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Improving Safety in BrazilThe Salus Vitae Story
6th December 201628th Annual National Forum on Quality Improvement in Healthcare
Camila Sardenberg, Kathy Luther, Kevin Rooney, Paulo Borem & Camila Lajolo
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BREAKING THE ICE
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Practicing your Portuguese
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Tell your colleagues something you have done that is unique.
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THE SYSTEM WE ARE TRYING TO IMPROVE
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The environmentCountry profile : upper middle income• Population 208.000.000• GDP 1.75 trillion dollars• Expenditure on health : 8.3% GDP
Health system• Public system: universal access , free
of charge, decentralized• Private system : 25% population• 5.100 general hospitals
‐ 71% beds for the public system‐ 34% occupancy rate‐ Majority small: 50 beds
Source: http://data.worldbank.org/country/brazil and http://www.who.int/countries/bra/en , accessed on 11/10/2016. Data for 2014 (expenditures) and 2015 , Couto R et al. Erros acontecem. IESS, Belo Horizonte 2016.
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Congregação de Santa Catarina
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Associação Congregação de Santa Catarina
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Associação Congregação de Santa Catarina
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11
“We are here because we believe are more just and compassionate world is possible”
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Your turn...What does your system look like?
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A BURNING PLATFORM : MOTIVATION FOR CHANGE
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https://www.dropbox.com/s/9rq3tjzs8f0yne0/HSJ-Hemodialise.mp4?dl=0
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Inspiration
Courtesy of Jason Leitch
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Is there a burning platform for change in your organization? Do you need to convince people there is a
problem?
Is there any improvement initiative that has inspired you to take action?
What was special about it?
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Will
ExecutionIdeas
Key factors for success
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Which of the three factors for success would be more challenging in your
organization?
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SOLUTION: MOVING BEYOND JUST QUALITY CONTROL
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A galvanizing aim
It is not about reducing harm,
but suffering
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A clear set of actions
High impact leadership
Improvement science in action
Patient safety collaborative
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A method
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High impact leadership
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Courtesy of M.Pugh.
Swensen, Pugh, McMullan, Kabcenell. High-Impact Leadership: Improve Care, Improve the Health of Populations &
Reduce Costs. Institute for Healthcare Improvement; 2013. Available: www.ihi.org.
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New Mental ModelsHow leaders think about challenges and solutions
Courtesy of M.Pugh.
Swensen, Pugh, McMullan, Kabcenell. High-Impact Leadership: Improve Care, Improve the Health of Populations &
Reduce Costs. Institute for Healthcare Improvement; 2013. Available: www.ihi.org.
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Would leaders in your organization support an improvement initiative?
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Improvement Science in Action
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Sponsor: Leonardo Figueiredo de MenezesProject Leader: Daniela Contage Siccardi Menezes
Team: Ana Paula Stutzel, Andressa Amaral, Gabriela Fecher
One team´s journey
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Reduce bed turnaround time (BTT) in Santa Isabel ward from 4 hours (232 minutes) to 2 hours (120
minutes), by March 31, 2016.
Setting a clear quantifiable aim
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July, 2015 September, 2015
Becoming a team
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Mr. Potato Head and PDSA
Learning the method
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Reliable data July - September 2015
Utilization of software ZELA for bed sanitation management
Test: Sep/30/2015
Implementation: Oct/02/15
Medical discharge released on real-time system
Test: Aug/19/2015
Implementation: Nov/05/2015
Real-time hospital bed panel “Leito à Vista”
Test: Oct/26/2015Implementation: Dec/15/2015.
Hospital discharge communication
Test: Dec/21/2015Implementation: Feb/18/2016
Hospital discharge folderTest: Dec/07-18/2015
Implementation: Jan/04/2015
Steady pace of testing ideas
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Achieving sustainable results
Bed turnaround time- Santa Isabel Ward
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Successful spread
“Is it always like this or is it just because it’s me?”
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Patient Safety Collaborative
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A bold (scary) aim
↓CLABSI, VAP, CAUTI by 50% in 13 adult ICUs by
December/216
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http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=303
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Would people be afraid of setting bold improvement aims in your
organization? Why?
What would it take to convince them otherwise?
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Select
Topic
(Develop
Mission)
Planning
Group
Develop
Framework
& Changes
Enroll participants
Prework
LS 1 LS 3LS 2
Support: email, extranet, video conferences, site visits, sponsors,
monthly team report
Dissemination
Publications,
Congress, etc.
SExpert
Meeting AP
1AP
2AP4*
LS – Learning Session
AP – Action Period
*AP4 –continue
reporting data as
needed to
document
success
Holding
the GainsLS 4
S
P
A D
A method : 18 month IHI Breakthrough Series (BTS)
S
P
A D
S
P
A D
Source: IHI
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Results: 42% reduction in CLABSI rates
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Results: 39% reduction in VAP rates
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Results: 41% reduction in CAUTI rates
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300 patients free
fromsuffering HAIs
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Top
5 challenges
Setting bold aims
Org. changes
Technical knowledge
Getting
measures
right
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Top
5 challenges
Setting bold aims
Org. changes
Technical knowledge
Getting
measures
right
Sustainability…the greatest challenge
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What would you do to sustain the results?
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PATIENT CENTERED CARE...IT IS ABOUT THEM, AFTER ALL
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Sharing your own stories
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https://www.dropbox.com/s/x8469e3wh5e18g6/Retrospectiva_WMTY_IHI%20%281%29.mp4?dl=0
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