1. GHA Hospital Engagement Network HAC Learning Collaborative Webinar ~ May 16, 2012 Kathy McGowan, GHA Kelley Dotson, GHA Anne Hernandez, A LLIANT | GMCF

2. Learn. Act. Improve. Spread. Keep the Drum Beat Going. Success Story o Pressure Ulcer Prevention Education o Documenting a Small Test of Change Questions & Answers Action Items Learning Objectives

3. Learn. Act. Improve. Spread. Keep the Drum Beat Going. WHAT HAS WORKED? Teri Newsome, RN, ICP Vice President of Quality Habersham Medical Center All Teach ~ All Learn

4. Learn. Act. Improve. Spread. Keep the Drum Beat Going. Small Test of Change EDUCATION

5. Learn. Act. Improve. Spread. Keep the Drum Beat Going. What have you ALREADY done??? Collect baseline data Complete Root Cause Analysis Complete Process Flow Map (Chart) Select specific HAC to address Prioritize your “cause”

6. Learn. Act. Improve. Spread. Keep the Drum Beat Going. What to do NEXT??? Develop Corrective Actions & A Follow-up Determine workable solutions for the root causes Re-visit any “quick fix” solutions that were put in place Use other PI tools to assist

7. Learn. Act. Improve. Spread. Keep the Drum Beat Going. Team’s Role Team designs a plan (Plan) Team creates time-lined actions (Do) Team/assigned individuals measure (Study) Team acts on the outcome of measurements (Act)

8. Learn. Act. Improve. Spread. Keep the Drum Beat Going. Depending on the aim, your team should choose PROMISING CHANGES and use Plan-Do-Study-Act (PDSA) cycles to: 1.Test a change quickly on a small scale 2.See how it works 3.Refine the change as necessary before implementing it on a broader scale Science of Improvement ~ Testing Change

9. Learn. Act. Improve. Spread. Keep the Drum Beat Going. AIM What are we trying to accomplish? MEASURES How will we know that a change is improvement? CHANGES What changes can we make that will result in improvement? Key changes are then implemented in a cyclical fashion Performance Improvement Team Should Ask Three Questions:

10. Learn. Act. Improve. Spread. Keep the Drum Beat Going. Think SMART Your Goal should be SMART S pecific M easurable A greed to R elative T ime-based (becomes standard process)

11. Learn. Act. Improve. Spread. Keep the Drum Beat Going. GOAL: Overall goal you would like to reach Every goal will required multiple smaller tests of change Small Test of Change Worksheet

12. Learn. Act. Improve. Spread. Keep the Drum Beat Going. PLAN Describe your first (or next) test of change Person Responsible When to be done Where to be done Provide non-slip/skid socks to patients at risk for falls Materials Manager 4 weeksMed-Surg Unit Small Test of Change Worksheet Describe your first (or next) test of change

13. Learn. Act. Improve. Spread. Keep the Drum Beat Going. PLAN List the tasks needed to set up this test of change Person Responsible When to be done Where to be done 1. Research most appropriate product availableMaterials Mgr. & Med-Surg RN Mgr. 10 daysDepartment 2. Obtain three quotes on productMaterials Mgr.14 daysDepartment 3. Determine number needed for trial periodMed-Surg RN Mgr. 7 daysIT 4. Place orderMaterials Mgr.21 daysDepartment 5. Educate staff on use of non-slip/skid socksMed-Surg RN Educator 14 daysMed-Surg Unit 6. Add to Order/Entry SystemRN/IT Liaison21 daysIT 7. Stock in PyxisMaterials Mgr.24 daysMed-Surg Unit 8……. Small Test of Change Worksheet List the tasks

14. Learn. Act. Improve. Spread. Keep the Drum Beat Going. PLAN Predict what will happen when the test is carried out Measures to determine if prediction succeeds 1. Falls will decrease by 75% in one month 1.Monitor falls daily on Med-Surg unit  Track weekly rate x 4 weeks 2. 3. Small Test of Change Worksheet Predict what will happen

15. Learn. Act. Improve. Spread. Keep the Drum Beat Going. DO Describe what actually happened when you ran the test of change: STUDY Describe the measured results and how they compare to the predicted results: ACT Describe what changes to the plan will be made for the next cycle from what you learned: Small Test of Change Worksheet Do Study ACT

16. Learn. Act. Improve. Spread. Keep the Drum Beat Going. ACTION ITEMS – To Do by May 30th 1.Send one completed “Worksheet for Testing Change” to GHA 2.Contact Kelley Dotson, GHA or Nancy Fendler, GMCF if you need further assistance selecting a goal or completing a small test of change.

17. Learn. Act. Improve. Spread. Keep the Drum Beat Going. Educational TELNET/Webinars Next Telnet/Webinar 3 rd Wednesday every month June 20, 2012 11:00 am – 12:00 pm

18. Learn. Act. Improve. Spread. Keep the Drum Beat Going. Evaluations Please let us know how we are doing Please complete the electronic survey