Innovative Approaches to Prevention of Falls - Positive Deviance and Frontline Ownership

INNOVATIVE

APPROACHES TO

PREVENTION OF FALLS—

POSITIVE DEVIANCE AND

FRONTLINE OWNERSHIP

Guest Presenter: Dr. Michael Gardam

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Your Presenters and Faculty

Nadine Glenn--CPSI

Gina Peck--CPSI Susan McNeill--RNAO

Verity White--RNAO

Dr. Michael Gardam Hélène Riverin--CPSI

From where are you joining?

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Using Front-Line Ownership to Prevent Falls

Michael Gardam

University Health Network

“Insanity: doing the same things over and over again and expecting

different results.”

8

With which statement do you most agree?

A. Improved education can solve most quality and safety issues;

B. Healthcare workers generally know what they need to do but for whatever reason, they don’t do it;

C. Improving quality and safety invariably requires more money;

D. Standardized tools and processes will efficiently bring about change.

Traditional Healthcare Culture

• Need to get things done immediately

• Evidence-based practice (scientific proof)

• Information and data are trusted

• Culture change is complicated

• Leaders need to ‘step-up’

• Top-down leadership

Zimmerman et. al. Healthcare Papers 2013

How we think the healthcare world works:

A B

How it really works:

W B BLACK BOX

In a Linear World

• One size can fit all

• Copying best practices makes sense

• Top down leadership (“develop the program and roll it out”) works

• Checklists work

In a Complex World

• One size never fits all

• What works here may not work there

• “this is how we do things here”

• There is no “one big fix”

• Bottom up leadership works

• Social immune response

Safety Strategies

① Prevention

①Resilience

Prevention

Reality

Resilience

RONT

INE

WNERSHIP

Zimmerman et. al., Healthcare Papers, 2013

Ownership

Buy in

How to get here?

From here?

Principles

• Participation is voluntary – everyone can opt in or opt out

• Bottom up, top down and sideways

• Make the invisible visible

• Include the unusual suspects

• Go slow to go fast

• Nothing about me without me

• Act your way into a new way of thinking

Rebuilding the wheel…

25

Example: Hand hygiene

TRIZ

Nursing engagement

Ideas…

different socks

fall monitors

Bedside report

talking to patients

stay with patients while

in the bathroom

“busy” aprons

change blood draw

time

Current Collaborative Performance shows Falls across 6 hospitals declined by 13%

In comparison to the baseline rate, a total of

14 falls have been prevented in 2013

Falls: BOZ total trend

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013

Falls

pe

r 1

,00

0 P

atie

nt

Day

s

BOZ Total Trend with intervention Trend without intervention

Culture SHIFT • Taking time to think

• Practice-based evidence (social proof)

• Stories and relationships are trusted

• Culture change is simple

• Leaders need to step back

• Bottom up leadership from the front-line

What we have learned

• Rarely are there significant education deficits.

• Healthcare workers do know what they need to do.

• Remarkable change can occur for no money.

• Standardize outcomes but not necessarily processes

michael.gardam@uhn.ca

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“Taking the Pulse” Poll

15-Nov-

13 36

But wait….There’s more! Please do not exit the call without completing the poll

Dr. Michael Gardam

Registered Nurses’ Association of Ontario

CPSI—Technical hosting

All attendees who are working diligently to

make care safer

Thank you for sharing and learning on the

Falls Community of Practise

Thank you

Assessing delirium: pragmatics and confounders

– November 19, 2013– 12:00 p.m.-1:00 p.m. EST

The ten obstacles to Hand Hygiene

– December 10, 2013—2:00 p.m.-3:00 p.m. EST

For dial-in information, please go to: www.saferhealthcarenow.ca

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