Transforming Wales, Transforming the World: The 1,000 Lives Campaign and the International Patient S

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Transforming Wales, Transforming the World
The 1,000 Lives Campaign and the International
Patient Safety Movement1,000 Lives Campaign --
Learning Session ZeroCardiff, WalesMarch 18,
2008Joseph McCannonVice President Institute
for Healthcare Improvement
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Ground to Cover

• An overview of national efforts to improve health
  care safety and quality
• A case study from the United States
• Some key lessons and insights as you embark on
  your ambitious program
• Questions and discussion

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An International Movement of Movements
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An International Movement of Movements (cont)

• Wales
• Canada
• Denmark
• Scotland
• Japan
• Brazil
• Russia
• South Africa
• Ghana
• Laboratories for large-scale change

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So

• whats going on here?

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The Five Eras of Health Care Improvement

• 1. Migration from apprenticeship to science
• Combination of bioscience and health care science
  
• Maturation of health services research
• Development of agenda for patient safety and
  quality improvement
• Improvement at the center of strategic action

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IHIs Rings of Activity
Prototype
Innovation
Dissemination
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Campaign Origins

• Origins of IHIs 100,000 Lives Campaign
• Frustration with persistent variability in the
  quality of care, along with the national scope
  and rate of change
• Belief that our sense of urgency was shared by
  leaders and providers throughout the system
• Charismatic leadership
• Belief in the value of a shared, explicit set of
  aims.

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100,000 Lives Campaign Objectives (December 2004
June 2006)

• Save 100,000 Lives
• Enroll more than 2,000 hospitals in the
  initiative
• Build a reusable national infrastructure for
  change
• Raise the profile of the problem - and our
  proactive response

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Six Changes That Save Lives

• Deployment of Rapid Response Teamsat the first
  sign of patient decline
• Delivery of Reliable, Evidence-Based Care for
  Acute Myocardial Infarctionto prevent deaths
  from heart attack
• Prevention of Adverse Drug Events (ADEs)by
  implementing medication reconciliation
• Prevention of Central Line Infectionsby
  implementing a series of interdependent,
  scientifically grounded steps called the Central
  Line Bundle
• Prevention of Surgical Site Infectionsby
  reliably delivering the correct perioperative
  antibiotics at the proper time and taking several
  other associated actions
• Prevention of Ventilator-Associated Pneumoniaby
  implementing a series of interdependent,
  scientifically grounded steps called the
  Ventilator Bundle

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100,000 Lives Campaign Objectives (December 2004
June 2006)

• Save 100,000 Lives
• Enroll more than 2,000 hospitals in the
  initiative
• Build a reusable national infrastructure for
  change
• Raise the profile of the problem - and our
  proactive response

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100,000 Lives Campaign Objectives (December 2004
June 2006)

• Save 100,000 Lives
• Enroll more than 2,000 hospitals in the
  initiative
• Build a reusable national infrastructure for
  change
• Raise the profile of the problem - and our
  proactive response

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100,000 Lives Campaign Objectives (December 2004
June 2006)

• Save 100,000 Lives
• Enroll more than 2,000 hospitals in the
  initiative
• Build a reusable national infrastructure for
  change
• Raise the profile of the problem - and our
  proactive response

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The 100,000 Lives Campaign Scorecard

• An estimated 122,000 lives saved by participating
  hospitals (through work on the Campaign but also
  through other improvements and work on
  complementary initiatives)
• Over 3,100 Hospitals Enrolled
• Over 78 of all discharges
• Over 78 of all acute care beds
• Over 85 of participating hospitals sending IHI
  mortality data
• Participation in Campaign Interventions
• Rapid Response Teams 60
• AMI Care Reliability 77
• Medication Reconciliation 73
• Surgical Site Infection Bundles 72
• Ventilator Bundles 67
• Central Venous Line Bundles 65
• All six 42

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Additional Campaign Status

• Over 55 field offices (nodes)
• Vibrant national partner support
• Thousands on national calls and unprecedented web
  activity
• New tool development and harvesting
• Unprecedented media coverage (Newsweek, US News
  and World Report, Wall Street Journal, New York
  Times, JAMA)
• Related campaigns forming nationally and globally
• Changes in standard of care in participating
  facilities (e.g. over 25 hospitals going a year
  without a VAP)

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The Six Interventions from the Prior Campaign
Plus

• new interventions targeted at harm
• Prevent Pressure Ulcers... by reliably using
  science-based guidelines for their prevention
• Reduce Methicillin-Resistant Staphylococcus
  Aureus (MRSA) Infectionby reliably implementing
  scientifically proven infection control practices
• Prevent Harm from High-Alert Medications...
  starting with a focus on anticoagulants,
  sedatives, narcotics, and insulin
• Reduce Surgical Complications... by reliably
  implementing all of the changes in care
  recommended by the Surgical Care Improvement
  Project (SCIP)
• Deliver Reliable, Evidence-Based Care for
  Congestive Heart Failureto reduce readmissions.
• Get Boards on Board.Defining and spreading the
  best-known leveraged processes for hospital
  Boards of Directors, so that they can become far
  more effective in accelerating organizational
  progress toward safe care

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Some Early Returns

• Enrollment eclipsing 3,700 hospitals (70-75 of
  all US hospital beds)
• Nodes in all 50 states and 155 mentor hospitals
• Outstanding national call attendance (250-500
  lines per call)
• More than 50,000 downloads of intervention
  materials (very strong interest in MRSA, Pressure
  Ulcer and Boards on Board interventions)
• Increased action in rural, pediatric and public
  affinity groups
• Promising intervention-level results
• 4,000 lines engaged on National Action Day
• Over 30 million new media impressions
• Vibrant Fall Harvest in all 50 states and DC

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Early Returns (continued)

• 150 New Jersey Hospitals reduced pressure ulcers
  by 70
• Many Campaign hospitals report going over a year
  without a ventilator-associated pneumonia,
  central-line infection
• Exceptional results on virtually every
  intervention in every state and every type of
  facility

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The Big Questions

• Will we help drive a massive national reduction
  in harm? (Results)
• Will we help hospitals in a meaningful way?
  (Value)

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What are the Key Elements of Success in a
Hospital?

• Leadership
• Honest review of data
• Prioritization
• Proper resourcing
• Clinician engagement
• Capacity with improvement and project management

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Framework for Change Within the Organization

• Will
• Ideas
• Execution (profound knowledge infrastructural
  commitment)

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What are the Key Elements of Success in a State
or Nation?

• Leadership attention and fidelity to crisp aims
• Optimism
• Joy and heart
• Frontline ownership
• Simplicity and practical direction
• Sophisticated coordination among all stakeholders
• Vibrant sharing and networking (all teach all
  learn)

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Forces of Note in Transforming Health Care
(Complex Dynamics)

• Consumers
• Caregivers
• Policy/politics
• Payers/Purchasers
• Media
• Research Community
• Information Technology
• Push for Transparency

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What are the Key Elements of Success in a State
or Nation?

• Leadership attention and fidelity to crisp aims
• Optimism
• Joy and heart
• Frontline ownership
• Simplicity and practical direction
• Sophisticated coordination among all stakeholders
• Vibrant sharing and networking

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Important Lessons on Large-Scale Change

• Large scale is a challenge and a blessing.
• Devolve control and trust local adaptation
  (ecosystem).
• Make peace with instability practice creativity
  and opportunism
• Balance partnership and independence (clear
  operating values).
• Obsession with logistics is a healthy obsession.

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A Sequence of Change

• An innovative discovery
• A demonstration in 50 hospitals
• Outstanding results in 4 states
• Interest from purchasers and payers
• A state law in 14 states
• A national mandate
• A part of graduate-level training
• An expectation and a standard
• Confidence in ability to make change
• More ambitious aims

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An International Movement of Movements
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Laboratories for change

• Studying differences in
• Scale
• Pace
• Measurement
• Resources
• National interest or felt need
• Local skill
• Tolerance of media and policymakers

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Remember

• The network youre building

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Remember

• The network youre building
• The story youre in the midst of telling

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Remember

• The network youre building
• The story youre in the midst of telling
• The patients and family that deserve the best
  care possible (your aim)

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Why Optimism?

• We need a detailed, hopeful vision.
• Incredible care-givers and innovators across the
  nation.
• Our families are aging, getting sick, managing
  chronic disease (this is very personal)
• Because this is not boiling the oceanit is hard
  work but it is possible.
• I dwell in Possibility Emily Dickinson