INNOVATIVE
APPROACHES TO
PREVENTION OF FALLS—
POSITIVE DEVIANCE AND
FRONTLINE OWNERSHIP
Guest Presenter: Dr. Michael Gardam
Thank you for joining us.
Nous vous remercions de
votre participation.
Your line will be muted until
the call begins.
Les lignes seront sous-
silence au début de cet
appel.
Did you Join the Call Correctly?
Êtes-vous connecté à l’appel correctement?
You Joined Correctly! There IS a phone icon beside your name. You will be able to join the breakout sessions.
Vous êtes bien connectés! On voit un icône de téléphone près de votre nom. Vous pourrez vous joindre aux salles d’exercise virtuelles (Breakout sessions).
Login before making phone connection
Veuillez vous joindre à la partie vidéo en suivant le lien à l’ordinateur avant de
téléphoner pour joindre la partie audio
You Joined Incorrectly!There is NO phone icon beside your name. You will be Unable to join the breakout sessions.
Vous êtes bien connectés! On voit un icône de téléphone près de votre nom. Vous pourrez vous joindre aux salles d’exercise virtuelles (Breakout sessions).
If there is NO phone icon beside your name: S’il n’y a pas de téléphone noir près de votre nom
1. Hang up and disconnect from Audio WebEx.
Raccrocher
et vous serez déconnecté de la partie Audio de WebEx
2. Click the audio Icon. If needed, rejoin using original link. Enter name & Email & click on Join Now Cliquer sur l’icône audio. Au besoin, suivre le lien original. Entrer votre nom & courriel puis cliquer sur ¨Join Now¨
3. A popup will display the phone information./ Une boîte de dialogue offre l’information téléphonique
Direct Line
Enter
number
Ligne
directe,
entrer
votre
numéro
Line with
Extension
“ I will call in”
Ligne avec poste
Or/ou
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?
Use your pointer.
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
Questions?
Or type your question into Chat. Remember to select “All Participants”
Raise your hand
“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
Mark your Calendars for
these Upcoming Calls