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Finding Your Destination: Using the IHI Improvement Map to Achieve Breakthrough Performance
Evan Benjamin, MD, Senior Vice President, CQO Jan Fitzgerald, RN MS, Director of Quality
Baystate Medical CenterMassachusetts, USA
AAGENDAGENDA
• What Is the Improvement Map and How Does It Help?
• How one can use the Improvement Map to Organize and Accelerate Your Improvement Efforts
• How to use the Improvement Map to set Goals
• The Community of Improvement Map
What are your worries regarding improvement at your hospital?
• The IHI Improvement Map is an open resource, available free of charge to anyone, any where.
• The Improvement Map builds off the work of the 100,000 and 5 Million Lives Campaigns and represents IHI’s next frontier of hospital work
• The Improvement Map helps:Make sense of the many complex demands hospitals faceBrings together the best knowledge available on the key process improvements
Helps hospital staff (from leaders to the front lines) set change agendas, establish priorities, organize work, and optimize resources
Ways to Use the Improvement Map
• “I want to know what is involved in improving a key process in my hospital.”
• “We want to assess our current improvement project and see if we are doing all we can.”
• “I want to assess how far we have come with improvement and how far we have to go.”
• “I want to make an improvement agenda for my hospital (department, division) that will get us to best performance as quickly as possible”
Using the Improvement Map to Achieve Breakthrough
Performance at Baystate Medical Center
Baystate Medical Center• 700 Bed Tertiary Care Referral Center
Massachusetts USA (population of ~1M)• Flagship of Baystate Health, Inc. • 41 K admissions/year • Annual surgical volume: 29,043 • Teaching Campus of TUFTS UNIVERSITY
• 9 Residency Programs, 300 Residents & Fellows• 1200 Member Medical Staff, 206 Faculty MDs• Level 1 Trauma Center • IHI Mentor Hospital
VPQ to Dept. Head: Analyze Your Area
Each Department Head IDs their key processes using the Service Line Filters
Adherence: Assess for each process:•
Fully Implemented
•
In Progress•
Just Started
•
Not on the Table
Senior Executive Using the Improvement Map
Findings from Analysis of Adherence to Standards
Domain Percent of Processes Fully Implemented
Patient Care Processes 61%
Support Care Processes 50%
Leadership and Management Processes
58%
Overall 57%
Using the Map
VPQ Summarize for Senior Executive
Team Review
Senior Executive Team IDs Priorities:
•
Daily Goal Setting •
MultidisciplinaryRounds
VPQ to Dept. Head: Analyze Your Area
Each Department Head IDs their key processes using the Service Line Filters
Adherence: Assess for each process:•
Fully Implemented
•
In Progress•
Just Started
•
Not on the Table
2
3
1
Improvement Map for Focused Agendas
• Governance and Leadership• Patient Safety• No Pay Events• Positive Patient Experience• Infection Control• Regulatory: Joint Commission
0.001.002.003.004.005.006.007.008.009.00
10.00
per 1
000
disc
harg
es
Monthly Code Rate per 1000 Discharges Goal Mean
BMC Quarterly Skin Review: Hospital Acquired Wounds
02468
1012
CY04Q2
CY04Q4
CY05Q2
CY05Q4
CY06Q2
CY06Q4
CY07Q2
CY07Q4
CY08Q2
CY08Q4
CY09Q2
CY09Q4
M ont h
% P
atie
nts
HAW/100 pt days
NBenchmark
GOAL
Acute MI Care: Door to Angioplasty (PCI) within 90 Minutes
0
20
40
60
80
100
Jan-
07
Mar
-07
May
-07
Jul-0
7
Sep-
07
Nov
-07
Jan-
08
Mar
-08
May
-08
Jul-0
8
Sep-
08
Nov
-08
Jan-
09
Mar
-09
May
-09
Jul-0
9
Sep-
09
Nov
-09
% P
atie
nts
BMC RateHQI TOP 10% Target
BMC SCIP Composite Care Score
0
20
40
60
80
100
Apr-02
Aug-0
2Dec
-02
Apr-03
Aug-0
3Dec
-03
Apr-04
Aug-0
4Dec
-04
Apr-05
Aug-0
5Dec
-05
Apr-06
Aug-0
6Dec
-06
Apr-07
Aug-0
7Dec
-07
Apr-08
Aug-0
8Dec
-08
Apr-09
Aug-0
9Dec
-09
% P
atie
nts
BMC Rate
HQA Top Decile
Baystate Medical Center% Patients with Appropriate DVT Prophylaxis
0
20
40
60
80
100
Jan-
03M
ar-0
3M
ay-0
3Ju
l-03
Sep-
03No
v-03
Jan-
04M
ar-0
4M
ay-0
4Ju
l-04
Sep-
04No
v-04
Jan-
05M
ar-0
5M
ay-0
5Ju
l-05
Sep-
05No
v-05
Jan-
06M
ar-0
6M
ay-0
6Ju
l-06
Sep-
06No
v-06
Jan-
07M
ar-0
7M
ay-0
7Ju
l-07
Sep-
07No
v-07
Jan-
08M
ar-0
8M
ay-0
8Ju
l-08
Sep-
08No
v-08
Jan-
09M
ar-0
9M
ay-0
9Ju
l-09
Sep-
09No
v-09
% P
atie
nts
BMC rate Target
Gap Analysis
Where Are You Now? Gap Analysis
• When at http://www.ihi.org/ImprovementMap, go to the gray “Take Action” box and click on the Gap Analysis link.
• Identify what you have started, and what you have in place
• Share your learning by completing the Survey
Hospitals that show the greatest improvement are those that know where they are and where they are going.
The Improvement Map can help you to understand both.
How Far Have We Come?Be part of the community on the way to hospital- wide excellence
at www.ihi.org/programs/improvementmap.
No. of Processes in Place
No. of Processes Started
% in this Domain
Patient Care Processes
Support Care Processes
Leadership and Management Processes
Percent Total Processes
Track » Share » Compare »
21
12
11 94%
100%12
100%7 5
40 97%28
Number of Processes in Place
Number of Processes Started
Percent of Processes Underway or Improved
Patient Care34 total Processes in this Domain
Support Care24 total Processes in this Domain
Leadership and Management12 total Processes in this Domain
All Acute Care Key Processes70 total Processes in this Improvement Map
Improvement Gap Analysis
Actions
TBD
Patient Care Processes
Not Started Started Improvement In Place
BMC’s Gap Analysis
Gap Analysis National Data: Informal Survey National Forum - 12/09 1002
Responses: Challenge vs. Success
All Processes
Red Pins, Challenges
39846%
Silver Pins, Sucesses
46854%
518 52%
488 48%
Total: 1006
Leadership and Management Processes
0 5 10 15 20 25
L1 Set Direction: Aims
L1 Set Direction: Alignment &Coordination
L2 Foundation: Build Capabilityfor Execution & Improvement
L2 Foundation: Governance &Improvement
L2 Foundation: Operating Values
L3 Will: Connect Leaders to theFront Line
L3 Will: Measure, Oversee, &Communicate Transparency
L3 Will: Patients & Families
L4 Ideas: Innovation & KnowledgeManagement
L4 Ideas: Scanning
L5 Execution: Portfolio of Projects
L5 Execution: Reliable Processes
02468101214161820
Silver = Success
Red = Challenges
Gap Analysis National Data: Informal Survey National Forum - 12/09
1002 Responses
• Leadership:Challenges: Alignment, Execution, Connecting leaders to front lineSuccesses: Setting aims (60/40 split)
• Support Care Process:Challenges: Med Rec*, Teamwork, TransitionsSuccesses: Infection Prevention
• Patient Care Processes:Challenges: Positive Experience, Sepsis managementSuccesses: RRTs, Ventilator Bundles
What Does the Gap Analysis Tell You?
1. What can one do with the analysis?
2. How is doing the Gap analysis helpful
3. How can one learn from others using the Map?
4. How else can the Gap analysis be used by an organization?
Map Mentor Hospitals
Mentor Map
Baystate Medical Center Acute Myocardial Infarction
Congestive Heart Failure Pressure Ulcers
Surgical Complications Surgical Site Infections
Opportunities to Work Together
• The Improvement Map is designed to accelerate shared learning among health care organizations. Share your experience:
Join the online discussion at www.ihi.org/improvementmapImprovement Map Mentor HospitalsIHI faculty and staff are part of the [email protected]@baystatehealth.org
Discussion and Experience
• What questions do you have?
• For those of you that have used the Map, what other uses have you found or can imagine?
