Recommended toolkit: Spread & Sustainability of Best Practices

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Recommended toolkit Spread Sustainability of
Best Practices

• Sujani Jayanetti
• September 9th, 2009

Safer Healthcare Now! Atlantic Node
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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 patients disease which may lead
  to extended hospital stay, disability, or even
  death (Baker et al. 2004).

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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)

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Introduction

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

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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)

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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 wont 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 arent you?
• Source Fraser 2002, p. viii

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Make it Happen!!!
Source Greenhalgh et al. 2004, p.593
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IHI Spread Framework
Source Massoud et al. 2006 IHI n.d.
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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
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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!

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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

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Survey

• Created using themes from focus group
• 34 questions
• Sent to 53 key stakeholders in Atlantic Canada
  NB, NL, NS, PEI
• 45 response rate

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Survey Results- Respondents
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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.

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Survey Results- How important is patient safety
work to
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Survey Results- Within your organization there
are patient safety champions among
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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

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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

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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

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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)

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Survey Result- Resources
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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

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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

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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!

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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

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Questions
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Acknowledgement

• Theresa Fillatre
• Theresa.Fillatre_at_cdha.nshealth.ca
• Dannie Currie
• curried_at_cbdha.nshealth.ca
• Pauline MacDonald
• Focus Group Participants
• Survey Respondents

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References

• Baker, G. R., Norton, P. G., Flintoft, V., Blais,
  R., Brown, A., Cox, J. Etchells, E., Ghali, W.
  A., Majumdar, S.R., OBeirne, 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),
  1678-1686.
• 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), 581-629.
• IHI. (nd). Case for Improvement. Retrieved on
  July 4, 2009, from http//www.ihi.org/IHI/Topics/I
  mprovement/SpreadingChanges/SpreadCaseforImproveme
  nt.htm.

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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
  http//www.ihi.org/NR/rdonlyres/661BCB93-1FED-4ADB
  -86FE-4DDD84445AFD/0/AFrameworkforSpreadWhitePaper
  2006.pdf
• 5 Million Lives Campaign. (2008). Getting Started
  Kit Rapid Response Teams. Cambridge, MA
  Institute for Healthcare Improvement. Retrieved
  on July 21, 2009, from http//www.saferhealthcare
  now.ca/EN/Interventions/RRT/Documents/RRT20Gettin
  g20Started20Kit.pdf.
• Vincent, C. (2006). Patient Safety. Toronto
  Elsevier Limited.