PQCNC PI Science Enhance Partnerships 20130904

7/30/2019 PQCNC PI Science Enhance Partnerships 20130904

1/20

Using Performance Improvement

Science to Enhance Partnerships

with Patients & Families

Presented by: Sue Collier, MSN, RN, FABC

Performance Improvement Specialist

Patient-Family Engagement

Perinatal Quality Collaborative of NC

Learning Session 1

September 4, 2013


2/20

Source:

Langley, et al. The Improvement Guide, 1996

The PDSA

cycle providesthe tactical

approach to

work

The three

questions

provide the

strategy

The Model for Improvement

Act Plan

Study Do

What change can we make

that will result in

improvement?

How will we know that a

change is an improvement?

What are we trying toAccomplish?


3/20

What will happenif we try

something

different?

Lets try it!Did it work?

Plan Objective

Questions &

predictions

Plan to carry out:

Who?When?How? Where?

Do Carry out plan

Document

problems

Begin data

analysis

Act Ready to

implement?

Try something

else? Next cycle

Study Complete data

analysis

Compare to

predictions

Summarize

Whats next?

The PDSA Cycle


4/20

Hope is not a plan.

Some is not a number.

Soon is not a time.

What are we trying to accomplish?

The Project AIM is:

Not just a vague desire to do better

A commitment to achieve measured improvemento In a specific system

o With a definite t imel ine

oAnd numeric goals


5/20

Aim statements

Are clear and concise

Include numerical goals that require

fundamental change to the system

Specify the population or group that will benefitfrom the improvement

Generally include stretch goals

Help avoid drift May need to be refocused over time


6/20

Examples of an aim statement

We will improve care for all our patients withchronic disease by making improvements in ourclinic that impact the six dimensions of quality, asoutlined in the Institute of Medicine report,

Crossing the Quality Chasm: A New HealthSystem for the 21st Century.

Reduce adverse drug events (ADEs) on allmedical and surgical units by 75 percent within 11

months. Improve medication reconciliation at transition

points by 75 percent within 1 year.
http://www.ihi.org/knowledge/Pages/Publications/CrossingtheQualityChasmANewHealthSystemforthe21stCentury.aspxhttp://www.ihi.org/knowledge/Pages/Publications/CrossingtheQualityChasmANewHealthSystemforthe21stCentury.aspxhttp://www.ihi.org/knowledge/Pages/Publications/CrossingtheQualityChasmANewHealthSystemforthe21stCentury.aspxhttp://www.ihi.org/knowledge/Pages/Publications/CrossingtheQualityChasmANewHealthSystemforthe21stCentury.aspxhttp://www.ihi.org/knowledge/Pages/Publications/CrossingtheQualityChasmANewHealthSystemforthe21stCentury.aspx


7/20

Every System is perfectly designed to

achieve the results it gets


8/20

Attribution Carol Haraden, PhD

What Changes Can We Make?

Understanding the System for Weight Loss

Primary

DriversOutcome

Secondary

Drivers

Process

Changes

AIM:

A New

ME!

Calories In

Limit daily

intake

Track

Calories

Calories

Out

Substitute

low calorie

foods

Avoid

alcohol

Work out 5days

Walk to

errands

Plan

Meals

Drink H2O

Not Soda

drives

drives

drives

drives

drives

drives

drives

drives


9/20

Decrease OB

AdverseEvents

Become proficientin managing low

frequency, high riskevents

Practice low frequency, high risk events in drills

Assess staff and providers skills and confidence

Identify risks

Improve teamworkand communication

Provide teamwork training to staff and providers

Include teamwork and communication practice in simulation drills

Use results of HSOPS to identify areas for improvement

Use briefing, huddles and debriefing

Learn from risks andimprove care

systems

Assess and report risks

Use the Learning from Defects tool to analyze events and risks

Include patients inplanning and safety

Include patients and families in briefing, huddles and debriefing

Encourage and invite patients to speak up with their concerns

Provide patient centered and appropriate patient education


10/20

Drivers to achieve goal: SSI reduction

Standardizedapproach to the

recruitment,training, and

engagement ofpatients andfamilies aspartners

Process for identifying

patients/familymembers for

improvement teams

Action Plan

Team education

Referrals

Process to contact,

invite, and engagepatient/family membersin improvement efforts

Approach Methods

Agreement onEngagement

(Patient & Staff)

Invitation andAttendance

Process for educating

providers/staff re:importance of

patient/family perspectiveAction Plan

EducationMethods

Patient/Family

Faculty


11/20

The Model for Improvement

Act Plan

Study Do

What are we trying toAccomplish?

How will we know that a

change is an improvement?

What change can we make

that will result in

improvement?

The three

questions

provide the

strategyThe PDSA

cycle providesthe tactical

approach to

workSource:Langley, et al. The Improvement Guide, 1996


12/20

PDSA Worksheet


13/20

Hunches

Theories Ideas

Very Small

Scale Test

Follow-up

Tests

Wide-Scale Tests

of Change

Implementation of

Change

Changes That Result inImprovement

Spread

Sequential building of knowledge

under a wide range of conditions

What are we trying toaccomplish?

How will we know thatachange is an improvement?

What change can we make that

will result in improvement?

Model for Improvement

A P

S D

A P

S D

Repeated Use of the PDSA Cycle


14/20

If we includepatients and

families in

planning and

learning, they will

take a more active

role in safety

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%100%

1 2 3 4 5 6 7 8 9 10111213141516171819202122232425weeks

Percent

12

3

45

6

Mini-measuretracks improvement

cycles

Cycle 1: Day 1: one clinical team on one shift does their

briefing at the bedside with one patient and asks the patient

and family to participate

Cycle 2: Day 2: One clinical team does briefing

at the bedside with all patients on one shift

Cycle 3: Patients are providing useful

information in the briefing and are more

engaged in their care. All teams begin

briefing at bedside, with patients.

Cycle 4: Analyze failures,

determine plans for patients who

dont want to participate

Cycle 5: Standardize and

document

Cycle 6: Educate

staff on new

standards

99% Reliability

A

P D

S

A

P

D

S

AP

D S

A

P

DS

A

PD

S

A

P

D

S

A P

DS

Change Idea: Include patients and families in

briefing, huddles and debriefing


15/20

Working in Parallel on Multiple Change Concepts

(Aim: Engage Patients & Families)

A P

DS

A

PD

S

A

PD

S

AP

DS

A P

DS

A

PD

S

A

PD

S

AP

DS

A P

DS

A

PD

S

A

PD

S

AP

DS

A P

DS

A

PD

S

A

PD

S

AP

DS

Identify

Patient/Fa

mily

Advisors

Contact

potential

advisors

Include

patients

on teams

Educate and

improve provider

skills and

knowledge


16/20

Tips for Small Tests of Change

Test with volunteers Use simulation or role play

Do not try to get buy-in, consensus, etc.

Be innovative to make each test feasible

Collect useful data during each test

As cycles proceed, test over a wider range ofconditions

Start small: 1:3:5:all (one patient, one day, oneunit, one physician)


17/20

Testing v. Implementation

Testing:Trying and adapting existing knowledge on a

small scale; learning what works in your system

Implementation:

Making this change a part of the day-to-day

operation of the system (Would the change

persist even if its champion were to leave the

organization?)


18/20

Why Test?

Why Not Just Implement then Spread?

Increase degree of belief in the change idea

Document expectations and results

Build a common understanding

Evaluate costs and side-effects

Explore theories and predictions

Test ideas under different conditions

Learn and adapt for the next test


19/20

For more information contact

Sue Collier, MSN, RN, FABC



[email protected]

919.677.4157
mailto:[email protected]:[email protected]


20/20

Using Performance Improvement

Science to Enhance Partnerships

with Patients & Families

Presented by: Sue Collier, MSN, RN, FABC



Perinatal Quality Collaborative of NC

Learning Session 1

September 4, 2013

Documents

PQCNC PI Science Enhance Partnerships 20130904