Presentation on theme: "The [Insert Hospital/Hospital System Name Here] Experience"— Presentation transcript:
1 The [Insert Hospital/Hospital System Name Here] Experience [Insert Name of Program Coordinator Here][Title of Program Coordinator][Name of Hospital]**Template Presentation Developed with Florida Hospital Heartland Division as part of the Adventist Health System Experience.**
2 CLABSI Success Summary Since [Year], central line-associated bloodstream infections have been reduced in the [name units] at [hospital name] by [xx percent].Since [Year], approximately [xx] lives have been saved, and [$xxxxx] in excess costs have been saved.
3 [Insert Logo/Name of Hospital Here] [Insert picture here to illustrate figures to the left][###] Acute Care Bed[###] Long Term Care Beds[###] Admissions[###] ED Visits[###] Home Health Visits[###] Outpatient Visits[###] Nursing Home Patients
4 [Insert Hospital/Hospital System Name/Logo Here] Net Revenue [$#######]Net Earnings [$#######]Community Benefit [$######]Medicaid Unreimbursed Cost [$#######]Medicare Unreimbursed Cost [$######]Community Health and Wellness [$#####]Faith-based and Spiritual Health [$#####]Capital Improvements to Infrastructure [$######]
5 [Insert Hospital/Hospital System Name/Logo Here] [Insert bullets outlining any awards and/or recognitions that you may have a received as a result of your participation in CUSP][Awards][Recognitions]
6 CUSP (n): a point of transition a fixed point on a mathematical curve at which a point tracing the curve would exactly reverse its direction of motiona point on the grinding surface of a toothan ornamental pointed projection formed by or arising from the intersection of two arcs or foils
7 CUSP Framework Evaluate Culture Train staff in the science of safety 3. Engage staff to identify defect4. Senior executive partnership/safety rounds5. Continue to learn from defects6. Implement tools for improvement7. Re-evaluate CultureEVALUATE CULTURESAQ OR AHRQIF YOU AREN’T ADDRESSING THE ITEMS IDENTIFIED BY THE SURVEY, YOU ARE WASTING YOUR TIME AND YOUR MONEYTRAIN IN SCIENCE OF SAFETYALSO TRAIN IN THE SCIENCE OF IMPROVEMENT & CHANGE MANAGMENTENGAGE STAFF TO IDENTIFY DEFECTSTHIS CONTINUES TO BE ONE OF OUR MOST DIFFICULT ISSUESCOMFORTABLE REPORTINGFEEL COMPELLED TO REPORTSENIOR EXECUTIVE PARTNERSHIPFOCUSED EXEC ROUNDING AFTER THEY HAVE BEEN TRAINEDIT IS MORE: DEVELOPING A SAFE RELATIONSHIP WITH SOMEONE WHO CAN SAY “YES” TO BIG IDEAS AND HELP BREAK DOWN BARRIERSOTHER KEY PARTNERSHIPS: PHYSICIANS, FINANCE, MARKETINGCONTINUE TO LEARN FROM DEFECTSAS THE FREQUENCY OF DEFECTS DECREASES, THE ANALYSIS OF EACH CASE SHOULD INCREASEIMPLEMENT TOOLS FOR IMPROVEMENTLEARN FROM OTHERS, BUT DO NOT RELY ON OTHERSTRY PROVEN TOOLS BUT ALSO MODIFY AND IMPROVEDON’T BE AFRAID TO TRY SOMETHING NEW, THAT’S HOW INNOVATION OCCURSRE-EVALUATE CULTUREANNUALLY- CULTURE DOES NOT CHANGE QUICKLYLIKE ANY OTHER RELATIONSHIP, THE CULTURE (THE RELATIONSHIP BETWEEN THE PEOPLE AND THE ORGANIZATION) MUST ALSO HAVE CONTINUED INTENTIONAL EFFORT TO KEEP IT HEALTHY
8 ObjectivesTo understand the benefit of including change management theory within the performance improvement methodologyTo understand the three key components of effective change management
9 Traditional Improvement Methods Joint Commission Ten Step ModelPlan-Test-Act-CheckShewhart Cycle – PDCAHCA Focus-PDCASix Sigma – DMAICXerox Ten Step BenchmarkingToyota Production SystemBaldridgeISO9000Scientific MethodRapid Cycle ImprovementDecision Making CycleE&Y Seven Step IMPROVE ProcessOrganizational Dynamics FADE CycleAHIMA Process Improvement CyclePlannedSystematicOrganization-wideCollaborativePrioritizedData drivenAction oriented
10 Cultural Assessment Results Insert a chart/figure illustrating the results of the cultural assessment/safety attitudes questionnaire.
11 Insert another figure/chart/graph illustrating cultural assessment results. Tip: Make this figure/chart/graph compare each of the units within your organization.Insert another figure/chart/graph illustrating cultural assessment results.Tip: Display a figure that would compare your organization against others.
12 Change Management Theory Below are best practice metaphors used to exemplify this theory:The Rider, The Elephant, The Path (used in this template)Aim, Will, CapacityADKARSix Change ApproachBusiness Process Re-engineeringKaizenPsychological Concept Theory
13 Direct the Rider Follow the Bright Spots Investigate what’s working and clone itScientific Approach:HICPAC Guidelines47 separate recommendationsNon-technical approachAPIC Elimination GuideBundlesAdopting best practices can make you as good as the competition…adapting best practices can make you better.
14 Direct the Rider Script the Critical Moves Make the right choice easy Think in terms of critical behaviorsHard StopsStandardizationChecklistsTime OutsRemindersReferencesWhat looks like resistance may be a lack of clarityHelpful ToolsFailure Mode and Effect AnalysisWorkflow AnalysisFlowcharts/Decision Tree
15 Direct the Rider Point to the Destination Explain WHY Communicate relentlessly8 times X 8 waysTailor message to the audienceBe truthfulEmphasize what is important to the target audience, but don’t eliminate other motivatorsHave clear organizational aims and link the project to the organization’s strategic goals
16 Quality & Safety Team Service Growth Finance MISSION Be one of the safest hospitals in the countryAdverse Events < 36 events per 100 admissionsCore Measure Composites > 75th percentileAll departments >60% for Safety ClimateMISSIONEngage and retain employees and physicians.Employee separation <16%Employee engagement > 75th %ileRN vacancy <3.5%First year Turnover < 30%Physician satisfaction > 50th %ilePhysician participation in survey >65%Monitor and respond to customer needs and concernsHCAHPS measures >75th percentilePress-Ganey overall satisfaction >80th %ileIncrease market shareMarket Share >52%Market Preference > 52%Emergency Department Visits > 53,148Cardiac Program Procedures > 715Admissions >13,059Support our mission, vision, and valuesEBDITA >$15,092,000Cost per Adjusted Admission < $7006Foundation Fundraising > $1 millionNote: This is a conceptual model used by the Florida Hospital Heartland Division to illustrate the alignment of quality and safety within the organizational mission.
17 Pop Quiz Who is stronger, the Rider or the Elephant? The rider can control the elephant’s path while he is strong and refreshed. When he gets tired, the elephant starts to get more freedom to wander in his own direction. It is the same with us.We can know the right thing to do and know it is important, but if we have to continually make a conscious choice to choose what we should do over what we want to do, eventually we will give in.
18 Move the Elephant Find the Feeling Simply knowing what to do isn’t enoughPrevent decision fatigueTalk in terms of patients, not cases and ratesLearn to say, “We caused…”Don’t allow rationalizationShare storiesPatientFamilyStaff
19 Move the Elephant Shrink the Change Prioritize interventions Take one bite at a timeRapid cycle improvementSmall Tests of ChangeChoose wiselyWin acceptance by resultsYou don’t need a randomized, double-blind study or a significant p-value to make decisionsHelpful ToolsPrioritization MatrixPick ListWhat can be done by next week
20 Move the Elephant Grow your People Create a sense of identity and instill the growth mindsetEngagementPatient Safety ContractFront Line team membersExecutive ChampionsCulture of LearningLearning from defectsRoot Cause AnalysisGlobal Trigger Tool
21 Shape the Path Tweak the Environment When the environment changes, the behavior changes.So change the situation.Removing concentrated electrolytes from unitsSeparating pediatric medications from adult medicationsStandardize the central line kitImportant questionsWhere else is ____________ done?Who else does _______________?Who orders _______________?Remember to verify changes are still in place
22 Shape the Path Build Habits Look for ways to encourage or break habits Mnemonics: PASS, RACE, APIE, SOAPChecklistsTime OutsEducation is not an action planBenefit limited to those present at the timeTeach the teacher transition of informationImportance of following the instruction becomes diminished as time passes since last defect
23 The Checklist Manifesto The most effective obstacle to effective teams, it turns out, is not the occasional fire-breathing, scalpel-flinging, terror-inducing surgeon…the more familiar and widely dangerous issue is a kind of silent disengagement, the consequence of specialized technicians sticking narrowly to their domains.The evidence suggests we need them to see their job not just as performing their isolated set of tasks but also as helping the group get the best possible results.~Atul Gawande MD
24 Shape the Path Rally the Herd Behavior is contagious, help it spread. Can you create herd immunityCreate a sense of urgencyHow much? By when?Link the process and the outcomesWhen the outcome is infrequent, measuring the process provides the motivation and the outcome data provides the celebration.Constructive competitionUnblind the dataCelebrate successesA dream is just a dream. A goal is a dream with a plan and a deadline.–Harvey Mackay
25 Insert chart/table illustrating recent infection data from CUSP activities
26 Insert chart/table illustrating CLABSI infection rates over entire time of project participation
27 CLABSI Success Summary Since [Year], central line-associated bloodstream infections have been reduced in the [name units] at [hospital name] by [xx percent].Since [Year], approximately [xx] lives have been saved, and [$xxxxx] in excess costs have been saved.
28 ResourcesAtul Gawande, The Checklist Manifesto, New York: Metropolitan Books/H. Holt and Co., 2010.Chip Heath and Dan Heath, Switch: How to Change Things When Change is Hard, New York: Broadway Books, 2010.