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Annette Bartley RGN BA (Hon) MSc MPH Director of the Safer Patient Network Health Foundation/ IHI Fellow Co-facilitator of CHAIN QI sub-group 5/7/20151.

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Presentation on theme: "Annette Bartley RGN BA (Hon) MSc MPH Director of the Safer Patient Network Health Foundation/ IHI Fellow Co-facilitator of CHAIN QI sub-group 5/7/20151."— Presentation transcript:

1 Annette Bartley RGN BA (Hon) MSc MPH Director of the Safer Patient Network Health Foundation/ IHI Fellow Co-facilitator of CHAIN QI sub-group 5/7/20151 © Annette Bartley Consulting Limited

2 Why do we need to improve? 5/7/20152 ©Annette Bartley Consulting Limited

3 5/7/20153

4 Institute of Medicine Aims Safe (no needless deaths) Timely (no unwanted waiting) Efficient (no waste) Effective (No needless pain or suffering) Patient and family centred (no helplessness) Equitable (for all) IOM= Crossing the Quality chasm 2001 (IHI) 5/7/20154

5 First do no harm… Fundamentals of patient safety Prevention Detection Mitigation 5/7/20155

6 The Reality in Practice 5/7/20156

7 Every system is perfectly designed to achieve exactly the results it gets. New levels of performance can only be achieved through dramatic system-level redesign. System-Level Redesign 5/7/20157

8 “ Quality improvement begins with love and vision. Love of your patients. Love of your work. If you begin with technique, improvement won’t be achieved.” A. Donabedian, M.D 5/7/20158

9 Bringing the Work of Many Initiatives into a Coherent Whole Health Foundation Safer Communities National Patient Safety Agency (NPSA) Safety Alerts Matching Michigan NHS III LIPs Productive Series NICE Quality Standards The Patient Safety First Campaign Safer Patients Network (SPN) The Health Foundation (with IHI) CMO England VTE WHO World Alliance for Patient Safety Department of Health (DoH) High Quality Care for All IP&C CNO High Impact Changes QIPP 5/7/20159

10 From what… to how A little less conversation a little more action 5/7/201510

11 Deming’s Thoughts on Transformation Metanoia: Reorientation of one’s way of life (The New Economics. Deming, p. 95, 1993) Begins with individual More than a change Develop new habits of mind 5/7/201511

12 Where to begin Will Ideas Execution 5/7/201512

13 13 Executive Perceptions vs. Frontline Perceptions: Executives overestimate: Teamwork Climate 4X Safety Climate 2.5X Executive Confidence vs. Executive Accuracy: -Often wrong but rarely in doubt… -Currently no incoming data-streams -Halo Effects -Frontline data fills the gap

14 5/7/201514

15 Health Care Processes Desired - variation based on clinical criteria, no individual autonomy to change the process, process owned from start to finish, can learn from defects before harm occurs, constantly improved by collective wisdom - variation Current - Variable, lots of autonomy not owned, poor if any feedback for improvement, constantly altered by individual changes, performance stable at low levels Terry Borman, MD Mayo Health System 5/7/201515

16 Reliability Post office Ritz Carlton Mc Donald’s Virgin Flights 5/7/201516

17 New Methods and Tools 5/7/201517

18 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 the improvements we seek ? ActPlan StudyDo The Model for Improvement... Aims Measurement Ideas, evidence, hunches, other people etc. The three fundamental questions for improvement The fourth question: how to make changes Langley, Nolan et al 1996 5/7/201518

19 Repeated Use of the PDSA Cycle Hunches Theories Ideas Changes That Result in Improvement AP S D A P S D AP SD D S P A DATA Very Small Scale Test Follow- up Tests Wide-Scale Tests of Change Implementation of Change What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement 5/7/201519

20 Small Scale Tests of Change on: One clinic One patient One doctor One nurse One day / shift 5/7/201520

21 Where do I begin? Hunches & Theories Gap in knowledge Set about testing your theory Cause & Effect 5/7/2015

22 Steps to reliable care Do the acid test? Segment your population Design an articulated process goal, Agree a clear outcome goal connected to the process with some supporting evidence. Use the prevent, detect, mitigate theoretical design to understand failures and to learn how to redesign Design your first test of change Determine the tempo of change 5/7/201522

23 Improvement requires a clear aim Measurement & Action 5/7/201523

24 Process Eyes Make the process for preventing Pressure Ulcers (&Falls) visible to ALL Measure it -so we can ‘see’ if it is adhered to and effective Make it easy for others to do the right thing (simple checklists, reminders) The right process with high % compliance WILL influence outcomes

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27 Days without a hospital acquired pressure ulcer (ABM LHB Wales) Clear Aim Engaged Team Simple measures- just enough data Tests of change Results 5/7/201527 638

28 Patients as partners “ If quality is to be at the heart of everything we do, it must be understood from the perspective of patients.” 5/7/201528

29 Nothing about me without me 5/7/201529

30 The Value of Networks “Good Networks are horizontal partnerships which value professional expertise and mutual learning. In doing so, they overcome hierarchy and create connections between different levels of the system. They are support structures for improving the quality of care and patient safety ” 5/7/201530

31 How can CHAIN assist the Allied Health Professions? Motivate and inspire Making Connections between individual improvers Empowering professionals to use evidence Sharing knowledge and experience Tools and Techniques for Improving practice 5/7/201531

32 John Seeley-Brown 4 L’s Lurking Linking Learning Leading Research / online communities 5/7/201532

33 Distributed leadership Marshall Ganz “We got used to the politics of disappointment -- figuring out how soon we were going to be let down.... There’s a different dynamic in the... politics of hope. It’s much more challenging. It means you’ve got to get up and do something. There’s opportunity. If you don’t take advantage of that opportunity, you really have to bear responsibility for not doing so. That’s how I see the time we’re in. ” Marshall Ganz http://mitworld.mit.edu/speaker/view/1047 http://www.youtube.com/watch?v=NglXpj94Z2o http://www.youtube.com/watch?v=LhCoz5hMhTI

34 Get organised! Find your carpenters! Provide them with the tools! Stand back as they get going! The Politics of hope 5/7/201534

35 Michelangelo’s Thoughts on Transformation “In every block of marble I see a statue as plain as though it stood before me, shaped and perfect in attitude and action. I have only to hew away the rough walls that imprison the lovely apparition to reveal it to the other eyes as mine see it.” -- Michelangelo 5/7/201535

36 Hey… what’s a mountain goat doing way up here in a cloud bank? Questions?

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38 Managing improvement in the context of multidisciplinary teams What does this mean to you? Does anyone have experience/examples of working within an effective team? What are the key characteristics of an effective team? What about working in an ineffective team? What might that look like? What do teams need to enable them to improve the quality of care? 5/7/201538


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