Presentation on theme: "SPICE and Service Improvement Methodology"— Presentation transcript:
1SPICE and Service Improvement Methodology Improving Quality in Practice. Approaching Improvement in a Complex SystemSPICE and Service Improvement MethodologyJonathon GrayDirector Healthcare ImprovementWales Centre for Health
7The First Law Of Healthcare Improvement “Every system is perfectly designed to achieve exactly the results it gets”Therefore, Although Not All Change Is Improvement, All Improvement Is ChangeWhat’s it all about?Delivering right care, at the right time, in the right place by the right person etcSource: Don Berwick, IHI (Boston)
8Welsh Policy Context Where are we going? What do we need? Wales: A Better CountryWhere are we going?Designed for LifeWhat do we need?Healthcare Standards for WalesWhat do we do?The Healthcare Quality Improvement Plan: Designed to DeliverHow will we get there?
9Aims for Improvement“By 2015, Wales will have minimized avoidable deaths, pain, delays, helplessness, and waste.”Designed for LifeSafetyEffectivenessPatient ExperienceTimelinessEfficiency
10“The needs of the patient come first…..” No needless deathsNo needless pain or sufferingNo unwanted waitingNo helplessnessNo waste……For anyone
11What do we need to measure and why? IHI Model for Improvement
12CAUTION!Gathering data can bring new and surprising knowledge to those who dare to seek it!
14Hospital Death Rate (Standardized for Age, Sex, Race, Payer, Admission Source & Type) vs Charge per Admission (Standardized for Age and Diagnosis) -- AHRQ 1997 Data
15Organisation with a Memory 15,000 to 70,000 adverse events each year in the Wales NHS hospital sector ( % of admissions)£100 million direct cost in additional hospital days aloneClinical negligence cost - £85m ( )Half might be avoidable.Source: Organisation with a memory - CMO England)
16Essential Elements for Large-Scale Change WillIdeasExecution
17We will explore new ways of working, recognising that there may now be better and different methods
19The Knowledge Base for Continual Improvement Subject andDisciplineKnowledgeKnowledge forImprovementSystemsVariationPsychologyPDSA+Key Themes in SPICE methodology: Evidenced basedAimed at collecting fact not anecdoteBuilds on what the research and evidence so far tells us IC should look likeTests it, critically evaluates, highlights areas for improvementContinual Improvement
20The Project Method: The Model for Improvement (Nolan, et al.) ActPlanStudyDoWhat 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?Key Themes in SPICE Methodology: Continuous ImprovementUsing the Tool to identify small scale change projects and review their impactCQI for the Tool itself; review and adaptation
21Repeated Use of the Cycle Changes That Result in ImprovementAPSDDATADSPAAPSDAPSDHunches Theories Ideas31
22Leadership Set-up Better Ideas Social System Measurement and Feedback -Target population Adopter audiences-Successful sites Key partners-Initial spread strategySocial System-Key messengers-Communities Technical support-Transition issuesCommunication Strategies (awareness & technical)Knowledge ManagementMeasurement and FeedbackLeadership-Topic is a key strategic initiative-Goals and incentives aligned-Executive sponsor assigned-Day-to-day managers identifiedBetter Ideas-Develop the case-Describe the ideasKey Themes in SPICE methodology: Outcome focusedClinical and social outcomesLooks at whole personMulti disciplinary approachChecks what we’re doing achieves individual’s goals i.e. that we do good not harm?? can link this to increased compliance & patient safetyKey themes in SPICE methodology: Practitioner EngagementPractitioners involved in the development and testing of the toolEnsures it’s relevant to their ethos and motivationSuccess will be dependent on their continued feedback and suggestions for improvementKey Themes in SPICE methodology: Sustainability & SpreadSupporting social movement by- creating a network/Community of Practiceshared learningjoint problem solvingSpreading good practiceKeeping it live
23Acknowledgements: Improving Chronic Illness Care, a national program of The Robert Wood Johnson Foundation
24Components of an Improvement System STRATEGY--Leadership--System Aims--Finance--Training--EnvironmentTECHNIQUE--Statistics and Measurement--Systems Knowledge--Group Process--PDSA--ToolsCULTURE--Teamwork--Cooperation--Operating Values--Beliefs and MythsMANAGING IMPROVEMENT
26Justin Micalizzi (by Dale Ann Micalizzi) “On January 15th, 2001, Justin, a healthy 11-year old boy, was taken into surgery to incise and drain a swollen ankle. He was dead by 7:55 a.m. the next morning, leaving behind two grieving and bewildered parents who desperately wanted to know why their son had died. But medical care was to fail them twice- first their son died and then no one would explain to them why.”
27Justin Micalizzi (by Dale Ann Micalizzi) I know the chaos, the nursing shortages, overtime, the financial obligations, the insurance company guidelines and the arrogance that interferes with the quality of care. I have worked in healthcare and education for over 20 years. I also know, when it came time for my son’s surgery, you remove the chaos. You develop a team effort to review all information and establish a plan. You openly communicate between specialists, remove arrogance and intimidation and have a common goal to heal. It is your obligation to complete checklists, check and double check medications and dosages, assign a nursing team and treat every case as a possible emergency with the patient as your ONLY focus. Look at the child; listen to the parents and use common sense and professional judgment when making all decisions. Slow down! You are holding my child’s life in your hands. Justin WAS important and should have been important to his healthcare providers also. I trusted you.
28Justin Micalizzi (by Dale Ann Micalizzi) The hospital failed us, the nurses who were his advocates failed us, and the technicians who didn’t draw pre-op labs failed us. And, most importantly, the surgeon who gave the case to the resident and was NOT even in the OR at the time of surgery failed us. The health department failed us by accepting the medical personnel’s information as truthful. The hospital CEO failed us by not providing us with any information or support. Error upon accepted error killed my son and my faith in a medical system that was meant to comfort and heal. We will not let this happen to another family. The pain is unbearable.
29Justin Micalizzi (by Dale Ann Micalizzi) “….. when it came time for my son’s surgery, you remove the chaos……”