiatives
• Senior management buy in
• Better use of data and measurement to inform service development
• Better support for expansion and embedding of QI practices (e.g. success of pressure ulcer / falls collaborative)
Staff – Outcomes
• Greater access and
Service User – Outcomes
Collaborative evaluation - in addition to clinical outcomes we will also evaluate:
1. Knowledge and skills (at start of day 1 and end of day 3)
Assessment of:
2. Collaborative day feedback form (end of day one)
a) Experience and suggestions for how we may improve the collaborative day
3. IHI team effectiveness scale (during story boards)
To help us determine how well teams are doing in meeting improvement goals and implementing changes.
4. AAR for National QI Team after each collaborative
day
collaborative)
Help us determine what elements of the partnership worked well / what didn’t work e.g. site visits/ web-exes/ element of one to one interviews with site leads
10 minutes
& hand into one of the National Quality Improvement Team
Brid Boyce & Teresa O’Callaghan
Why Falls, and Bone Health?
Why Pressure Ulcers?
approach?
Collaborate for
• Leading SRE
What is an Improvement Collaborative?
A collaborative is a short-term (6- to 15-month)
learning system that brings together a number of teams from healthcare settings to seek improvement in a focused topic area.
The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003
How- Applying IHI Collaborative Model methodology
The Role of Collaboratives in Improvement Culture
• Support health care organisations to make "breakthrough" improvements in quality for better care outcomes.
• Help organisations to create a structure in which interested teams can easily learn from each other and from recognised topic and improvement experts in areas where they want to make changes.
The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003
Understand the context of Front line care
• What is good about it?
• What’s not so good about it?
• What could be improved?
Whole system approach
services
Tool to aid system leaders, managers
to focus efforts towards key areas
Tool to aid front line staff as a sense check of areas that
require continuously improvement
Recognises significant service
Standardise norms
PUTZ 1DNE 2014
Reduce PU by 50% in DNE by end of 9 months
CAWT 2014
Reduced Falls by 58% across social care in DNE by 9mts
PUTZ 2 2015-2016
Reduce PU by 50% across IEHG and CHO5, 789 by 9mts
Challenge of prevention, who can help?
Family
Person
Friends
Patient Safety
There is one in 1 000 000 chance of a traveller being harmed
while on an aircraft. In comparison, there is a one in 300 chance of a patient being
harmed during health care. (WHO 10 Facts about Patient
Safety ,2018)
Why Falls (WHO, 2018)
Falls are the second leading cause of accidental or unintentional injury deaths worldwide.
Each year an estimated 646 000 individuals die from falls globally of which over 80% are in low- and middle-income countries.
Adults older than 65 years of age suffer the greatest number of fatal falls.
37.3 million falls that are severe enough to require medical attention occur each year.
Prevention strategies should emphasize education, training, creating safer environments, prioritizing fall-related research and establishing effective policies to reduce risk.
Why Falls in Ireland
EU Policy (European Commission & WHO, 2010)
Publication on progress achieved by European Countries in implementing the EC
recommendations on the prevention of injury and the promotion of safety demonstrated:
Lack of National Policy to address
this issue
balance)
• Bone health can be improved
• Quality of life is impacted (pt & Family)
• Impact on other parts of the system when a serious fall occurs
• Associated with contributing to death
• Some are preventable
• Cost
“If quality is to be at the heart of everything we do, it must be understood from the Perspectives
of the patients “ (Lord Darzi)
How do you view Patients and
families as partners?
Eileen Tormey
Team Values
MAKING CULTURE VISIBLE
Every day thousands of our staff live our values of care, compassion, trust and
learning. Sometimes this is visible, sometimes it is not.
In order to shape our culture around these values, so that they are evident every
day in every workplace, we have translated our values from words into behaviours
that we can all demonstrate.
Behaviours that make culture visible
Quality Improvement is a collective role
What do effective QI teams look like?
Team aim and vision for Improvement
Team Goal / Priority setting
Measuring, Communicating
Team Crest
Design Your Team Crest
Patient Story
Liz Maddox
Tea and Networking
Dr Michael Carton
Learning Objectives for this session
1. Understand what Quality and Quality Improvement mean
2. Understand what quantitative and qualitative data are
3. Understand the model for improvement (IHI)
4. Understand how to develop a SMART aim statement
5. Know what the term PDSA means and what ‘A small test of change’ means
Institute of Medicine definition of Quality (2001)
Patient centred
Irish National Definition of Quality
Person Centred
Effective
Safe-
Better health & wellbeing
seek opportunities to support/partner with patients in improving their own health & wellbeing
QUALITY CARE
Quality is…
“Quality is goodness…it is the extent to which we meet the needs and wants of those we care for” Don Berwick
Irish study on service users expectation of quality in healthcare- Person Centred Quality (Brilli et al., 2014)
Don’t harm me
HSE Executive Management Team
Characteristics of a Quality Service
• Continuously improve the quality and safety of their care and focus on achieving best outcomes for their service users
• Provide safe, effective, person-centred care that promotes
better health and wellbeing for those using their service • Have good leadership, clear accountability, effective
management and a well-organised effective workforce • Effectively use information to plan and deliver high quality safe
services
• Effectively and efficiently use available resources to achieve best outcomes for their service users. (SSBHC. HIQA, 2012)
Quality Improvement in Healthcare
58
“In healthcare everyone has two jobs: to do your work and to improve it.”
Professor Paul Batalden, Senior Fellow
Institute for Healthcare Improvement, 2007
What is Quality Improvement?
•Better patient outcomes
Defining Quality Improvement (HSE, 2016) (adapted from Batalden, Davidoff Qualty Saf Health Care 2007)
Building planes in the sky
• https://www.youtube.com/watch?v=Y7XW- mewUm8&list=RDY7XW-mewUm8&index=1
QUALITY
The Framework for Improving Quality in our Health Service
Which way I ought to go from here?
“ Would you tell me please, which way I ought to go from here?” said Alice.
“That depends a good deal on where you want to get
to” said the Cat. “ I don't much care where” replied Alice. “Well then it doesn't much matter which way you
go.” said the Cat
What does Quality look like for you?
How do we get there?
• Even when we know where we want to go, we still need a method for getting there
• The Science of Quality Improvement is one of a number of ways
Model for
Q1 What are we trying to accomplish?
• Right care, in the right place, at the right time
• Better care for every one
• Patient centred efficient pathway
Q1 What are we trying to accomplish?
Specific: who, what, where, when
Measurable: numeric goals
Actionable and Achievable
Timeframe: short cycles of tests, by when
Is this a good Aim Statement?
• to get some patients off the waiting list soon
“Some is not a number, soon is not a time”
Don Berwick
What should & should not be in the aim statement?
• The (patient) outcome you wish to achieve
• The solution you wish to implement
Tips
• Who is impacted?
• Is it supported by evidence or experience?
• Where will the change occur?
• Does the aim have meaning for staff & patients?
SMART Aim Statement structure
from: ____________________________ (baseline %, rate, #, etc)
Why spend time on an aim statement?
To answer and clarify “what are we trying to accomplish?”
To develop a shared language
To facilitate organisational conversation
Aim Statements
Aim Statement SMART Score
1. To improve patient satisfaction in the ED from 20% to 50%
2. To reduce the waiting time for an OPD appointment by 50% in 2015
3. To increase reporting of incidents on labour ward from 3 per 100 births to 6 per 100 births.
4. To ensure 100% compliance with all CVL bundle elements in ICU1 by medical and nursing staff by March 31st 2015.
CREATE A SMART Aim Statement
SPECIFIC Specifies the goal or intent Focus on achieving ONE thing only
MEASURABLE Direct relationship between the increase and the decrease of a measure and the achievement or the loss of the goal Increase/Decrease or with Improve/Reduce…then describe what is to be measured, and quantify by how much
ACHIEVABLE Ensure that the team will be able to take action to overcome any anticipated barriers to achieving the goal(measurable results)
RELEVANT Ensure the goal is relevant and within the teams ability to achieve, control, or influence
TIMEBOUND The goal has a target date ..by when
Q2 How will we know that a change is an improvement?
• If our Aim Statement is Measureable, we can collect some data that will help us answer this question
Data in Healthcare
It contains:
Qualitative and Quantitative Data
“No data without stories, no stories without data”
The Three Faces of Performance Measurement Improvement Accountability Research
Who? Audience Medical group Purchasers Science community (Customers) Quality improvement team Payers General public Providers and staff Patients / members Users (clinicians) Administrators Medical groups Why? Purpose Understanding of Comparison New knowledge, without regard for it's (a) process Basis for choice applicability (b) customers Reassurance Motivation and focus Spur for change Baseline Evaluation of changes What? Scope Specific to an individual medical site Specific to an individual medical group Universal (though often limited and process and process generalisability) Measures Few Very few Many Easy to collect Complex calculation Complex calculation Approximate Precise and valid Very precise and valid Time period Short, current Long, past Long, past Confounders Consider, but rarely measure Describe and try to measure Measure or control How? Measurers Internal and at least involved in the External External and usually prefer to control selection of measures both process and collection Sample size Small Large Large Collection process Simple and requires minimal time, cost, Complex and requires moderate effort Extremely complex and expensive and expertise and cost May be planned for several repeats Usually repeated Need for Very high None for objects of comparison - the goal High, especially for the confidentiality (Organisation and people) is exposure individual subjects
Solberg et al. (1997)
Some basic principles of Measurement for Improvement
The role of Subject Matter Experts
• To understand what the data is saying, subject matter experts need to be involved in interpreting the data.
Give me an example of subject matter experts in the service you work in?
YOU!
The Banana Measurement Exercise
1. As a team, measure the length of your banana
2. Document how you measured the banana
3. Tell one of the facilitators your answer
4. Swap the definition and banana with another group
5. Follow their instructions and measure their banana
6. Tell one of the facilitators the answer
The importance of the operational definition
• How does this relate to the collection of data using your safety cross?
• “if you don’t know where you came from, you can’t know where you are going”
Baseline
• Baseline – you need some data to tell you what your starting point is
• It is important
• …but don’t put off improving just to get great baseline data
Q3 What changes can we make that will result in improvement?
• We need to generate some ideas on what changes we can make that would help us achieve our aim
Where do the ideas for Improvement come from?
• Subject matter experts
Service Users and Families
• Have a unique insight into how your service is working
Avoid Inspirational Overload
The Driver Diagram
Primary Drivers (What must be present to achieve our aim )
Secondary Drivers (What must be present to deliver each driver )
Project Aim
• Heat measure • Timer • Measure of cooked meat
A motivated person/Team
• Whats in it for them is clearly understood and comunicated
• Proper training
• Selected supplier • Appropriate storage • Stock management & reorder system
• Appropriate and tested oven
Primary Drivers (What must be present to achieve our aim )
Secondary Drivers (What must be present to deliver each driver )
Driver Diagram for - The Perfect Roast Chicken
How to Develop and Use a Driver Diagram
1. Overall aim statement – a clear, action orientated statement
2. Primary drivers – system components which will contribute to achieving the aim ( identify what you want)
3. Secondary drivers – elements within the associated primary driver ( identify how to achieve primary drivers, what you need)
4. Ideas for tests of change
Tasks and tests
Small Tests of Change
Video
“Insanity: doing the same
and expecting different
Plan – Do – Study - Act
• Plan- predict/ plan and agree the who, what, how and when of your test (after your base line measure is undertaken and SMART aim agreed)
• Do – Carry out your agreed changes in different circumstances (days, nights, weekends)
• Study – examine the difference beside your baseline noting improvements or NOT
• Act- decide to adopt the change in practice or start again!
• Plan- predict/ plan and agree the who, what, how and when of your test (after your base line measure is undertaken and SMART aim agreed)
• Do – Carry out your agreed changes in different circumstances (days, nights, weekends)
• Study – examine the difference beside your baseline noting improvements or NOT
• Act- decide to adopt the change in practice or start again!
• Accept
• Adopt
• Discard
Lets Practice PDSA’s with a coin toss Objective of the game is to reach the desired target with your coin.
• Prediction- Plan: Decide who is going to toss the coin/ what type of coin/style of throwing
• Do: stand behind a line and throw the coin as close to the target as possible. Measure the distance from the coin to the target location.
• Study: did you reach the target? How near were you?
• Act : New prediction/plan
• Don’t forget to keep a record of your tests!
Cycles of Tests build Confidence
BASELINE Measurements
improvement
Top Tip
• Don’t be afraid to include PDSA cycles that have not resulted in the desired effect – there can be just as much learning in these tests
The principles of PDSA’s
• Break down change into manageable bite-sized time-limited chunks
• A PDSA cannot be too small !!!!!!
It can be too big !!
• Small changes can be tested without causing upheaval to the whole system
Tell other’s what you are doing
• If it doesn't work, try something different based on your learning
Document what did/didn’t work
Appreciation
Quality Improvement Toolkit
• Michael insert slides
Available on internet for use and a webinar will be scheduled between Learning day one and two
Twitter: @NationalQI
Web: www.qualityimprovement.ie
PUTZ Lead -Brid Boyce
Dr Michael Carton

putz falls improvement collaborative

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