Improvement Forum A webinar series for QI Managers, Nurse Leaders and others supporting healthcare improvement in Wisconsin’s hospitals April.

Improvement Forum

A webinar series for QI Managers, Nurse Leaders and others supporting healthcare improvement

in Wisconsin’s hospitals

April 2012

Are you ready to improve faster?

Our Topic for April 2012

Stephanie Sobczak, QI ManagerTom Kaster, QI Coordinator

Wisconsin Hospital Association

Today’s Agenda

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Objective: Reviewing tools and approaches to accelerate implementation of

interventions.

• Content Sharing– The current pace of improvement in healthcare– The need for acceleration– Re-thinking approaches

• Resources• Discussion Questions

In the news….

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Question

Polling:What do you think the rate of improvement is in

American hospitals?

A. More than 50% per yearB. At least 20% per yearC. About 10% per yearD. Less than 3% per year

Disclaimer information here… 5

The Pace of Improvement

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Source: “AHRQ National Healthcare Quality Report, 2008,” Agency for Healthcare Research and Quality. Last accessed: September 13, 2010.

The Key Question

Why does it take so long to adopt a new practice when the evidence is clear?

And how are we going to achieve this…….

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The 40/20 Goal

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• Keep patients from getting injured or sicker. Reduce preventable hospital-acquired conditions by 40%.

1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years.

• Help patients heal without complication. Reduce all hospital readmissions by 20% .

1.6 million patients will recover from illness without suffering a preventable complication requiringre-hospitalization within 30 days of discharge.

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What does this mean for Wisconsin

Nationally

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60,000 lives saved/3 years

1.6 million patients will recover from illness without a preventable re-hospitalization within 30 days of discharge.

1.8 million fewer injuries to patients.

Wisconsin

550 lives saved/year

16,500 fewer injuries/year

15,000 re-admissions/year

What does this mean for Wisconsin

Nationally

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60,000 lives saved/3 years 4 patient lives

1.6 million patients will recover from illness without a preventable re-hospitalization within 30 days of discharge.

1.8 million fewer injuries to patients.

One Hospital

120 fewer injures

105 preventable re-admissions

By Hospital

Over 3 years:

• >99 Beds will save 8 Lives• 26-99 Beds will save 3 Lives• <26 Beds will save 1 Live

that otherwise might have been harmed.

Disclaimer information here… 12

Myths about Improvement

1) If you give people the facts, they will change.2) If you create a new policy or rule, people will

follow them3) The same message works with everyone4) Everyone engages at the same time5) Every new approach should be implemented

in the same way

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The Why?

Why does it take so long to adopt an evidence based practice?

Some reasons, and solutions….

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Knowing doesn’t mean changing

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Add info on 17 year adoption gap

Health care is very complex

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Make it meaningful

Healthcare is complex,change is constant

So it is even more important to help people see what they can impact, personally, in their day to day work.

Keep it simple, make it “doable”, slow down.

Disclaimer information here… 17

Assess readiness to change

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Engage the Engaged

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Non-Engaging Methods

• Starting with an entire department

• Relying on evidence only• Getting “buy-in”• Trying to convince a laggard

first• Utilizing an early adopter

who has little credibility

Engaging Methods• Seeking champions who are

opinion leaders (they may not have a formal title)

• Starting small on a project with a few key participants

• Spread after early adopters work out most of the bugs through tests of change

• Use early adopter peers as spokespersons for spread

“What can you get done by next Tuesday?”

Dr. Don BerwickFounder, Institute for Healthcare ImprovementFormer Administrator of CMS

Don’t wait to do something

Disclaimer information here… 20

Obstacles to rapid improvement

Some factors that get in the way of speedy improvement

• Reliance on the STP• Unintentional Bottlenecks

• “Not enough time”• Premature Implementation

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Reliance on the “same ten people”

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STP

• Do you have a core group of people that serve on many teams?

• Do they get “burned out”?

• Do new staff know how to get involved in improvement efforts?

• Is it clear that improvement is everyone’s job?

The Bottleneck Effect

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OB Events

OB Events

PressureUlcers

PressureUlcers

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ReadmissionsReadmissions

CAUTICAUTI

Adverse Drug

Events

Adverse Drug

Events

VTEVTE

CLABSICLABSI

SurgicalInfectionSurgicalInfection

VAPVAP

Safety CultureSafety

Culture

A lot to work on over here

Few people to lead QI over here

Addressing these two issues

• Can QI Leaders serve in an oversight role rather than running teams?

• Can more front line staff be involved?

• Do teams understand their accountability?

• Is the improvement skill set adequate?

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“Many hands make light work”

Not Enough Time

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Pat Rutherford of IHI:

“ The longer I work in this field, the more I’m convinced that real improvement won’t happen unless our nurses and clinicians can stop doing dumb stuff.”

Where can you “find time”?

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One nurse’s movements within 1 hour

Opportunity for improved workflow

How to address this?

Examine where staff are stuck in “non-value” added time:

• Looking for information• Looking for equipment• Looking for supplies• Looking for or waiting for other staff• Excessive documentation• Time spent waiting for meds or labs

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What to do

“Lean” the care environment – apply 5S

Leverage new EMR functions

Redesign the work flow between staff

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Leaping into Implementation

• “Just do It” is very tempting.• It seems like it’s efficient• It assumes that each unit

works in the same way.• It assumes that staff will

change their behavior without experience.

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Policy Book

Premature Implementation

Perverse Outcomes:• Partial adherence to the “new way”• Out right resistance – after the P&P is adopted• Slipping back into old processes over time• No time to measure/prove the improvement• Moving on to the next thing too soon

= REWORK!

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Be systematic & consistent

• How an intervention is adopted should be consistent and repeatable

Staff can focus on the learning the new content or skill, rather than how

something is implemented.• BUT what you design (to encourage adoption to

happen) can be adapted within the PDSA cycle.

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Aims

Measurement

Change ideas

Testing ideas before implementing changes

Discussion

What have you found helps speed the pace of improvement in your hospital?

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In summary: Accelerating Improvement

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3. By engaging more front-line staff in adopting new practices

6. By actively sustaining the improvements through measuring, monitoring and oversight

4. By slowing down to involve more people in tests of change

2. By allowing natural leaders to lead

1. By being systematic in the overall approach

5. By providing absolute clarity on the team’s accountability

Resources

Understanding Resistance:http://www.focusedperformance.com/articles/resistanceslides.pdf

IHI’s Gap Analysis Tool:http://www.ihi.org/offerings/Initiatives/Improvemaphospitals/Documents/IHIGapAnalysis.pdf

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Readiness assessment example

Questions and Answers

What can we learn from each other?

Stephanie Sobczak, MS, MBAManager QI, Wisconsin Hospital Association

Next Month’s Topic: Assessing Evidence Based Practice