new improvers transforming healthcare

Welcome to D1 NEW IMPROVERS TRANSFORMING

HEALTHCARE

Eight leaders from around the world will present their strategies for engaging

clinicians in quality improvement training in a Pecha Kucha style format

Please tweet #Quality2014 & #d1

“

After this session, participants will be able to:

• Gain a range of perspectives and insight from leaders of initiatives to engage pre- and post-registration clinical trainees in quality improvement

• Experience the Pecha Kucha presentation method, which massively increases the impact of presentations and retention of ideas by an audience

• Learn as much about strategies to engage trainees in quality improvement in 90 minutes as might take four hours through conventional presentations

• Experience an exhilarating variety of ideas and projects from a worldwide range of viewpoints

Join in!

Please tweet your comments, views and questions with the hashtags #Quality2014 and #d1

We will review your tweets at the end of the presentations

Clarity and brevity in presentations are endangered practices

Source of image: onlignment.com

Source of image: jennifermccrea.com

Source of image: borrowed from www.sha.org

My learning in a nutshell

Talk to the person next to you:

What would it take for you to make a presentation in 6 minutes, 40 seconds?

Our Pecha Kucha presenters

1. Emma Donaldson

2. Sherril Gelmon

3. Imran Qureshi

4. Margriet Schneider

5. Michelle Mello

6. Emma Vaux

7. Damian Roland

8. Kim Oates

#Quality2014 #d1

The holy triad of great presentations

Source of basic image: geospatial.uonibi.ac.ke

Joel Meilleur

The holy triad of great presentations

• Be brief

Joel Meilleur

#Quality2014 #d1

The holy triad of great presentations

• Be brief • Be brilliant

Joel Meilleur

#Quality2014 #d1

Joel Meilleur

The holy triad of great presentations

• Be brief • Be brilliant • Be gone

#Quality2014 #d1

Emma Donaldson

Clinical Lead for Quality Improvement,

Salford Royal NHS Foundation Trust,

England

#Quality2014 #d1

Engaging trainees in Quality

Improvement

Dr Emma Donaldson

Clinical Director of Quality Improvement

Salford Royal NHS Foundation Trust (UK)

@E_arnotsmith

2003

2006

Opportunity

2008

Cardiac Arrests per 1000 Admissions

1.28

0.52

2009

Building capability

Sepsis per 1000 central line days

33.332.3

12.2

26.1

35.7 36.2

0.0

42.0

39.5

7.9

12.8

15.4

29.1

14.5

0.0

16.7

9.3 8.8

0.0 0.00.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov

Se

ps

is p

er

100

0 c

en

tra

l li

ne

da

ys

Median = 29.1

Median = 8.8

Better care for sick babies

Improved access for complex patients

CVC Infection per 1000 Catheter Days

29.1

8.8

0

5

10

15

20

25

30

35

40

45

50

Month

16.4

1.7

DON’T JUST TICK THE BOX

TICkLE it!

Make it easier

Make participation a side effect

Edit don’t create

Reward participation

34

Promote quality contributors

Sherril Gelmon

DrPH, Professor of Public

Health, Portland State University,

USA

#Quality2014 #d1

Improvement for Physicians-in-Training: A Longitudinal Curriculum

Sherril Gelmon, DrPH

Paige Hatcher, MD, MPH

Theoretical Framework

Triple Aim + Model for Improvement

Balancing Needs of Learners

Mastery of improvement

Accreditation

Integration

Competence

Program Curriculum

Year2-ClinicalImprovement

Year3-LeadershipDevelopment

Year4-ResidentsasTeachers

Team-Based

Clinical

Improvement

Year1-PersonalImprovement

Investment in Improvement

Year Curriculum

Time (x 12)

Independent

Work

Clinic

(x 3)

Total

1 7.5/year 300 72 606

2 7/year 180 120 636

3 6/year 0 168 586

1828 Hours!

Foundation: Personal Improvement

Improvement in Clinical Settings

Applying Improvement Tools

0 2 4

6

8

10

12

14

16

18

20

1/2

3/0

7

1/2

5/0

7

1/2

7/0

7

1/2

9/0

7

1/3

1/0

7

2/2

/07

2/4

/07

2/6

/07

2/8

/07

PDSA Cycle #1

27%

13%

20%

13%

13%

7%

7%

# Times

Coaching is Key

Accountability

Systematic Evaluation

• Annual survey, focus groups, regular feedback

• Observations and presentations

Satisfaction with Curriculum

0

10

20

30

40

50

60

70

80

90

100

2012- 20132011- 20122010- 20112009- 20102008- 20092007- 2008

Percent of Learners Satisfied with Teaching of Improvement

Mastery of Concepts

PercentageofResidentsA endingWrap-Ups:Mean73%

Pre

Post

0

2

4

6

8

10

ResidentsFaculty

6.78.75

7.4 7.6

Pre-Test/Post-TestResultsResidents&Faculty

0%

5%

10%

15%

20%

25%

30%

35%SCAP RFHC

Clinic Visit Process

Check in Medical

Assistant Provider Orders Pre-Visit

Making a Difference: Vaccination Rates

54.26% 54.19% 54.39%58.30% 57.61%

64.68%67.94% 66.60% 66.80%

69.96% 70.03%

40.00%

45.00%

50.00%

55.00%

60.00%

65.00%

70.00%

75.00%

Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13

TDaP

Jul-12

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Spread

• Residents Faculty Department

• Clinic Hospital City State

• Other residencies Fellowships

Faculty as Coach/Role Model

• Unique skill set

• Accessible

• Enthusiastic

• Just-in-time tools

Relevance of Topics

Trainees Become Teachers

Conclusions Systematic curriculum

Build competencies

Longitudinal experience

Imran Qureshi

Director General DAPS Global

England

#Quality2014 #d1

Dr Imran Qureshi Founder of DAPS Global DAPS (Doctors Advancing Patient Safety) Microbiology Specialist Registrar Previous BMJ Quality Clinical Lead imran@dapsglobal.com www.dapsglobal.com

2009 - Berlin

10 DAYS Quality

Improvement Projects

1

2

3

DAPS Global Summer School

3 DAYS 30

DELEGATES HEALTHCARE INNOVATION

• Speak Up

• NHS Sleeeeeeep

• Don’t Kill Bill

• Anti-Bullying

CAMPAIGNS & APPS

WORKSHOPS

DEBATES

• Leadership

• Communication

• Human Factors

• Surgeons should full disclose Their mortality & morbidity data

• Foreign patients attending for Emergency care should be charged

AUDITS ESSAYS

THROMBOPROPHYLAXIS HANDOVER ANTIBIOTIC ALLERGIES AWARENESS OF MEDICATIONS PATIENT EXPERIENCE

CHILD PROTECTION ALCOHOL IMPACT SURGICAL SAFETY BULLYING 4-HOUR TARGET

summit.dapsglobal.com

MUST HEALTHCARE INNOVATION BE CONFINED TO HEALTHCARE PROFESSIONALS?

QUEEN MARY UNIVERSITY OF LONDON WHITGIFT SCHOOL – SOUTH CROYDON

The Hobbit

“There is more in you of good than you know, child of the kindly West. Some courage and some wisdom, blended in measure. If more of us valued food and cheer and song above hoarded gold, it would be a merrier world.”

Margriet Schneider

Professor of Internal Medicine & Chair of the Division of Internal

Medicine & Dermatology, University Medical Center,

Utrecht, The Netherlands

#Quality2014 #d1

Michelle Mello Head of

Commissioning (Nursing),

NHS England, England

#Quality2014 #d1

Wonder & Improve an innovative way for training leadership skills

Prof. Dr. Margriet Schneider

Program Director Internal Medicine

Ambassador Quality & Safety Program

Chair of the Division of Internal Medicine and Dermatology,

University Medical Center Utrecht, the Netherlands

“Do you ever wonder why?”

“Should you wonder why?

Wonder & Improve

• Value critical minds and create awareness

• Share, ownership

• Empower by offering tools

Competencies of a medical expert

CanMEDS 2015: Manager = Leader

‘Service’ Leaders

‘Frontline’ Leaders

Basic leadership skills

Wonder & Improve

‘Service’ Leaders

‘Frontline’ Leaders

Wonder & Improve

• Elective 1 hr session

• Residents and Program director

• Supportive staff member

• Update and progress of former projects

• New items

• Items within reach for improvement

Wonder & Improve How does it work I ?

Wonder & Improve How does it work II ?

• Prioritize by scoring 3-2-1 credit points

• Chose 3 items

• Formulate goals

• Appoint residents

A resident wondered ……

Why nurses keep coming to me for

non-urgent questions about their

patients AFTER clinical rounds?

I’m losing focus!!!!

What changed?

Examples of change:

• Read back procedure

• A 2-day ATLS training

• Redesign of clinical rounds

• Uniform dress code

• Upspeeding of admittance procedure

Implementation in The Netherlands

• observations,

• interviews,

• documentanalysis,

• evaluation forms

0 10 20 30 40 50

Resident related

Effective

Patient-centered

Efficient

Timely

Equitable

Safe

Effects Wonder & Improve 114 improvement topics

Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: The National Academies Press; 2001.

Awareness

“though I’m new here, I’m

invited to think out loud -

when a topic arises that I

feel like I could commit to,

I should go for it.”

Residents discovered:

• Their position

• Their responsibility

• Their affinity and skills

Ownership & Empowerment

Residents feel:

• Being heard

• Supported

• Better equipped

‘The simple fact that there is

attention from supervisors for my

problems gives me the courage

to keep on going and keep

improving’

Educational Triangle

Stevens L. 2002; Zin in Leren

Autonomy

Competency Relation/Collaboration

Wonder & Improve

Your mother is here …

Tell her I will be in time, and please give her

some coffee …

Acknowledgements to: UMC Utrecht

Liesbeth van Rensen, PhD

Judith Voogt, medical student

Utrecht School of Governance,

University Utrecht

Prof. Mirko Noordegraaf, PhD

Lieke vd Camp , masterstudent

Thomas Beerhuis, masterstudent

Introducing Care Makers

Michelle Mello Proud Nurse

The Care Makers

Olympic Spirit

Volunteering

Compassion in Practice

Care Makers are born

Selection

Volunteering experience

Commitment to 6Cs

Desire to improve care

Work with and support colleagues

Social Media

Social Media reach

2,000+ 2.5m

600+

Support and development

It will take too long

It can’t be done

Making a difference!

Reasons not to

change It’s

impossible It’s not our problem

It’s too ambitious

It’s too complicated

What Care Makers say

"I've had a fantastic year it's like a magic wand being waved in our organisation, it has put the excitement back in nursing #patientcare“ Lisa Reith, Care Maker

Where are we now

Where are we now

Care Maker App

Care Maker of the year award

Research programme

Impact

Impact

400

The concept grows

Reflections

Reflections

The future

Emma Vaux

Consultant Nephrologist & Director of Quality

Improvement, Royal Berkshire NHS

Foundation Trust, England

#Quality2014 #d1

Making Every Moment Count

“Quality in action: Striving for

excellence”

Emma Vaux

Clinical Lead

Hester Wain

Head of

Patient Safety

Anne McDonald

Head of clinical Quality Improvement

The Royal Berkshire Hospital project team

Background

Aims

• Quality improvement as normal

practice

• High quality training

• Develop supporting resources

What we did….

IMPACT

LEARNING

SATISFACTION

RESULTS

Kirkpatrick Model of Training

Evaluation How

AIM

S

OU

TC

OM

ES

BETTER TRAINING BETTER CARE

Trainee-led ideas Incidents

Simulated learning

Complaints

Project outcomes

Quality improvement projects

Improvement change

New skills Resources

30 trainees

Resources

RBFT Academy

Quality

Improvement

Management

Leadership

Governance

Patient

Multi-disciplinary Board

Project team

Junior doctors

Learning experience

“I realise how good QI is ….it is relevant to

day to day practice… …it’s simple …..makes

a big difference to our patients……… It is

worth giving it high priority in our clinical

duties.”

45 trainees completed 27 projects

Learning experience

“I was very passionate about the experience…….

it was so good to do such a project and be able to

keep monitoring it.”

Gaining of knowledge and skills

“This has been a very

valuable learning experience

into clinical quality

improvement as well as

being brilliant for my CV”

Behaviour change

“My whole outlook has changed…

I now look for situations to improve…”

Organisational change

“The magic is in seeing a

trainee identify a

problem they

encounter and feel

empowered to make a

change”

Hospital Board

74%

projects

achieved

their aims

Practice outcomes

Human Financial

Resources

Learning

Key factors for success

‘You hear about

projects and they

sound really huge

but this has

opened my eyes

to how you can do

little things and

make small

changes that

make a big

difference’

•Core hospital business

•Core team

•Communications strategy

Key factors for success

‘I identified it in my own appraisal as the

best thing I have done all year.’

Consultant supervisor

•Pool of ideas & supervisors

•Multi-disciplinary team & patient involvement

•Showcase

Spread

•Resources Methodology

Experience Learning

Summary

‘I would definitely, definitely do a

quality improvement project

again’

Damian Roland

Consultant and Lecturer in Paediatric Emergency Medicine,

Leicester Royal Infirmary, England

#Quality2014 #d1

-

The largest day of simultaneous action in the history of the NHS

A new method of change...

-

The largest day of simultaneous action in the history of the NHS

Change starts with me..

Maker

...I want to make a difference

Anyone can pledge – It’s personal to you!

Change Starter

I have not failed...

Thomas Edison

Tell a personal story

Be authentic

Practice what you preach…

Support early adopters…

Recognise a different

type of radical…

twitter.com/NHSChangeday

youtube.com/NHSChangeDay

facebook.com/NHSChangeDay

changeday.nhs.uk

Embrace Social Media

nhschangeday.podbean.com

vimeo.com/nhschangeday

Kim Oates

MD Dsc, Director of Undergraduate Quality & Safety Education,

Clinical Excellence Commission, Australia

#Quality2014 #d1

Identifying and nurturing future leaders in patient safety March 2014 – Kim Oates

Kim Oates Paediatrician, medical academic and grandfather

Identifying and nurturing future leaders in patient safety

In Australia, the average age of the best known quality and safety

leaders is 62 Where are the future leaders?

Clinical Excellence Commission

My task: To infiltrate medical schools

How much Patient Safety is taught in Australian Medical Schools?

70% of Deans thought there was a lot

42% of medical educators thought there was a lot less than their Deans thought

78% of medical students thought there was not much at all

The results of infiltration

Four medical Schools

Two nursing schools

One School of Allied Health

First year

Why we make errors

Blame and safe cultures

Using leadership skills to

make patients safer

Listening to patients and their families

Second Year

Human factors Open disclosure

Teams and communication

The patient is part of the team

Clinical documentation

Safe handover

Diagnostic error

Managing fatigue

Coping with disruptive

behaviour

Final year medicine

0

500

1000

1500

2000

2500

3000

3500

4000

4500

2010 2011 2012 2013 2014 andbeyond ??

The program grows

Number of healthcare students taught

LEADERS

ELECTIVES

STUDENTS

POST GRADUATES

ADMISSIONS

24 %

Contact us!

Helen Bevan

Emma Donaldson

Sherril Gelmon

Imran Qureshi

Margriet Schneider

Michelle Mello

Emma Vaux

Damian Roland

Kim Oates

@HelenBevan

@E_arnotsmith

gelmons@pdx.edu

imran@dapsglobal.com

m.m.e.schneider@umcutrecht.nl

@MSHmello @CaremakersUK

@VauxEmma

@Damian_Roland

Kim.oates@sydney.edu.au

#Quality2014 #d1