24
Building National Health Care Quality Improvement Campaigns to Succeed: Lessons from the CUSP: CLABSI Project AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

  • Upload
    calix

  • View
    45

  • Download
    0

Embed Size (px)

DESCRIPTION

Building National Health Care Quality Improvement Campaigns to Succeed: Lessons from the CUSP: CLABSI Project. AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust. Presentation Overview. CUSP: CLABSI Project Origins and Background - PowerPoint PPT Presentation

Citation preview

Page 1: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Building National Health CareQuality Improvement Campaigns to Succeed:

Lessons from the CUSP: CLABSI Project

AHRQ Annual MeetingSept. 27, 2010

Steve Hines, PhDHealth Research and Educational Trust

Page 2: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Presentation Overview

CUSP: CLABSI Project Origins and BackgroundThe Challenge of Evolving a National ProjectImplications for Project Design and PlanningFinal Thoughts

Page 3: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Project Origins and BackgroundIn the beginning was the Keystone Project . . .

. . . and it was very good!

Page 4: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

CUSP: CLABSI Project Rationale

Blood stream infections kill 40,000-60,000 persons each year.Reducing the BSI rate from 5 per 1,000 days to 1 per 1,000 days will save 20,000 lives annually.Michigan Keystone Project showed that this level of reduced CLABSI rate was achievable and sustainable.Project made central part of Secretary Sibelius’ Healthcare Acquired Infection Reduction Initiative.

Page 5: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

CUSP: CLABSI Project Goals

Outcome Goals:Reduce BSIs to 1 per 1,000 central line daysSome states and hospitals view CLABSI elimination as the goalImprove unit safety culture

Reach hospitals in all 50 states, the District and Puerto RicoInclude both ICUs and other units with CLABSI risksInclude critical access hospitals

Page 6: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

CUSPEducate on the science of safetyIdentify defectsAssign executive to adopt unitLearn from defectsImplement teamwork and communication tools

CLASBIWash hands prior to procedureUse maximal barrier precautionsClean skin with chlorhexidineAvoid femoral linesRemove unnecessary lines

CUSP: CLABSI Implementation Content

Page 7: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

CUSP CLABSI Intervention ProcessesIndividual Components

Planning/ orientation callsBaseline data collection period for CLABSI and safety cultureKickoff meetingMonthly infection rate and team process data submissionMonthly content calls Monthly coaching callsMonthly feedback reports on outcome and process measuresMid-course meetingEnd-of-project meeting

Project spans two years and requires participation in:2-3 in-person meetings48-60 calls led by national project team24 internal meetings of implementation teamMonthly data collection, submission, and assessment (lessons learned/root cause analysis)

Page 8: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

The Challenge of Evolving a National QI Project

Page 9: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

A Tale of Two Airplanes

Wright Flyer P-51 Mustang

Design & Build Prototype 4 years 117 days

Production Time 6 months for Flyer II & III 21 minutes at peak

Range 24 miles 1,100+ miles

Speed 39 mph 400+ mph

Altitude 200 feet 30,000+ feet

Page 10: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Obstacles to EvolvingProven initial model: Change distances project from proof method will workProject databases: Stability justifies creating and building a robust national databaseEvaluation: Simpler and cleaner to assess outcome of a single interventionProject planning: Proposal submission process requires plan easier to execute than to modifyBudgets/Contracts: Executed agreements with subcontractors commit resources for specific tasksClarity: Change creates questions and confusion

Page 11: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Lessons from Two Airplanes

Change is difficult, risky, but absolutely essential for mass production (or a national rollout to succeed.

Page 12: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Predictable Evolutions in National QI Campaigns1. Key challenge shifts from obtaining proof

change is possible to achieving change in specific units.

2. Baseline problem level changes from 5 infections per 1,000 central line days to 2-3 infections per 1,000 central line days.

3. Goal changes from under 1 infection per 1,000 central line days to total elimination .

Page 13: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Predictable Evolutions in National QI Campaigns4. Participant expectations change from

uncertainty of success despite effort to (over)confidence in success with minimal effort.

5. Participants change from innovators and early adopters to mid- to late-majority hospitals.

6. External environment changes from project as unique and innovative to project as one of many improvement activities in the area.

Page 14: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

National QI Campaign Paradoxes

The more successfully a national QI campaign begins, the more pressure there will be for it to remain unchanged and the more need it will have to evolve quickly and substantially.Nothing guarantees failure more than continued, unreflective reliance on the processes that first produced success.

Page 15: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Factors Evolving From To

Challenge Definition

Creating evidence improvement is possible

Practical guidance on achieving improvement

Proof rates can be lowered

Proof decreases are sustainable

Baseline Defect Rate

Recognition of a significant problem

Erroneous belief the problem is fixed

3-4 Sigma improvement strategies

5 Sigma improvement strategies

Preparing to Successfully Adapt to Change

Page 16: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Factors Evolving From ToProject Goals Significant reduction Complete eradication

Achieving superior performance

Avoiding inferior, substandard care

Participant expectations

Change is doubtful, long, and hard

Change should be fast and simple

Comprehensive and redundant training

Efficient, streamlined training

Dependence on project leadership for success

Dependence on internal and local leadership for success

Preparing to Successfully Adapt to Change

Page 17: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Factors Evolving From To

ParticipantsInnovators and early adopters

Mid and late majority and laggards

Proof from national experts and visionaries

Proof from local and regional leaders

External Environment

Project is unique, exciting, and cutting edge

Project is one route to success among many

Few implementation activities have occurred

Partial interventions have occurred in many places

Coordination with alternate projects irrelevant

Coordination with alternate projects essential

Belief problem is unfixable independently

Belief problem can be fixed without external help

Preparing to Successfully Adapt to Change

Page 18: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Implications for Leaders of National QI Campaigns and Funding Organizations

Proposal EvaluationBudgetingGoal SettingProject LeadershipOperational ProcessesData BasesEvaluation

Page 19: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Implications for Leaders of National QI Campaigns and Funding Organizations: Key Questions

Project Dimension From ToProposal Writing & Evaluation Is it a viable, proven plan?

What is the plan for adapting to inevitable change?

BudgetingAre all resources allocated to good causes?

Are resources fungible and are unallocated resources retained to support needed adjustments?

Goal SettingWhat outcome goals are set at the outset?

Are change goals defined and outcome goals adjusted?

Page 20: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Project Dimension From To

Project LeadershipDoes project have stable, credible leadership?

Does project have a plan to develop and transition to new, local or regional leaders?

Operational Processes

Are processes well defined and proven?

How will processes become faster and more efficient?

Data basesWill stable, robust databases be created?

Can databases inexpensively evolve to reflect needed changes?

EvaluationWere processes followed and outcomes achieved?

Did processes evolve to achieve outcomes more efficiently?

Implications for Leaders of National QI Campaigns and Funding Organizations: Key Questions

Page 21: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Final ThoughtsCritical to distinguish between essential success factors and processes for helping hospitals implement them.

Success factors for CUSP: CLABSICulture change that makes safety a priority and empowers every employee to hold every other employee accountable for safetyOperational changes that reduce infections

Processes likely to morph: Set of meetings and calls used to educate, motivate, and empower unit staff to implement CUSP: CLABSI.

Page 22: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Final ThoughtsCritical to recognize inherent tensions in national campaigns.

Consistency & clarity vs. need to changeStrong national leadership vs. flexible local leadershipDesign that supports strong, clean evaluation of impact vs. design that maximizes operational impactProcesses likely to morph: Set of meetings and calls used to educate, motivate, and empower unit staff to implement CUSP: CLABSI

More research and reflection required on how to make national campaigns successful and efficient (e.g. Scale Up & Spread Conference funded by AHRQ, Commonwealth Fund & others.

Page 23: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

Final Thoughts

Need to account for context in planning and executing a campaign:

Inevitable that parts of campaign will not take place in ideal context

Could be ideal when funded, less enthusiasm during implementationCould be ideal at kickoff, but requires visionary funder that correctly times the trend

Need strategies for both directly influencing participants and for shaping the national environment to support campaign’s goals.

Page 24: AHRQ Annual Meeting Sept. 27, 2010 Steve Hines, PhD Health Research and Educational Trust

QuestionsAbout presentation:

Steve [email protected]

About participating in CUSP: CAUTI or CUSP:[email protected]

Disclaimer: Although the CUSP:CLABSI project is funded by AHRQ and is being led by a partnership that includes Johns Hopkins University and the Michigan Health and Hospital Association, the opinions in this presentation are exclusively those of the presenter. Like an effective national campaign, these views are also likely to evolve over time.