1. Recommended toolkit: Spread & Sustainability of Best Practices
Sujani Jayanetti
September 9th, 2009
Safer Healthcare Now! Atlantic Node

2. Introduction
Patient safety is an international, national, and local issue
The range of adverse events that occur in healthcare facilities are astonishing.
Adverse events are unintentional unfavorable events that are due to healthcare management rather than the patient’s disease which may lead to extended hospital stay, disability, or even death (Baker et al. 2004).

3. Introduction
Adverse events may occur due to many reasons including; infections, medical errors, dangerous omission, incorrect procedures, incorrect diagnosis, and lack of effective team communication.
USA- Hospital Acquired Infections cause 90,000 deaths annually; costing $ 5 billion (Vincent 2006)
Canada- 70,000 adverse events (37%-51% are preventable) (Baker et al. 2004)

4. Introduction Canadian Patient Safety Institute (CPSI)- 2003
Safer Healthcare Now! (2005)- Based on 100,000 Lives Campaign in the US
Ten evidenced based interventions

5. SHN! Ten Evidence Based Interventions
1. Deploy Rapid Response Teams/ Quick Response Teams (RRT/ QRT)
2. Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarctions (AMI)
3. Prevent Adverse Drug Events (ADEs)
4. Prevent Central Line Infections
5. Prevent Surgical Site Infections (SSI)
6. Prevent Ventilator-Associated Pneumonia
7. Prevent harm from antibiotic resistant organisms
8. Medication Reconciliation in long term care to reduce adverse drug events in long term care settings
9. Prevent harm resulting from falls in long-term care settings
10. Prevent Venous Thromboemoblism (VTE)

6. Why participate in spread of best practices
Patients’ and carers’ [service] expectations are increasing
Wide variation in outcomes and processes between practitioners and organizations is no longer acceptable
New technology is available to improve care and delivery processes
What worked in the past won’t necessarily work in the future
Shortages of resources, notably time, to invent own solutions
If your neighboring colleagues and organizations are improving by copying and re-inventing good practice, why aren’t you?
Source: Fraser 2002, p. viii

7. Make it Happen!!!
Source: Greenhalgh et al. 2004, p.593

8. IHI Spread Framework
Source: Massoud et al. 2006; IHI n.d.

9. Sustainable Organizations
The IHI Get it Started Kit lists 6 properties that exist in organizations that have shown sustainability of interventions:
Supportive Management Structure
Structures to “Foolproof” Change
Robust, Transparent Feedback Systems
Shared Sense of the Systems to Be Improved
Culture of Improvement and a Deeply Engaged Staff
Formal Capacity-Building Programs
Source: 5 Million Lives Campaign 2008

10. Focus Group May 22, 2009 WebEx 6 Participants
Atlantic Provinces: Nova Scotia, New Brunswick, Newfoundland
Aim: To understand the barriers and success factors to spread and sustainability of best practices in Atlantic Node SHN!

11. Focus Group- Emerging themes
Necessity for a culture change towards patient safety
Need for proper leadership & champions
Need for clinician involvement
Necessity for adequate communication
The need for monitoring, measuring, and providing feedback of interventions
The need for more resources (staffing, measurement resources, training)
The false perception that patient safety alone is a good enough incentive

12. Survey Created using themes from focus group 34 questions
Sent to 53 key stakeholders in Atlantic Canada: NB, NL, NS, & PEI
45% response rate

13. Survey Results- Respondents

14. Survey Results- Culture
Majority responded- Organizational structure supports patient safety and quality improvement work
Two third responded - quality improvement is nonnegotiable
Two third responded- has a history of sustaining quality improvement work
54% responded- structures in place to sustain and hardwire quality improvement work.

15. Survey Results- How important is patient safety work to:

16. Survey Results- Within your organization there are patient safety champions among:

17. Survey Results- Education & Training
54% of direct care providers see a positive change
33% of the time physician champions involved in SHN! interventions
50% agreed roles and responsibilities are clearly defined; 25% some progress is being made
95% agreed there needs to be more training continued education

18. Survey Results- Communication
58% responded patient and family perspectives guides quality work; additional 12% said these perspectives were used
Need to be considered since they are clients and contributes to system and behavioural change.
Staff surveys used third of the time; ½ of the organizations use leadership walkabouts

19. Survey Results- Monitoring and Improvement measures
75% of respondents use measurements
42% reported quality improvement data are displayed in easy to read charts and posted in clinical areas
Only 54% understand what the results of the collected data mean
The significance of measurement was emphasized in the focus group when one participant said an SHN! intervention failed because they were not, “able to get the rates, so the teams fell off. Measurements need to be meaningful all the time” (Participant 4).

20. Survey Results- Incentives
96% reported the intrinsic value in providing safer care and was a good incentive to get staff on board
Critical element to improving care
However, insufficient for change in behaviour
Rewards and recognition necessary
Note: Calgary Health Region found physician buy in difficult without financial incentives (Baker et al. 2008)

21. Survey Result- Resources

22. Eleven Recommendations
Steering Committee for SHN! interventions
Develop and use a formal improvement spread plan
Monitoring, measuring, and feedback
Closer integration, engagement, communication among healthcare providers
Physician champions for all SHN! interventions

23. Eleven Recommendations
Champions not only at the frontline, but also senior leaders
Staff and healthcare provider input is needed
Training and education
Safety Competency Framework by CPSI
Recognition and rewarding achievers
Compiling and sharing how patient and family perspectives are brought to organizational and provincial decision tables

24. Take home message:
The whole organization from the Board of Directors to the point of service teams and individuals must be aligned in their efforts towards patient safety improvement and great outcomes. There is a need to take a holistic approach in strengthening all components of the system to maximize patient safety outcomes.
A chain is only as strong as its weakest link!

25. Tips &Tools New Idea Scorecard Adoption Exercise Project Charter
Team Charter
PDSA Cycles
Quality Improvement and Change Implementation
Quality Tools
Improvement Tracker
Dr. Jan Davies as a consultant
Walkabouts
Patient Safety Rounds
Physician Quality Officers
Spread planner
Spread Check List
Checklist for Readiness to Spread

26. Questions

27. Acknowledgement Theresa Fillatre: Dannie Currie: Pauline MacDonald
Dannie Currie:
Pauline MacDonald
Focus Group Participants
Survey Respondents

28. References
Baker, G. R., Norton, P. G., Flintoft, V., Blais, R., Brown, A., Cox, J. Etchells, E., Ghali, W. A., Majumdar, S.R., O’Beirne, M., Palacios-Derflingher, L., Reid, R.J., Sheps, S., Tamblyn, R. (2004). The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. JAMC, 170(11),
Baker, G. R., MacIntosh-Murray, A., Porcellato, C., Dionne, L., Stelmacovich, K., & Born, K. (2008). High Performing Healthcare Systems Delivering Quality by Design. Toronto: Longwoods Publishing Corporation.
Fraser, S. W. (2002). Accelerating the Spread of Good Practice. A Workbook for Health Care. United Kingdom: Kingsham Press.
Greenhalgh, T., Robert, G., MacFarlene, F., Bate, P., Kyriakidou, O. (2004). Diffusion of Innovation in Service Organizations: Systematic Review and Recommendations. Milbank Quarterly, 82(4),
IHI. (nd). Case for Improvement. Retrieved on July 4, 2009, from ement.htm.

29. References
Massoud, M.R., Nielsen, G.A., Nolan, T., Schall, M.W., Sevin, C. (2006). A Framework for Spread: From Local Improvements to System-Wide Change. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement. Retrieved on July 21, 2009, from 4DDD84445AFD/0/AFrameworkforSpreadWhitePaper2006.pdf
5 Million Lives Campaign. (2008). Getting Started Kit: Rapid Response Teams. Cambridge, MA: Institute for Healthcare Improvement. Retrieved on July 21, 2009, from g%20Started%20Kit.pdf.
Vincent, C. (2006). Patient Safety. Toronto: Elsevier Limited.