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Rhetoric to Reality. Creating and Sustaining Culture Change. The Execution “Bundle”. If evidenced based practice can be bundled and effective in the clinical arena, then why not on the management side? - PowerPoint PPT Presentation
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Rhetoric to Reality
Creating and Sustaining Culture Change
The Execution “Bundle” If evidenced based practice can be bundled
and effective in the clinical arena, then why not on the management side?
What are the principles that when consistently applied over time generate positive, sustainable change?
When do you use a sledgehammer and when do you use a scalpel?
Can I Give You Some A.D.V.I.C.E.? Assess Design Validate Innovate Confront Eliminate
Assess Facility values – what is important to the
stakeholders? Do they value change? Prefer status quo? What are the social norms Who are the pivotal characters Who or what are the obstacles
Design Physician Orientation to set the expectations Medical Staff Leadership Education Medical Staff Documents that support the
values• Mandatory protocol use• “Opt out” vs. “Opt in” language• Physician Conduct Policy with progressive discipline
OPPE that reflects individual, specialty specific, performance
Let the standards work for you
Validate Administrative Walk Arounds Town Hall Meetings “Lemonade Stand” Daily Dose The Buzz The Leader Patient Safety Climate Surveys
Innovate Resource Center Concept Concurrent Data Collection –
• Multidisciplinary CHF Rounds• PI Specialist stationed in PACU• Canopy list of all vaccine patients• Canopy list of possible POA Patients
Glycemic Control Team Mobility Team Crew Resource Management Projects Psychiatric Crisis Center
Confront Obsolete institutional belief systems Rumors and innuendo Informal Leaders Convoluted Processes Unsafe Practice
Eliminate Disruptive Behavior
• Physicians• Staff• Contractors
Negative Influence• Informal Leaders• “Naysayers”
Waste• Lean Principles• “6S”
ICU Length of Stay
5.72
4.554.27
3.67 3.69 3.49 3.45
22.5
33.5
44.5
55.5
6
FY02 FY03 FY04 FY05 FY06 FY07 FY08
3.34
2.71
1.48
2.77
0
0.5
1
1.5
2
2.5
3
3.5
4
Baseline FY06 FY07 FY08
Ventilator-Associated Pneumonia
Central Line BSI’s
2.412.72
2.93
3.51
4.07
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Baseline FY05 FY06 FY07 FY08
Sepsis Management Bundle
0
20
40
60
80
100
Dec-
05
Jan-
06
Feb-
06
Mar
-06
Apr-0
6
May
-06
June
'06
July
'06
Aug'
06
Sep'
06
Oct'0
6
Nov'
06
Dec'
06
Jan'
07
Feb'
07
Mar
'07
Apr'0
7
May
'07
Jun'
07
Jul'0
7
Aug'
07
Month
% P
atie
nts
Severe Sepsis/Septic Shock Mortality Protocol Patients
37.5
66.67
100
16.67
0
12.5
0 0
17
0
10 11
30
15
25
1419
12
23
14
00
20
40
60
80
100
Sep-05 Jan-06 Mar-06 May-06 July'06 Sep'06 Nov'06 Jan'07 Mar'07 Jun'07 Aug'07
Month
% P
atie
nts
2004 2005 2006* 2007FYTD
Average LOS
25 24 19 18
All Severe Sepsis/Septic Shock with at least one day in ICU, excluding palliative care
* Severe Sepsis/Septic Shock Protocol Orders and Bundles based on Surviving Sepsis Campaign guidelines implemented
Glucose Control
0
10
20
30
40
50
60
70
80
Month
% P
atie
nts
>150 mg/dL 60-150 mg/dL 0-59 mg/dL
Nurse driven policy to initiate Insulin drip protocol for two BG >150 mg/dL
Revised policy to Institute Insulin Drip Protocol for one BG >150 mg/dL
ICU Mortality FY02 – FY08
8.7 9.33 8.9 8.36 8.2
14.5114.22
0
2
4
6
8
10
12
14
16
FY02 FY03 FY04 FY05 FY06 FY07 FY08
ICU Collaborative October 2003
ICU 6 Year Outcomes FY03-FY08 40% reduction in ICU LOS 41% decrease in vent length of stay 57% reduction in VAP rate (3.34 to1.48). 41% drop in BSI rate (4.07 to 2.41). 40% decrease in sepsis mortality ICU glycemic control between 60- 150 mg/dL
was averaging around mid 50% levels and improved to around 68-70%.
42% reduction in ICU mortality
4.5