1. Getting to Zero-Safer Care Improvement Programme Annette Bartley RGN BA MSc MPH Health Foundation/IHI Quality Improvement Fellow

2. Programme Aims Alignment with Safety Express To reduce the incidence of Avoidable Hospital /Community Acquired Pressure Ulcer Reduce of Falls (falls with harm) Reduce Catheter Associated Urinary Tract Infections (CAUTI) Prevention of Venous Thromboembolism ( VTE)

3. Action Planning Session 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

4. Alignment -Harm Free Care

5. Prevention of Pressure Ulcers

7. The Model for Improvement will underpin the programme, enabling teams to connecting an aim to action and measurement which will enable you to demonstrate their progress.

8. Developing a systems-based approach to the prevention of hospital acquired pressure ulcers Risk Identification Communication of Risk status Risk Assessment Appropriate preventative strategy implemented Evaluation of outcome What will success look like?

9. Three Types of Measures Outcome Measures: Voice of the customer or patient. How is the system performing? What is the result? Process Measures: Voice of the workings of the system. Are the parts/steps in the system performing as planned? Balancing Measures: Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures? (e.g. unanticipated consequences, other factors influencing outcome)

10. Measurement Guidelines The question - How will we know that a change is an improvement? - usually requires more than one measure A balanced set of five to eight measures will ensure that the system is improved Balancing measures are needed to assess whether the system as a whole is being improved

11. Measurement- It is YOUR data!! (data MUST be locally owned) Outcome measures – Incidence ( count on safety cross) – Days between events Process measures – Percent Compliance with risk assessment – Percent Compliance with process ( bundle) – Percent compliance with Intentional Rounding tool Balancing measures Patient Experience Staff satisfaction Length of Stay Complaints Staff turnover /Sickness rates Budget implication

12. Visual Measurement 12 34 56 (3) 78 (1) 9101112 131415161718 1920 (1) 212223 24 (1) 25 (1) 26 Days since last... 2728 (1) ___ days 293031

13. Real Time Data for improvement – Process

14. Intentional Rounding – What is it? Structured process where frontline staff regularly round on patients and reliably perform scheduled/required tasks Rounding with purpose- linked to an aim 8 key behaviors 1.Opening key words – managing up 2.Perform scheduled tasks 3.Address the 3 p’s of pain, potty? position (SKIN Bundle)(toileting), and 4.Assess comfort needs 5.Environmental assessment 6.Closing key words 7.Explain when you or others will return 8.Document the round on the log

15. Tools – Rounding Log

16. Tools – Badge Card

17. Tools – Accountability Tool

18. Intentional Rounding -Benefits Provide staff with better control of their time Improved outcomes / promote safety Results Increase Patient Satisfaction Decreases anxiety Increase trust and give sense of comfort Increase Employee Satisfaction

19. The Snorkel

20. Fostering Creativity and Brainstorming?

21. Methods for Generating New Ideas Change Concepts Using Technology Critical Thinking IDEO Brainstorming Metaphorical Thinking Observation Provocation Prototyping Idealized Design

22. Innovation and Work Redesign http://theartofinnovation.com/purchase.htm

23. Resources for “Snorkel”

24. Outline of “Snorkel” Review of Project Vision and Charter What do we know about …. Propose a Design Challenge Storytelling How might we….? Brainstorming Select top ideas (multi-vote) Prioritize ideas for development Plan prototypes Enactments Design first series of tests

25. Storytelling In lieu of doing actual observations, use storytelling to “observe” actual experiences Recall an actual story or experience which relates to the specific design challenge (personal, friend or family member or work-related experience) Who was involved? What happened? How did individuals feel and react? Give an example Tell stories in small groups (nor more than 2 minutes each)

26. How might we….? (used to create ideas for the brainstorming) …. Prevent harm …Engage Patients and families in preventing harm …Optimise nutrition Ideas should be actionable Write each idea on post-it notes or flip c

27. Rules for Brainstorming (20 mins) Chose one or two “how might we scenarios…. encourage wild ideas go for quantity – want more than 500 ideas defer judgment be visual – draw pictures one conversation at a time build on ideas of others stayed focused on topic (“how might we…” scenarios) Write each idea on post-it notes

28. Multi-voting to Select Top Ideas Cluster together similar ideas from brainstorming exercise Use dots to vote: What are your personal favorites? What idea would you most like to try on your unit? What idea do you think will have the biggest impact toward achieving the “how might we…” Participants can distribute their dots however they want –- all on one idea, each dot on a separate idea, or anything in between Report out on favorite ideas (where there are most dots)

29. Matrix of Change Ideas Low Impact High Impact Low Cost High Cost Translate high-cost solutions into low- cost alternatives. Strive for high-impact, low-cost solutions.

30. Outline of “Snorkel” Review of Project Vision and Charter What do we know about…… Propose a Design Challenge Storytelling How might we….? Brainstorming Select top ideas (multi-vote) Prioritize ideas for development Plan prototypes Enactments Design first series of tests

31. IDEO’s Design Principles 1.Keep people informed throughout process 2.Value people, time, and energy 3.Enable learning and teaching 4.Give people appropriate levels of control 5.Facilitate connections among people

32. Enactments Create an enactment to illustrate an extreme future vision for your prototype Create storyline and build Rehearse and refine Present to whole group Select elements and build on ideas

33. Thank You! Questions?