Getting to Zero-Safer Care Improvement Programme

Annette Bartley RGN BA MSc MPHHealth Foundation/IHI Quality Improvement Fellow

Programme Aims

• Alignment with Safety Express • To reduce the incidence of Avoidable

Hospital /Community Acquired Pressure Ulcer• Reduce of Falls (falls with harm)• Reduce Catheter Associated Urinary Tract

Infections (CAUTI)• Prevention of Venous Thromboembolism

( VTE)

Action Planning Session

Hunches Theories Ideas

Changes That Result in Improvement

A P

S D

APS

D

A P

S D

D SP A

DATA

Very Small Scale Test

Follow-up Tests

Wide-Scale Tests of Change

Implementation of Change

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

Alignment -Harm Free Care

Prevention of Pressure Ulcers

Prevent the Incidence of

Pressure Ulcers, Falls,

CAUTI, by April 2012 using the

Intentional rounding process

Patient and Family

Centred Care

Engage the wider MDT team Set sims and plan tests together Share learning

Ensure there is leadership support for this work at every level in the organization

Transformation Leadership at ward/unit level

Team work

Leadership engagement

Reliable Implementation of the

The Intentional Rounding process

Address the 8 key behaviours and incorporate the : SKIN Bundle Surface Keep Moving Incontinence Nutrition

Create Patient centered healing environment – Use the ESTHER story Support and Involve patients and families Provide spiritual and emotional support Ensure patients rights, privacy and dignity are maintained

Content Area Drivers Interventions

Educate staff regarding the assessment process, identification and classification of, and treatment of pressure ulcers Educate Patients & family Develop patient information pack

Training & Education

The Model for Improvement will underpin the programme, enabling teams to connecting an aim to action and measurement

which will enable you to demonstrate their progress.

Developing a systems-based approach to the prevention of hospital acquired pressure ulcers

Risk Identification

Communication of Risk status

Risk Assessment

Appropriate preventative strategy implemented

Evaluation of outcome

What will success look like?

Three Types of Measures

Outcome Measures: Voice of the customer or patient. How is the system performing? What is the result?

Process Measures: Voice of the workings of the system. Are the parts/steps in the system performing as planned?

Balancing Measures: Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures? (e.g. unanticipated consequences, other factors influencing outcome)

Measurement Guidelines

• The question - How will we know that a change is an improvement? - usually requires more than one measure• A balanced set of five to eight measures will

ensure that the system is improved• Balancing measures are needed to assess whether

the system as a whole is being improved

Measurement- It is YOUR data!! (data MUST be locally owned)

• Outcome measures – Incidence ( count on safety cross)– Days between events

• Process measures– Percent Compliance with risk assessment– Percent Compliance with process ( bundle)– Percent compliance with Intentional Rounding tool

• Balancing measures• Patient Experience • Staff satisfaction• Length of Stay• Complaints• Staff turnover /Sickness rates• Budget implication

Visual Measurement

1 2

3 4

5 6 (3)

7 8 (1) 9 10 11 12

13 14 15 16 17 18

19 20 (1) 21 22 23 24 (1)

25 (1) 26

Days since last... 27 28 (1)

___ days 29 30 31

Real Time Data for improvement – Process

Intentional Rounding – What is it?Structured process where frontline staff regularly

round on patients and reliably perform scheduled/required tasks

Rounding with purpose- linked to an aim8 key behaviors

1. Opening key words – managing up2. Perform scheduled tasks3. Address the 3 p’s of pain, potty? position (SKIN

Bundle)(toileting), and4. Assess comfort needs5. Environmental assessment6. Closing key words7. Explain when you or others will return8. Document the round on the log

Tools – Rounding Log

Tools – Badge Card

Tools – Accountability Tool

Intentional Rounding -Benefits

• Provide staff with better control of their time

• Improved outcomes / promote safety

• Results • Increase Patient Satisfaction • Decreases anxiety• Increase trust and give sense of

comfort• Increase Employee Satisfaction

The Snorkel

Fostering Creativity and Brainstorming?

Methods for Generating New Ideas

• Change Concepts• Using Technology• Critical Thinking• IDEO Brainstorming• Metaphorical Thinking• Observation• Provocation• Prototyping• Idealized Design

Innovation and Work Redesign

http://theartofinnovation.com/purchase.htm

GETncm/justsaycust-recrate-itemcommunittg/stores/dtg/stores/d-

Resources for “Snorkel”

Outline of “Snorkel”Review of Project Vision and CharterWhat do we know about …. Propose a Design ChallengeStorytellingHow might we….?BrainstormingSelect top ideas (multi-vote)Prioritize ideas for development Plan prototypes EnactmentsDesign first series of tests

Storytelling

• In lieu of doing actual observations, use storytelling to “observe” actual experiences

• Recall an actual story or experience which relates to the specific design challenge (personal, friend or family member or work-related experience)

Who was involved? What happened? How did individuals feel and react?

• Give an example

• Tell stories in small groups (nor more than 2 minutes each)

How might we….? (used to create ideas for the brainstorming)

…. Prevent harm

…Engage Patients and families in preventing harm

…Optimise nutrition

Ideas should be actionable Write each idea on post-it notes or flip c

Rules for Brainstorming (20 mins)Chose one or two “how might we scenarios….

• encourage wild ideas• go for quantity – want more than 500 ideas• defer judgment• be visual – draw pictures• one conversation at a time• build on ideas of others• stayed focused on topic (“how might we…”

scenarios)

Write each idea on post-it notes

Multi-voting to Select Top Ideas

• Cluster together similar ideas from brainstorming exercise

• Use dots to vote:

What are your personal favorites? What idea would you most like to try on your unit? What idea do you think will have the biggest

impact toward achieving the “how might we…”

• Participants can distribute their dots however they want –- all on one idea, each dot on a separate idea, or anything in between

• Report out on favorite ideas (where there are most dots)

Matrix of Change Ideas

Low Impact

High Impact

Low Cost High Cost

Translate high-cost solutions into low-cost alternatives.

Strive for high-impact , low-cost solutions.

Outline of “Snorkel”Review of Project Vision and CharterWhat do we know about…… Propose a Design Challenge StorytellingHow might we….?BrainstormingSelect top ideas (multi-vote)Prioritize ideas for development Plan prototypes EnactmentsDesign first series of tests

IDEO’s Design Principles

1. Keep people informed throughout process

2. Value people, time, and energy3. Enable learning and teaching4. Give people appropriate levels of

control5. Facilitate connections among people

Enactments

• Create an enactment to illustrate an extreme future vision for your prototype

• Create storyline and build• Rehearse and refine• Present to whole group• Select elements and build on ideas

Thank You! Questions?