“Everything is impossible until

someone does it”

Frank Federico

Institute for Healthcare Improvement

We Exist Because…

“Between the health care we have

and the care we could have lies

not just a gap, but a chasm.”- Institute of Medicine, Crossing the Quality Chasm, 2001

Some of Our

Groundbreaking Initiatives…

100,000 and 5 Million Lives Campaigns

IHI Open School for Health Professions

The IHI Triple Aim

The Improvement Map & Passport

STAAR (STate Action on Avoidable Rehospitalizations)

TCAB (Transforming Care at the Bedside)

Safer Patients Initiative (UK)

Ko Awatea

Scottish Patient Safety Programme

Chronic Care Initiative (Indian Health Service)

WIHI

Model for Improvement

What changes can we make that will result in an improvement?

What are we trying to accomplish?

How will we know that a change is an improvement?

Act Plan

Study DoPDSA

Associates in Process Improvement

Definition of Harm

World Health Organization (WHO) Collaborating Centers

for International Drug Monitoring defines an adverse

drug event as follows:

“Noxious and unintended and occurs at doses used

in man for prophylaxis, diagnosis, therapy, or

modification of physiologic functions.”

• The IHI Trigger Tool methodology includes these PLUS

any

Noxious or unintended event occurring in association

with medical care.

Eliminating Harm/Defects

Weak

Strong

Juran Trilogy

Does this ever happen?

Two patient care units are working on reducing

patient pressure ulcers on their units.

Unit A has reduced their rate by 60%, Unit B by

12%.

You ask the staff on Unit B about their work, and

they say, “Our patients are different”.

9

We understand the importance of interactions of people

We look for assumptions and beliefs that are behind

decisions and actions we take

We will rely more on intrinsic motivation and less on

extrinsic motivation

We appreciate differences in people and the importance of

attribution error

We understand that we have bad systems, not bad people

An Understanding of Psychology in

Improvement Work

Three Necessary Ingredients for

Improvement

Building Will

– Motivating health care provider organizations to think beyond the status quo and imagine a better system

Harvesting Ideas

– Finding, cultivating, or inventing new approaches for better patient care

Getting Results

– Providing the support, methods and tools for teams to take action

Health Care Benchmarking

“Benchmarking studies are perishable and time sensitive.

What is a standard of excellence today may be the

expected performance of tomorrow. Improvement is a

continuous process, and benchmarking should be

considered as a part of that process. As a result,

although different authors have defined benchmarking

in different ways, all these definitions have a common

theme, namely: the continuous measurement and

improvement of an organization's performance against

the best in the industry to obtain information about new

working methods or practices in other organizations.”

(Kozak, 2004).http://www.fmshk.org/database/articles/06mbdrflkay.pdf

You can benchmark against the average:

there are those who perform better and

those who perform worse than the average

Or, you can benchmark against the

best

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p

NH Scotland HSMR; Jan 2008 – June 2012

1.03

0.887521 less than expected deaths

James M. Anderson Center

for Health Systems Excellence

80% Reduction

Serious Safety Events per 10,000 Adj. Patient Days

Rolling 12-Month Average

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** The narrowing thresholds in FY2005-FY2007 reflect increasing census. Adjusted patient days for FY07 were 27% higher than for FY05.

** Each point reflects the previous 12 months. Threshold line denotes significant difference from baseline for those 12 months (p=0.05).

aSSERT Began

July 2006

Chart Updated Through 31Aug09 by Art Wheeler, Legal Dept. Source: Legal Dept.

Desired Direction

of Change

0

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Jan-

08

Apr

-08

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9

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Apr

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Oct-1

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Ventilator Associated Pneumonia Rate (per thousand ventilator days)

9.11

3.54

61% reduction

Central Line Bundle Compliance

65

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100

Jan-0

8

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-12

9.5% improvement

87%

96.5%

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Oct-1

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Central Line Infection Rate (per thousand line days)

2.8

0.84

70% reduction

Næstved Sygehus24

Sepsis Reduction

Days Between

Dage siden sidste VAP Længste periode uden cvk

26

421 638

Best Care Always

The IHI Open School (All HMC staff)

IHI Foundations Training Program(~500 staff)

HMC Local FellowshipProgram (12 – 36 staff)

IHI IAs and Fellows (1-5 staff)

Building Improvement Capability

Day-to-day leadership

Strategic Guidance and Operations

Knowledge from the field: Success and Challenges

Corporate Delivery Team(HMC and IHI)

Campaign Operations Team(HMC and IHI)

Campaign Leadership Team

Defining Needs, Managing

Operations

Qatar National Health

Strategy

HMC Academic

Health System

Human Resources

IT

The Hamad Medical Corporation Campaign

Collaborative Work streams

Campaign Ops Director

Program Managers

Fellows and Local Fellows

Multidisciplinary Improvement

Teams

Local Improvement

Improvement Capability

What We Plan to Accomplish

Reduce harm

Focus will be in prototype areas

Specific harms will be reduced

Time line: 1 year for pilot units

Aim

50% improvement in measures associated with the set

change packages in the participating teams by

September 2014

50% improvement in measures associated with the set

change packages across HMC by September 2015

How Will We Know

Measures

– Process and Outcome measures per change package

Participating Teams

– Year 1: prototyping with 40 teams

– Teams from Perioperative area, Med/Surg, General Ward,

Intensive Care

Year 2: Spread

HMC’s Best Care Always Collaborative

General Ward

Med/Surg

Critical Care

Peri-operative Care

VTE

CAUTI, MRSA, CDiff,

Sepsis

Pressure Ulcers

CLBSI

CAUTI, MRSA, CDiff

Sepsis

Ventilator Acquired

Pneumonia

Surgical Safety

Checklist

VTE

Surgical Site

Infections

VTE

Work-stream

Change PackagesWith TestedChanges

Our Journey Begins Today

Know where you are– Baseline Process and Outcome measures

Know where we want to go– Best Care Always, Safest Care First

Know how to get there– Change Packages

– Use an improvement method

Know when we arrive– Measures