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Creating a Culture of Safety – National Improvement Collaboratives JEANNE BANK, Safety Lead, Canadian Home Care Association MIKE CASS, Patient Safety Improvement Lead, Canadian Patient Safety Institute GLENDA KEENAN, Director, System Performance, Continuing Care, Nova Scotia Health Authority

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Page 1: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in

Creating a Culture of Safety – National Improvement Collaboratives

JEANNE BANK, Safety Lead, Canadian Home Care AssociationMIKE CASS, Patient Safety Improvement Lead, Canadian Patient Safety InstituteGLENDA KEENAN, Director, System Performance, Continuing Care, Nova Scotia Health Authority

Page 2: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in

Applying Improvement Collaborative Model to Home Care

• Modeled after Institute for Healthcare Improvement (IHI) Breakthrough series

• Sponsored by Canadian Patient Safety Institute (CPSI) Canadian Home Care Association (CHCA)& CFHI (Wave 1)

• Involves participating teams representing health authorities and home care providers from across the country

• Goal: collaboration and knowledge application to reduce preventable harm in the home

• 5 teams • 6 mo. • Falls

Wave 1

• 8 teams • 14 mo. • Variety of topics

Wave 2

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Wave 2 Home Care Safety Collaborative

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Key Elements of Program

Learning Sessions

Coaching Sessions Action Periods

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Dialogue Session # 1

Questions: 1. Thinking about quality improvement initiatives or similar

processes that you have been involved with, what one thing was key to the success of the initiative?

2. What was the biggest challenge ? How did you address this?

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Page 7: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in
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Page 9: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in

Problem Identification - Approximately 16% of clients receiving home care services were classified under the

Cognitive Impairment (CI) RUG

- 33% of the primary caregivers of clients in the CI RUG category who were discharged last year expressed feelings of distress, anger or depression (36% in Central zone)

• From the research – we understand that caregiver distress can lead to:

• Poorer health outcomes for caregiver (physical, psychological)

• Poorer health outcomes for clients

• Shorter length of stay at home

• Premature entry into LTC

• Preventable admissions to hospital

• Quality of life impact for both client & caregiver

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Project Aim

Reduce % of caregivers of clients within the Cognitive Impairment RUGs category in Central Zone experiencing

feelings of distress, anger or depression from 36% to 18% by June 2018.

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Draft Driver Diagram

Aim Primary Drivers Secondary Drivers Change Ideas

Reduce by 50% the number of CGs

expressing feelings of distress, anger or

depression in Central Zone.

Effective Case Management

Provide Person-Centered Care

Standardized Assessment of ClientMust do with ME approach

Education and Training

Access to CG Supports

Retraining program for staff during orientation

Effective Care Planning

Coordinate Information between Providers

Utilize CAPs fully in care Planning

System Navigation for Client and/or CG

Access to CC Services

Enable Clients to more effectively make informed decisions

Standardized Assessment of CG

Involving Clients and CGs in their own Health Care

Agency Responsiveness to Client/Caregiver

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Focus on CAPs

CAPs identify opportunities to influence health outcomesTriggers within broad areas such as:• Functional Performance• Cognition and Mental Health• Social Life• Clinical Issues

CAPs Structure:

• Problem statement• Goals of care• Triggers• Guidelines

InterRAI’s Clinical Assessment Protocols

(CAPs) are clinical algorithms that identify the need for care plans to address factors that may lead to adverse outcomes that are

amenable to clinical intervention.

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Healthcare Improvement ScotlandMust do with Me• What matters to you?

• Your personal goals and the things that are important to you have been discussed and form the basis of your care.

• Who matters to you?

• We have asked you about the people that matter most in your life and we have given you the opportunity to involve them in a way that you choose.

• What information do you need?

• We have provided you with understandable full information and supported you to make decisions that take account of your personal goals and the things that are important to you.

• Nothing about me without me

• You will always be given the opportunity to be involved in discussions. All information exchanges and communication between professionals or between different services or supports are transparent and always provide you with the opportunity either to bepresent or to contribute to the process.

• Personalized contact

• As much as possible, the timing and methods by which you contact and use services or supports are flexible and can be adaptedto your personal needs.

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Key IndicatorsOutcome Measures

% of CGs expressing feelings of distress, anger or depression% of CGs expressing that they are unable to continuing in caring activities

% of clients and caregivers satisfied with the case management service they received

Process MeasuresNumber of clients who receive case management services using enhanced CAPS training & proposed person centered approach

% of Care Coordinators satisfied with training content/approach

Balancing MeasuresPerceived value by staff

Impact to work load

# of referrals for services outside Continuing CareAmount of authorized continuing care services

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Key Pieces of WorkIndicators:- Finalize Measurement Worksheet- Development of Qualitative Outcome Survey & Methodology

Development of Change Initiatives:- Analysis of Current State- Literature Review on Leading Practices- Development of Case Management Protocols

Implementation of Change Initiatives:- Recruitment & Training of Care Coordinators

Collection, Monitoring and Tracking of Indicators

Refine Change Initiatives based on Results

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Lessons Learned

• Don’t mistake the solution for the problem

• Dedicated resources & time

• Capacity development

• Be realistic when scoping the project

• Important to identify & engage all key stakeholders

• Data limitations

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Dialogue Session # 2

1. Having heard about the experience of the Nova Scotia Health Authority with the Collaborative, what would be some of the challenges you might face in establishing an effective team to participate in a quality improvement initiative?

2. In your organization, what are some of the key safety-related problems that you would like to address?

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Creating a culture of safety-National Improvement Collaboratives.

Mike CassPatient Safety Improvement LeadCPSI

CHAC Summit Halifax 2017

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Reducing preventable harm in the home is a complex challenge.

• Solutions must involve active involvement of health care providers, clients and carers.

• Change and improvement happens in a dynamic environment.

• Safety Improvement Collaborative will support your organizations to rapidly plan, test, measure and make targeted changes to improve quality and patient safety in the home.

Solving Common Challenges in a Complex System

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What is involved

1. Create a team with QI, measurement, and front line experience

2. Engage patient and family advisors

3. Learn and implement QI methodology

o Develop an AIM statement

o Identify and Test change concepts

o Measure the effect of the changes tested

o Study the results

o Repeat

o When ready spread the successful changes

The National Safety Improvement Collaborative

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• Not be completed off the side of your desk• Plan in advance for

- Team meetings- Coaching calls

• Minute your meetings including assigned responsibilities

• Don’t leave things to the last minute

• Work with Executive Sponsor to ‘release time to reduce harm’

• Expect the unexpected

Team Roles and Responsibilities

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Who supports the changes?

Who is needed for Implementation?

Who is needs to know about the changes?

Who does the patient/client see?

Each member is a champion

The TEAM

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Patient and Family advisor:Member of core teamMay attend learning sessions Role is determined by Individual skills andNeeds of project

Team leader:

Complete the project charter Organize meetings Facilitate work Communicate with team and coachEnsures involvement of patients and familiesSchedules calls

Measurement lead:

Access/interpret/share data Identify baseline and ongoing performancePlot data pre and post testing change concepts Measure, interpret and report impact of the test of change

Executive Sponsor: Approve time and other resourcesEstablish an accountability mechanism Support the team

The TEAM

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PLANDO

STUDYACT

=

If a team member has a unique skill required at a specific point in the projectthat individual becomes “Leader” for that skill.

Attend Learning & Speaker Sessions

Collective Team Roles & Responsibilities

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• Organizations come together to facilitate learning and process improvement• Organizations share a commitment to making significant & rapid changes

Spread and adaptation of existing knowledge to multiple settings to accomplish a common purpose

How is this Achieved

The Method

MODEL

Designed to improve quality of care and

reduce cost

(1) The Breakthrough Series IHI’s Collaborative Model for Achieving Breakthrough Improvement (2003)http://www.ihi.org/resources/Pages/IHIWhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx

The Collaborative APPROACH

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The Model of Improvement

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Holding the gains…Sustaining your Improvement

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The importance of Measurement

Before we encourage sustaining or scaling up a new care practice, we must first know if it has improved care, or simply changed the way we provide care

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What do we measure?

1. Outcome measures2. Process measures3. Balancing measures

Page 30: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in

Outcome measures

Capture what is important to the patient/client/user and reflect how the overall system is working.

Answer the question:Are we fulfilling our aim?

Examples:1. Responsive Behaviours rates2. Pressure ulcer rates3. Falls rates

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Process measures

The voice of the process; they reflect how steps in the system are performing

Answer the question:Are we doing the things we thought would result in an improvement?Process measures are leading indicators

Examples:Percentage of clients screened for falls risk

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Balancing measures

Looking at a system from different directions / dimensions. What happened to the system as we improved process and outcome measures?

Answer the questions:Are we inadvertently having a negative impact on other parts of the system through our actions?What could go wrong if we do this?

Examples:Use of Restraints

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# of FallsFalls

Module

K2P

Falls on agenda

Joint Visits

Run Charts

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Patient Engagement:

Patient engagement is the involvement of patients and/or family members in decision-making and active participationin a range of activities (e.g. planning, evaluation, care, research and training).

Starting from the premise of expertise by experience, patient engagement involves collaboration and partnership with professionals.

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Patient Engagement:

Why is patient engagement so important?

Engage early, engage often

Page 38: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in

Sustainability:

Locking in the progress that you already made during the implementation cycle and continually building upon it (IHI, 2008).

The process through which new working methods, performance enhancements, and continuousimprovements are maintaianed for a periodappropriate to a given context (Buchanan et al, 2013; Ilot, 2016).

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Sustainability:

Page 40: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in

Key Components of Sustainability (Holding the Gains)

1. Supportive Management Structure2. Structures to “Foolproof” Change 3. Robust, Transparent Feedback Systems 4. Shared Sense of the Systems to Be Improved 5. Culture of Improvement and a Deeply Engaged Staff6. Formal Capacity-Building Programs

(IHI, 2008)

Page 41: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in

Spread

The process through which new working methods developed in one setting are adopted, perhaps with appropriate modifications, in other organizational contexts” (Ploeg, 2014).

Spread: Actively disseminating best practice and knowledge about every intervention and implementing each intervention in every available care setting (IHI, 2008)

Page 42: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in

Are you ready to spread your work?

A team is ready to spread their ideas and successes to other parts of the system when:

• They have been successful at testing, implementing, and holding the gains in their own environment.

• They can demonstrate their results through their data and stories;

• There is commitment among senior leaders and sponsors to spread the changes

• The topic is an important priority for the organization and communicated in strategic and business plans;

• A senior leader has been assigned to spread the changes.

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The faster we can spread good ideas, the better

home care will be.

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Successful Spread: Lessons Learned

Even the best ideas and practices don’t implement and spread themselves.

Patients and families are critical for system transformation.

Change of any size takes time, capacity and dedicated resources.

Leadership, dedicated staffing time, and resources are critical.

Page 45: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in

Take Home Messages

1. Accessing and managing data is challenging. 2. Being part of the Collaborative provides a framework and

impetus for organizations to do quality improvement work.3. Coaching is very helpful in supporting teams to do

improvement work.4. Patient and family engagement in improvement work is

valuable and meaningful5. You don’t know what you don’t know -The process of joining

and participating in the collaborative provides a great window into how an organization is functioning.

Page 46: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in

Patient Safety in Home Care

Curriculum

[email protected]

Page 47: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in

Dialogue Session # 3

1. As Mike has explained, there are many tools and resources available to help organizations with QI initiatives. What tools have you found to be the most useful?

2. Accountable care is the theme of our Summit – how do you see QI Collaborative approaches helping organizations to provide more accountable care?

3. What else would you like to know about the Collaborative?

Page 48: Creating a Culture of Safety – National Improvement ......and participating in the collaborative provides a great window into how an organization is functioning. Patient Safety in

Questions&

Comments


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