Modified R2R slides

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This slides are modified Original Slides Presented by Akarin Nimmannit MD Thai initiative that was considerably successful R2R Made innovation/QI easy for everyone to do

Text of Modified R2R slides

  • 1. Akarin Nimmannit MDManager of Routine to Research (R2R) Project Assistant Dean for Quality Development Faculty of Medicine Siriraj Hospital Mahidol University
  • 2. Definition of R2R Research Research question: Originate from routine service/work Solve the service/work problem Improve the quality of service/work Investigator/conductor The working staff (experiencing the problem) Might work with the invited expert Result: Measure the significant patient health outcome or service Surrogate outcome might not be relevant e.g. laboratory testing result Implementation: Research result must return to improve the patient care or serviceModified from the concept of Prof. Dr. Vicharn Panich, Chairman of MahidolUniversity Council
  • 3. 3
  • 4. Routine to Research (R2R) UnitLaunched in June 2004Health Services Research Management UnitMissions:Upstream to downstream Routine work problem Research question Research proposal development Research proposal review (IRB-ethical clearance and grant process) Research conduction monitoring Manuscript/ implementation (service improvement)Knowledge management (KM) for healthservices research
  • 5. R2R Management ApproachKM basedR2R is not a foreign body, but a further quality development progression. Integration of R2R research into common hospital quality development (CQI-PDCA)R2R is an investment, not another burden. R2R is voluntary work.Overcoming the unpleasant experiences and attitudes towards research R2R does not have to be very complex. R2R is not restricted only to the scholars.
  • 6. Medical Institute of the Kingdom toward International Excellence Clinical Human Capital Innovation &Excellence Excellence Publication Knowledge Routine work Knowledge Creation Translation Clinic Support (Front (Back office) office) Quality Criteria e.g. HA, JCIA & TQA Quality Criteria e.g. HA, JCIA & TQA
  • 7. Research Questions & Quality Development Topics are from..1. Workflow: Value Stream Mapping Care team: care process Laboratory: Specimen collection, preparation, obtain, handling, storage, process, report2. Complaints & Occurrence Reports What have happened What/How factors associated with the incidence What should be the solution/ What is the best way to solve the problem3. Indicators (process, output, outcome) Target, Timing Other institute/Best practice Standard criteria (HA/JCIA/ISO)4. Organizational goal (s)
  • 8. Knowledge Management (KM) for R2RDo believe R2R projects exists even before having the term R2RInspired to learn from real success story (sometime not success story)Good success story telling needs preparation (What & Whom to be shared)More learn, less teach
  • 9. Case: GYN UltrasonographyTransabdominal ultrasound has been performed for decadesTo obtain good vision, urinary bladder must have some volume of fluidWhat is the appropriate volume?How much water should patient drink?How long the patient bladder will be filled?A Randomized Controlled Study 9
  • 10. 93 GYN Pts with normal 93 GYN Pts with normal kidney function kidney function Randomization Drink Water Drink Water Drink Water 300 cc. 400 cc. 500 cc. n =31 n = 30 n = 32 Gynecologist independently perform GYN US when 1. Patients feel incline to urinate or 2. 45 min after drinking waterRedo US every 10 mins until Gynecologists satisfy with the quality of image
  • 11. Average waiting time and total bladder volume before transabdominal ultrasound in each study group (mean+SD)Important finding: 300, 400 & 500 cc in 60 mins
  • 12. Work instruction for advising the patient for GYN US With appointment No appointmentan hour before 1. Do not pass urine appointment time 2. Drink 300-500 (10-16 oz)1. Empty bladder cc of fluid2. Drink 300-500 (10-16 3. Do not pass urine oz) cc of fluid 4. Wait 45 minutes3. Do not pass urine until examination Patient to the US station
  • 13. Implementation Result US Success rate (%) Indicators Before 1 months 3 monthsComplete as 50 60.1 89AppointmentComplete as 70 81.1 94instruction (Noappointment )Satisfaction - 75.2 91
  • 14. Waste Elimination: Defect Rework, Overproduction, Waiting, Motion, Excessive Processing 14
  • 15. 220 R2R projects 130 Finished >80% return to improve services
  • 16. Hospital Management Asia: Human Resource DevelopmentTrain and benefit a large majority of staffAllow employees flexibility to learn at their own timeImprove a lot of the employee by way of effective professional training and life long learningEliminate service defect, reduce waste and improve communicationSignificant resultGood composition of team Were Born to Learn, Not to Be Taught John Abbott Author: Overschooled but Undereducated