Quality is Personal So is Harm

Manoj Jain, MD, MPH

www.MJain.net

Goal

• Share my journey

• Quality Improvement is a universal principle

• Quality Improvement is personal

Journey

First Do No Harm

• Primum non nocere• Hippocratic Oath – • Hippocrates 460BC to

370 BC• Hippocratic Corpus is in Epidemics: "The physician must...have two special objects in view with regard to disease, namely, to do good (and) to do no harm"

Ahimsa – Do not Harm

Jainism - Mahavira

• Philosophy of Nonviolence - Ahimsa

• Mahavira- 599 BC – 527 BC

Various Strategies to Reduce Harm:

Malpractice Suits• Only 2 percent of negligent injuries

resulted in claims

• Only 17 percent of claims appeared to involve a negligent injury.

• Win – Lose situation

Various Strategies to Reduce Harm:

• Regulations alone– A Compromise Lose- Lose

• Pay for Performance alone– A compromise lose – lose

Quality Improvement is the Nonviolence Strategy for

Change

Win –Win situation

All parties grow to recognize a greater Truth

Common Elements in Quality Improvement and Nonviolence

• Status quo is not acceptable

• Collective action is required

• Transparency is critical

We must make Quality Improvement personal

PDSA: The Wheel of Improvement

Wheels in Motion:Continuous Quality Improvement

4 Elements of Change

• Multidisciplinary Teams– Staff ownership

• Flow Meetings– Administrative support

• Bundles– Evidence based medicine

• Culture of Change– Horizontal decision-making

Adverse Events Per ICU Day*

0

5

10

15

20

25

30

10/1/2002 12/30/2002 3/30/2003 6/28/2003 9/26/2003 12/25/2003 3/24/2004

Multidisciplinary Rounds

Hand Hygiene Protocol

Vent Bundles

ICU Medical DirectorCentral Line Bundles

UTI Bundles

* A list of event triggers that have been shown to be indicators of potential quality of care issues (See trigger tool)

Nosocomial Infection RatesFY 2001-FY 2004 YTD

Average Cost Per ICU Episode

$3,406$2,874 $2,626

$0$500

$1,000$1,500$2,000$2,500$3,000$3,500$4,000

FY 2002 FY 2003 FY 2004 YTD

15.6% Decrease 8.6% Decrease

Essential Elements in Quality Improvement and Nonviolence

• Transparency– Public Reporting of quality data

Challenge to all:Marriage of Personal and

Professional• Take one personal deficiency (ask you

spouse) and apply PDSA or Lean

• Take one personal/cultural/religious attribute and apply it in your professional life

BUILD A TEAM

Thank You!

www.mjain.net