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7/30/2019 PQCNC PI Science Enhance Partnerships 20130904
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Using Performance Improvement
Science to Enhance Partnerships
with Patients & Families
Presented by: Sue Collier, MSN, RN, FABC
Performance Improvement Specialist
Patient-Family Engagement
Perinatal Quality Collaborative of NC
Learning Session 1
September 4, 2013
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Source:
Langley, et al. The Improvement Guide, 1996
The PDSA
cycle providesthe tactical
approach to
work
The three
questions
provide the
strategy
The Model for Improvement
Act Plan
Study Do
What change can we make
that will result in
improvement?
How will we know that a
change is an improvement?
What are we trying toAccomplish?
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What will happenif we try
something
different?
Lets try it!Did it work?
Plan Objective
Questions &
predictions
Plan to carry out:
Who?When?How? Where?
Do Carry out plan
Document
problems
Begin data
analysis
Act Ready to
implement?
Try something
else? Next cycle
Study Complete data
analysis
Compare to
predictions
Summarize
Whats next?
The PDSA Cycle
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Hope is not a plan.
Some is not a number.
Soon is not a time.
What are we trying to accomplish?
The Project AIM is:
Not just a vague desire to do better
A commitment to achieve measured improvemento In a specific system
o With a definite t imel ine
oAnd numeric goals
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Aim statements
Are clear and concise
Include numerical goals that require
fundamental change to the system
Specify the population or group that will benefitfrom the improvement
Generally include stretch goals
Help avoid drift May need to be refocused over time
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Examples of an aim statement
We will improve care for all our patients withchronic disease by making improvements in ourclinic that impact the six dimensions of quality, asoutlined in the Institute of Medicine report,
Crossing the Quality Chasm: A New HealthSystem for the 21st Century.
Reduce adverse drug events (ADEs) on allmedical and surgical units by 75 percent within 11
months. Improve medication reconciliation at transition
points by 75 percent within 1 year.
http://www.ihi.org/knowledge/Pages/Publications/CrossingtheQualityChasmANewHealthSystemforthe21stCentury.aspxhttp://www.ihi.org/knowledge/Pages/Publications/CrossingtheQualityChasmANewHealthSystemforthe21stCentury.aspxhttp://www.ihi.org/knowledge/Pages/Publications/CrossingtheQualityChasmANewHealthSystemforthe21stCentury.aspxhttp://www.ihi.org/knowledge/Pages/Publications/CrossingtheQualityChasmANewHealthSystemforthe21stCentury.aspxhttp://www.ihi.org/knowledge/Pages/Publications/CrossingtheQualityChasmANewHealthSystemforthe21stCentury.aspx -
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Every System is perfectly designed to
achieve the results it gets
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Attribution Carol Haraden, PhD
What Changes Can We Make?
Understanding the System for Weight Loss
Primary
DriversOutcome
Secondary
Drivers
Process
Changes
AIM:
A New
ME!
Calories In
Limit daily
intake
Track
Calories
Calories
Out
Substitute
low calorie
foods
Avoid
alcohol
Work out 5days
Walk to
errands
Plan
Meals
Drink H2O
Not Soda
drives
drives
drives
drives
drives
drives
drives
drives
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Decrease OB
AdverseEvents
Become proficientin managing low
frequency, high riskevents
Practice low frequency, high risk events in drills
Assess staff and providers skills and confidence
Identify risks
Improve teamworkand communication
Provide teamwork training to staff and providers
Include teamwork and communication practice in simulation drills
Use results of HSOPS to identify areas for improvement
Use briefing, huddles and debriefing
Learn from risks andimprove care
systems
Assess and report risks
Use the Learning from Defects tool to analyze events and risks
Include patients inplanning and safety
Include patients and families in briefing, huddles and debriefing
Encourage and invite patients to speak up with their concerns
Provide patient centered and appropriate patient education
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Drivers to achieve goal: SSI reduction
Standardizedapproach to the
recruitment,training, and
engagement ofpatients andfamilies aspartners
Process for identifying
patients/familymembers for
improvement teams
Action Plan
Team education
Referrals
Process to contact,
invite, and engagepatient/family membersin improvement efforts
Approach Methods
Agreement onEngagement
(Patient & Staff)
Invitation andAttendance
Process for educating
providers/staff re:importance of
patient/family perspectiveAction Plan
EducationMethods
Patient/Family
Faculty
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The Model for Improvement
Act Plan
Study Do
What are we trying toAccomplish?
How will we know that a
change is an improvement?
What change can we make
that will result in
improvement?
The three
questions
provide the
strategyThe PDSA
cycle providesthe tactical
approach to
workSource:Langley, et al. The Improvement Guide, 1996
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PDSA Worksheet
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Hunches
Theories Ideas
Very Small
Scale Test
Follow-up
Tests
Wide-Scale Tests
of Change
Implementation of
Change
Changes That Result inImprovement
Spread
Sequential building of knowledge
under a wide range of conditions
What are we trying toaccomplish?
How will we know thatachange is an improvement?
What change can we make that
will result in improvement?
Model for Improvement
A P
S D
A P
S D
Repeated Use of the PDSA Cycle
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If we includepatients and
families in
planning and
learning, they will
take a more active
role in safety
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%100%
1 2 3 4 5 6 7 8 9 10111213141516171819202122232425weeks
Percent
12
3
45
6
Mini-measuretracks improvement
cycles
Cycle 1: Day 1: one clinical team on one shift does their
briefing at the bedside with one patient and asks the patient
and family to participate
Cycle 2: Day 2: One clinical team does briefing
at the bedside with all patients on one shift
Cycle 3: Patients are providing useful
information in the briefing and are more
engaged in their care. All teams begin
briefing at bedside, with patients.
Cycle 4: Analyze failures,
determine plans for patients who
dont want to participate
Cycle 5: Standardize and
document
Cycle 6: Educate
staff on new
standards
99% Reliability
A
P D
S
A
P
D
S
AP
D S
A
P
DS
A
PD
S
A
P
D
S
A P
DS
Change Idea: Include patients and families in
briefing, huddles and debriefing
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Working in Parallel on Multiple Change Concepts
(Aim: Engage Patients & Families)
A P
DS
A
PD
S
A
PD
S
AP
DS
A P
DS
A
PD
S
A
PD
S
AP
DS
A P
DS
A
PD
S
A
PD
S
AP
DS
A P
DS
A
PD
S
A
PD
S
AP
DS
Identify
Patient/Fa
mily
Advisors
Contact
potential
advisors
Include
patients
on teams
Educate and
improve provider
skills and
knowledge
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Tips for Small Tests of Change
Test with volunteers Use simulation or role play
Do not try to get buy-in, consensus, etc.
Be innovative to make each test feasible
Collect useful data during each test
As cycles proceed, test over a wider range ofconditions
Start small: 1:3:5:all (one patient, one day, oneunit, one physician)
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Testing v. Implementation
Testing:Trying and adapting existing knowledge on a
small scale; learning what works in your system
Implementation:
Making this change a part of the day-to-day
operation of the system (Would the change
persist even if its champion were to leave the
organization?)
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Why Test?
Why Not Just Implement then Spread?
Increase degree of belief in the change idea
Document expectations and results
Build a common understanding
Evaluate costs and side-effects
Explore theories and predictions
Test ideas under different conditions
Learn and adapt for the next test
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For more information contact
Sue Collier, MSN, RN, FABC
Performance Improvement Specialist
Patient-Family Engagement
919.677.4157
mailto:[email protected]:[email protected] -
7/30/2019 PQCNC PI Science Enhance Partnerships 20130904
20/20
Using Performance Improvement
Science to Enhance Partnerships
with Patients & Families
Presented by: Sue Collier, MSN, RN, FABC
Performance Improvement Specialist
Patient-Family Engagement
Perinatal Quality Collaborative of NC
Learning Session 1
September 4, 2013