Presentation on theme: "Welcome! Improving Teamwork & Communication in Surgery November 15, 2012."— Presentation transcript:
Welcome! Improving Teamwork & Communication in Surgery November 15, 2012
Agenda Table Discussion Storyboards World Café Patient Perspective Team Planning Time Learning Systems Future Directions
Table Discussions Fresh eyes from everyone at your table Some questions to get us started…
1.Was there a moment when you said to yourself, This is why culture is important? 2.I feel like Im banging my head against the wall when ____. 3.I laughed when ____ happened. 4.If I could go back in time and do one thing differently, it would be _____. 5.Is there someone in your unit who really understands the purpose of culture improvement? Tell us about this person and what its like to work with them.
Credit: TeamSTEPPS Theory Burst: A Shared Mental Model is… The perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication. Teams that perform well hold shared mental models. (Rouse, Cannon-Bowers, and Salas 1992)
Shared Mental Model? Credit: TeamSTEPPS
Storyboard review Identify two topics to discuss during the World Café Worksheet in folder
Theory Burst Please Use CUS Words but only when appropriate! Credit: TeamSTEPPS
World Café Topic 1 Topic 2 Topic 3 Topic 4 Topic 5 7 minutes per topic
Team Planning Plan the next steps for when you return to your unit Worksheets in the folder For those without SAQ data, the project overview is provided for discussion
Confidential & Proprietary The Components of Learning and Improvement 1. Aims 2. Mapping Strategy and Tactics 3. Small Tests of Change (aka PDSA cycles) Let us look at each of these in detail and apply them to your work:
Confidential & Proprietary O UTCOME M AJOR I NFLUENCES A IM A CTION How The 3 Relate To Each Other: Aim Strategy Mapping PDSAs 1 1 L ET S E XPLAIN E ACH O F T HESE :
Confidential & Proprietary Lets use David to explain these relationshps: David comes to America, eats an American diet, now has a bit of a problem. He wants to get fit again. What should he do?
Confidential & Proprietary New David O UTCOME A IM : A new David! M AJOR I NFLUENCES Diet Exercise
Confidential & Proprietary New David Aim: David weighs 180 lbs in 18 months. Examples of Healthcare Aims: Decrease Surgical Site Infection by 25% in one year. In this unit, 75% of those surveyed will agree or strongly agree with the statement It is easy for personnel here to ask questions when there is something that they do not understand in 5 months. O UTCOME A IM : A new David!
Confidential & Proprietary Produce Aim Statement(s) Aim Statement: What by When Stretch goal Unambiguous Numeric Measurable (Use measures to help clarify Aims) Think about relative (better) versus absolute goals
Confidential & Proprietary Getting from Influences to Interventions O UTCOME M AJOR I NFLUENCES A IM : A new David! Diet Exercise A CTION Limit daily intake Substitute low calorie foods Avoid alcohol Bike to work Hacky Sack in office
Confidential & Proprietary Adding In Measurement O UTCOME M AJOR I NFLUENCES A IM : A new David! Diet Exercise A CTION Limit daily intake Substitute low calorie foods Avoid alcohol Bike to work Hacky Sack in office Weight BMI Body Fat Waist Size Daily calorie count Avg. calorie daily Avg. drinks per week Meals off- plan/week Sodas/week Repetitions/ Day Percent of days on bike Total Exercise calorie count
Confidential & Proprietary What This Looks Like On A Worksheet Linking STRATEGY to TACTICS STRATEGY AimMajor Influences TACTICS Interventions AIM (What by When) MEASURES Diet Low Calorie Food Smaller Portion Size Avoid Alcohol Bike to Work Hacky Sack Sitting Exercise Exercise David 180 lbs within 1 year Weight Waist Size See in Worksheet
Confidential & Proprietary Model for Improvement: Plan Do Study Act (PDSA) Make a Prediction PLAN DO STUDY ACT What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement?
Confidential & Proprietary Making a Prediction What is your hypothesis? What do you think will happen? No result is a failure as long as learning occurs Think ahead to future tests and how they might be shaped by the current small test.
Confidential & Proprietary Guidance for Testing a Change Concept A test of change should answer a specific question! A test of change requires a theory and a prediction! Test on a small scale and collect data over time Build knowledge sequentially with multiple PDSA cycles for each change idea Include a wide range of conditions in the sequence of tests Dont confuse a task with a test!
Confidential & Proprietary PDSA TESTING: QUESTIONS AND COMPONENTS What are you trying to accomplish in THIS test? What change are you testing? What is your THEORY and what do you PREDICT will happen? How will you know the effect of the change? Are there any TASKS to perform prior to the test? NOTES: PDSA Testing: Questions and Components See in Worksheet
Confidential & Proprietary PDSA TESTING: QUESTIONS AND COMPONENTS What are you trying to accomplish in THIS test? What change are you testing? What is your THEORY and what do you PREDICT will happen? How will you know the effect of the change? Are there any TASKS to perform prior to the test? NOTES: PDSA Testing: Applied to David riding a bike David agrees to ride a bike to work. Design the first and second tests that will get David riding his bike to work. Think – SMALL tests of change In putting together each test, answer every question to the right.
Confidential & Proprietary PDSA Testing: Questions and Components PDSA TESTING: QUESTIONS AND COMPONENTS What are you trying to accomplish in THIS test? Find out if David can ride a bike. What change are you testing? David rides around the building. What is your THEORY and what do you PREDICT will happen? Theory: If David can make it around the building, he knows how to ride a bike. Prediction: Hell succeed with flying colors. How will you know the effect of the change? Hell head out in one direction and return around the building. Or... he wont. Are there any TASKS to perform prior to the test? Borrow a bicycle. Clear the path of rocks and twigs. Watch out for cars in the parking lot. NOTES: May need to adjust the seat
Confidential & Proprietary O UTCOME M AJOR I NFLUENCES A IM : A new David! Diet Exercise A CTION Limit daily intake Substitute low calorie foods Avoid alcohol Hacky Sack in office Incremental Changes in PDSA Weight BMI Body Fat Waist Size Total Exercise calorie count Daily calorie count Can David ride a borrowed bike? 1 Can David ride to work one morning? 2 Can David ride to and from work in one day? 3 Can David ride safely at night in the dark? 4 Bike to work
Confidential & Proprietary PDSA TESTING: QUESTIONS AND COMPONENTS or Plan What are you trying to accomplish in THIS test? What change are you testing? What is your THEORY and what do you PREDICT will happen? How will you know the effect of the change? Are there any TASKS to perform prior to the test? NOTES: Do: Carry out the change or test and collect data Study: Analyze data and compare with your predictions; provide a summary Act: Are we ready to make a change? Plan for the next cycle
Confidential & Proprietary Test Number PDSA Test Person(s) Responsible DateResults and next steps PDSA cycles over time
1.Describe the concept – Expand on Allan Frankels presentation in June 2.Connection between learning systems and culture improvement – Learning processes can support our culture improvement work – We can direct our culture improvement efforts toward creating a learning culture Learning Systems
Definition A learning system is constantly learning about itself and using that information to move toward its goals. Some learning systems are learning organizations.
We cant make a learning system without a culture shift Because we are changing culture, we have the option to make a learning culture
Discussion What would tasks and processes that support learning look like in surgery areas? What do you think about working toward a culture of learning?
Future Directions Improve on a specific culture metric Embed teamwork behaviour Improve a clinical outcome (Connect with NSQIP) Build a learning culture & learning system
Timeline NovemberDecemberFebruaryMarchJanuaryApril Quality Forum Re-survey? Or Fall 2013? Continue Improvement Can we aim to present our experience in March? Do we want to repeat the survey? Spring or Fall?
Future Planning Planning Group to determine group direction Staying connected – Webinars – Qexchange – Cohorts – Other ideas? Research
Tomorrow Dr. Marty Makary Lizzie Edmondson Presentations from some of our teams! Surgical Safety Checklist Opportunities to connect with NSQIP and more!