listening to our patients b-3 10:45-12:00pm sue gullo, rn, bsn, ms managing director institute for...
TRANSCRIPT
![Page 1: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/1.jpg)
Listening to our PatientsB-3 10:45-12:00pm
Sue Gullo, RN, BSN, MSManaging Director
Institute for Healthcare Improvement (IHI)
![Page 2: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/2.jpg)
OBJECTIVES
• Describe national surveys that provide information on what women want.
• Discuss the components of patient centered care.• Identify 3 interventions that can be accomplished
on your unit to support patient centered care.• Assess your unit’s culture and use quality
improvement methodology to create a culture based on the patients’ needs.
2
![Page 3: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/3.jpg)
Perinatal Oxytocin Bundles
Perinatal Trigger Tool
Common EFMLanguage and
Training
ReduceVariation-
Meds, Emergencies
Implement Techniquesfor Effective
Communication
Engage Patients and
Families
Establish a multi-
disciplinary team training program
Establish Huddles,
Multi-disciplinaryrounds
DesignInterventionsFrom TriggerTool findings
Consistent (across disciplines)
CredentialingStandards
CollaborativeAnd Supportive
Culture
Vacuum Bundle
•Effective Team with Active Sponsor•Senior Admin and Board Level Support
3 m
on
ths
to 3
6 m
on
ths
Oxytocin Deep Dive- Pre-work
1-3 months 3-6 months
6-9 months
9-12 months
12-24 months
Patients on Improvement
Teams
Care is transparent
Second Stage Safety
![Page 4: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/4.jpg)
Perinatal Community
• Leadership help establish aims & goals• Senior Executives support sponsor• Assist in identification of needed resources and develops plan
to provide• Competent trained available staff
Leadership and Sponsor
• Implement oxytocin and vacuum bundle• Develop standard protocols for response to obstetrical
emergency • Design care process improvements based on trigger tool
analysis, event detection, sentinel event• Establish credentialing of core competency and training for all• Use ACOG/AWHONN guidelines for documentation and
staffing• Standardize administration of high alert medications –
oxytocin, magnesium sulfate, epidurals
Reliable DesignReduce Variation
• Adopt common language and interpretation of EFM with multi-disciplinary training i.e NICHD criteria
• Implement techniques for effective communication i.e. SBAR• Establish reliable techniques for handoffs• Establish Team Response Protocols• Establish a just culture – create consistent expectations for
performance and behavior across all disciplines • Implement Huddles• Design Simulations
Effective Teamwork
• Add patients and families on design teams, advisory groups• Co-create and discuss a plan of care with the patient and
family Conduct Patient/Family Focus Groups• Engage patients & families as partners in care• Communicate openly and honestly with family and patients at
regular intervals • Do what you say, mean what you do • Include patients and families on improvement teams
Patient/Family Centered Care
Reduce harm to 5 or less per 100 live
births
Zero incidence of elective deliveries prior to 39 weeks
Augmentation Bundle(s) Composite or Compliance great
than 90%
Improve organizational
culture of safety survey scores in
Perinatal units by 25%
100% of participating teams will have
documentation of Patient & Family
Centered Care
![Page 5: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/5.jpg)
Nothing about me, without me.
5
![Page 7: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/7.jpg)
Respect and dignity
• Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.
7
![Page 8: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/8.jpg)
Information Sharing
• Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete, and accurate information in order to effectively participate in care and decision-making
8
![Page 9: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/9.jpg)
Participation
• Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.
9
![Page 10: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/10.jpg)
Collaboration
• Patients and families are also included on an institution-wide basis. Health care leaders collaborate with patients and families in policy and program development, implementation, and evaluation; in health care facility design; and in professional education, as well as in the delivery of care.
10
![Page 11: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/11.jpg)
2 Key Documents
• “Evidence Based Maternity Care: What It Is and What It Can Achieve”
http://www.childbirthconnection.org/pdfs/evidence-based-maternity-care.pdf
• Toward Improving the Outcome of Pregnancy: Enhancing Perinatal Health Through Quality, Safety and Performance Initiatives
http://www.marchofdimes.com/TIOPIII_FinalManuscript.pdf
11
![Page 12: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/12.jpg)
Stakeholders
• Policymakers
• Healthcare professionals
• Childbearing women
12
![Page 13: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/13.jpg)
“The First Law of Improvement”
“Every system is perfectly designed to achieve exactly
the results it gets.”Paul Batalden
![Page 14: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/14.jpg)
2002
• The landmark Listening to Mothers I survey (2002) was the first time that women in the United States were surveyed at the national level about their maternity experiences.
14
![Page 15: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/15.jpg)
2006 Cost of Interventions- Misuse, Overuse, Underuse Underuse
“Only a small proportion of women experienced these beneficial practices:
use of highly rated drug-free methods of pain relief (e.g., immersion in a tub, shower, use of large "birth ball"), monitoring the baby with handheld devices instead of electronic fetal monitoring, drinking fluids or eating during labor, moving about during labor, giving birth in non-supine positions, and pushing guided only by their own reflexes rather than caregiver-directed pushing.”
http://www.childbirthconnection.com/pdf.asp?PDFDownload=LTMII_pressrelease15
![Page 16: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/16.jpg)
Childbirth is the #1 reason for hospital admission
Cesarean birth is the #1 surgical procedure in the United States.
![Page 17: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/17.jpg)
Click to edit Master title style
Click to edit Master subtitle style
17
Change in Distribution of Births by Gestational Age: United States, 1990-2006
Martin JA, Hamilton BE, Sutton PD, Ventura SJ, et al. Births: Final data for 2006. National vital statistics reports; vol 57 no 7. Hyattsville, MD: National Center for Health Statistics. 2009.
Source: CDC/NCHS, National Vital Statistics Systems.
![Page 18: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/18.jpg)
Click to edit Master title style
Click to edit Master subtitle style
18
U.S. Cesarean Section and Labor Induction Rates Among Singleton Live Births by Week of Gestation, 1992 and 2002.
Source: NCHS, Final Natality Data, Prepared by March of Dimes Perinatal Data Center, April 2006.
2002 Induction
2002 C-S
1992 C-S
1992 Induction
Ear
ly T
erm
![Page 19: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/19.jpg)
Click to edit Master title style
Click to edit Master subtitle style
19
Rates of Induction of Labor by Race and Hispanic Origin in the U.S.
Martin JA, Hamilton BE, Sutton PD, Ventura SJ, et al. Births: Final data for 2006. National vital statistics reports; vol 57 no 7.Hyattsville, MD: National Center for Health Statistics. 2009.
![Page 20: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/20.jpg)
20http://www.cdc.gov/nchs/data/databriefs/db24_fig5.png
![Page 21: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/21.jpg)
21
![Page 22: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/22.jpg)
22
![Page 23: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/23.jpg)
23
![Page 24: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/24.jpg)
24
![Page 25: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/25.jpg)
25
![Page 26: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/26.jpg)
www.ihi.org
![Page 27: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/27.jpg)
Key Theme
• An integrated system is key to achieving the aim of an excellent patient and family experience of inpatient hospital care.
• For example, excellent partnerships with patients contribute to safer care, and safer care results in better patient experiences.
![Page 28: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/28.jpg)
Key Theme
• Leadership behavior at the executive, middle, and front-line levels is essential to achieving exceptional results.
• Leadership commitment to creating an environment that nurtures and continuously improves the patient and family experience and results in positive outcomes is essential.
![Page 29: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/29.jpg)
Key Theme
• The path to achieving excellence in the patient and family experience includes a group of dynamic, positively reinforcing actions rather than a linear set of activities.
• For instance, effective leadership engages the hearts and minds of staff and providers, which in turn provides a foundation for respectful team communication and partnerships with patients and families, which in turn reinforces staff and provider engagement.
![Page 30: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/30.jpg)
![Page 31: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/31.jpg)
Safety Culture
Refers to the extent to which individuals and groups will:
• Commit to personal responsibility for safety • Act to preserve, enhance and communicate
safety concerns• Strive to actively learn, adapt and modify (both
individual and organizational) behavior based on lessons learned from mistakes or near misses
• Be rewarded in a manner consistent with these values
![Page 32: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/32.jpg)
Listening
• Involves effective communication
32
![Page 33: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/33.jpg)
We are competent.
We have teamwork and communication failures.
![Page 34: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/34.jpg)
• Patient care requires groups to work together effectively
• NASA research found more than 2/3 of air crashes involve human error – especially failures in teamwork
• Professional training focuses on technical, not interpersonal skills
Teamwork
![Page 35: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/35.jpg)
“Perceptions of Teamwork in L&D” Journal of Perinatalogy, June 2006
• Only 55% of respondents found it easy to speak up if they perceived a problem with patient care, and only half felt that conflicts were appropriately resolved.
• “In medicine, questions seeking advise or knowledge are welcome, whereas questioning someone’s performance or disagreeing with their actions is taboo.”
![Page 36: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/36.jpg)
• Communication breakdowns• Resentment or indifference to team concept • Competing priorities and goals among team
members• Language problems• Failure to compromise with goals• Poor coordination of activities among team
members• Role confusion – Role conflict
Negative Team Factors
![Page 37: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/37.jpg)
What Impacts Our Performance?
• Fatigue• Lack of sleep• Illness• Drugs or alcohol• Boredom• Frustration• Fear • Stress• Shift work• Reliance on
memory• Reliance on
vigilance
• Distractions• Noise• Heat• Clutter• Motion• Lighting• Too many handoffs• Unnatural workflow• Procedures or devices
designed in an accident prone fashion
![Page 38: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/38.jpg)
Provider Perspective
“In medicine, it is a challenge to be the one to criticize or evaluate a colleague when you perceive that mistakes are being made, or when you disagree with management.”
![Page 39: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/39.jpg)
Sharp End
![Page 40: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/40.jpg)
Case Study: “A 38-Year-Old-Woman With Fetal Loss and
Hysterectomy”
JAMA, August 17, 2005- Vol 294, No 7
Benjamin P. Sachs, MB, BS, Discussant
![Page 41: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/41.jpg)
Background
“38 year old woman admitted to the hospital for elective delivery of her first child, but the admission ended tragically with fetal loss, hysterectomy, and a prolonged hospitalization.”
![Page 42: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/42.jpg)
Dr. Sachs
“Although the complication that occurred is rare, unfortunately the types of failures in communication and teamwork are not.”
![Page 43: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/43.jpg)
6 System Failures Identified
1. Communication was poor
2. Mutual performance cross monitoring
3. Inadequate conflict resolution
4. Poor situational awareness
5. Physician workload was too high and there was no contingency plan in place to deal with the overload
6. Physician on call displayed “vigilance fatigue”
![Page 44: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/44.jpg)
Lessons Learned
Patients and Family:
• Appropriate consent
• Communication
• Feeling safe
• Able to ask for additional help “Code H”
![Page 45: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/45.jpg)
“A Reason to Change”
Luke Vincent Powers September 11, 2009
Presented by:
William Powers
![Page 46: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/46.jpg)
Discussion
1. What do you do well, and why?
2. What can you do better, and why?
3. What would you do differently, and why?
![Page 47: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/47.jpg)
What would you like to improve?
• Why?
• How do you know? What are your current results?
• How will you know a change is an improvement?
47
![Page 48: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/48.jpg)
What can every one of you do tomorrow?
1. No longer accept the status quo- ask why?
2. Start with one patient, one nurse, one doctor.
3. Stop the line when it is not right.
4. Love what you do.
![Page 49: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/49.jpg)
What are we trying toAccomplish?
How will we know that achange is an improvement?
What change can we make that will result in improvement?
The Model for Improvement
Act Plan
Study DoSource:
Langley, et al. The Improvement Guide, 1996.
The three questions provide the strategystrategy
The PDSA cycle provides the tactical tactical approach to work
![Page 50: Listening to our Patients B-3 10:45-12:00pm Sue Gullo, RN, BSN, MS Managing Director Institute for Healthcare Improvement (IHI)](https://reader033.vdocument.in/reader033/viewer/2022061305/55140157550346dd488b4923/html5/thumbnails/50.jpg)
50