numbers make the world go round: using data to drive change may 25th, 2012

Numbers Make the World Go Round: Using Data to Drive Change

May 25th, 2012

Presented by: T. Rollefstad SIA Safer Healthcare Now!, CPSI

We’ve got the data so now what?Session One

Where are we At and Where are we Going?

MorningSession 1

– Describe some methods to drill into the data for a focus

– Identify some next steps to use data for action

– Learn a method for making rapid change

Session 2– Learn to apply a method for

rapid change– Understand how to build

knowledge from testing

AfternoonSession 3

– Understand when to move from testing to implementation

– Create a plan for next steps

Session 4– Explore in dialogue, several

topics relevant to making change

Sourced from: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement (www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)

The improvement process

DP A

S

3Intervention Phase

Diagnostic Phase2

1

Project Phase

4

5

Sustaining Improvement Phase

Impact Phase

Project mission Project team

Conceptual flow of process Customer GridData-Fishbone-Pareto chart-Run charts-SPC charts

2 months

Plan a changeDo it in a small testStudy its effectsAct on the result

2 months

1 month

Annotated run chart SPC charts

DP

AS

DP

AS

D PASD

PA

S

Ongoing monitoring Outcome

Future plans

68% have selected a focus

63% have recruited a team

45-50% have completed a charter and begun testing

Diving into the Issues

What questions & methods did you use in trying to drill into your data to find a focus?

How did you choose the team members to work with you?

How did you gain support for your work?

Getting MORE information

Table Talk – Pick ONEShare with the table next to

you:• What questions & methods did

you use in trying to drill into your data to find a focus?

• How did you choose the team members to work with you?

• How did you gain support for your work?

Debrief

1. Project Phase

• “getting organized”i. decide on process that needs

improvingii. form teamsiii. write an aim statementiv. consider appropriate measures

AIM Statements• Should be SMART

SpecificMeasureableAppropriateResult orientedTime scheduled

To reduce the rate of infections in joint replacement surgery to less than 1% within 12 months

2. Diagnostic Phase

• Collect evidence and diagnose problem

• Determine the cause• Use tools to identify and organize

information

Tools: identify and organize• process flow chart• brainstorming• patient focus group • nominal group technique• tally chart• observation

Organize information• Affinity diagram• Pareto chart• Histogram• Graphs of current data-run and statistical

process control charts (SPC)• Huddles• Cause and effect diagram

Pareto Chart Observations

3. Intervention PhaseModel for Improvement

ACT PLAN

DOSTUDY

Langley, Nolan, Nolan Norman & Provost 1999

What are we trying to accomplish?

How we will know that a change is an improvement?

What change can we make that will result in an improvement?

Test Cycles

Act

• What changes are to be made?• Next cycle?

Plan• Objective• Questions and predictions (why)• Plan to carry out the cycle (who, what, where, when)

Study• Complete the analysis of the data

•Compare data to predictions

•Summarize what was learned

Do• Carry out the plan• Document problems and unexpected observations• Gather key data

How BIG shall we go?

6PDOO-WR-PHGLXPVFDOH

WHVW

9HU\ VPDOO-VFDOHWHVWV

0 $ - 2 5

2 QHF\ FOHWRLPSOHPHQWDWLRQ

0 HGLXP-VFDOHWHVWV

0 ,12 5

+,* + / 2 : &2 1 6( 4 8 ( 1 &(2 ) ) $ ,/ ( ' 7( 67

' ( * 5 ( ( 2 ) %( / ,( ) ,168&&( 662 ) 7+( &+$1* (

PDSA cycle

PDSA cycles – single testChanges that result in improvement

Hunches, theories and ideas

AS D

P

ASD PA

SD

P

ASD

P

Sourced from: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)

From Improvement to Spread

Spreading a change to other

locations

Developing a change

Implementing a change

Testing a change

Act Plan

Study Do

Theory and Prediction

Test under a variety of conditions

Make part of routine operations

Robert Lloyd

Fast Forward PDSASession Two

Pareto Chart Observations

Catheters in too long: Ideas to try• Include catheter

necessity in daily nursing assessments & shift change

• Develop nursing protocols to allow removal if criteria met

• Implement automatic stop orders for 48-72 hrs after insertion

• Place reminders (stickers) in patient order sheets requiring continuation of catheter order

• Use alerts in computerized ordering systems to indicate presence of a catheter & require documentation for continued need

How-To-Guide: Prevent Catheter-Associated Urinary Tract Infections. Cambridge, MA: IHI; 2011. (Available at www,ihi.org)

Test Cycles

Act

• What changes are to be made?• Next cycle?

Plan• Objective• Questions and predictions (why)• Plan to carry out the cycle (who, what, where, when)

Study• Complete the analysis of the data

•Compare data to predictions

•Summarize what was learned

Do• Carry out the plan• Document problems and unexpected observations• Gather key data

Huddle Group in the Fish Bowl

Instructions:1.Choose an idea to test2.Complete the questions for the PDSA planning

on the flip chart3.Discuss result in terms of your unit4.Record answers to the Study of that result5.Record the answers to the Act – change,

adopt, abandon?

Observer Group Outer Ring

Instructions:1.Was the prediction clear?2.Was the plan clear? W53.What did you learn in the study?4.How would you modify the test?

Catheters in too long: Ideas to try• Include catheter

necessity in daily nursing assessments & shift change

• Develop nursing protocols to allow removal if criteria met

• Implement automatic stop orders for 48-72 hrs after insertion

• Place reminders (stickers) in patient order sheets requiring continuation of catheter order

• Use alerts in computerized ordering systems to indicate presence of a catheter & require documentation for continued need

How-To-Guide: Prevent Catheter-Associated Urinary Tract Infections. Cambridge, MA: IHI; 2011. (Available at www,ihi.org)

Fish Bowl Debrief #1•What struck you about the planning portion?•How did the teams study the “do” observations?•What might you measure?•How might you change this test?

Six Outer Ring volunteers for next fishbowl

Observer Group Outer Ring

Instructions:1.Was the prediction clear?2.Was the plan clear? W53.What did you learn in the study?4.How would you modify the test?

Fish Bowl Debrief #2•What struck you about the planning portion?•How did the teams build on their learning?•What might you measure?•How might this testing work in your area?

Session Three

Moving from Testing to Implementation

From Improvement to Spread

Spreading a change to other

locations

Developing a change

Implementing a change

Testing a change

Act Plan

Study Do

Theory and Prediction

Test under a variety of conditions

Make part of routine operations

Robert Lloyd

Power of Testing CHATCLAVARDER

Develop, Test and Implement

Degree of belief that the change

will result in improvement

High

Developing a Change

Testing a Change Cycle 1, 2, 3…

Implementing a Change

A successful change

Change still needs further testing.

There is a risk of implementing at this

stage.

Unsuccessful proposed change

Low

Moderate

Source: Langley, et al. The Improvement Guide

Testing and Implementation

Similarities:• PDSA cycles • Building knowledge • Predictions • Data

Differences:• Testing is temporary,

implementation is permanent

• Support processes • Expectations of failure• Social impacts and

resistance• Balancing measures

IMAGINE 1 YEAR FROM NOW

What does fully implemented look like?

4. Impact and Implementation

Sourced from: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)

Impact and implementation

phase

Implement the changes

Measure impact • Annotated run chart• SPC charts• Other graphs

5. Sustaining Improvement

1. Once an intervention has been introduced, the intervention and any improvements need to be sustained.

2. This may involve:• Standardization of existing

systems and processes• Documentation of policies,

procedures, protocols and guidelines

• Measurement and review of interventions to ensure that change becomes part of ‘standard’ practice

• Training and education of staff

Sustaining Improvement

PhaseSustain the

gains• Standardization• Documentation• Measurement• Training

Sourced from: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)

Leading Your ChangePlanning your next steps

Work Plan Exercise

• Take 30 min to document your next steps and tests using the work sheet provided

• Report out one of your planned next steps or tests

Tanis Rollefstad, RN, BN, MACT candidateSafety & Improvement Advisor

SHN, CPSITanis.rollefstad@hqca.ca