new improvers transforming healthcare
DESCRIPTION
Session D1 at International Forum for Quality and Safety in Healthcare, Paris 10 April 2014. This is a Pecha Kucha style presentation, which is a series of 20 slides, each running for 20 seconds, a total of 6 minutes and 40 seconds.TRANSCRIPT
Welcome to D1 NEW IMPROVERS TRANSFORMING
HEALTHCARE
Eight leaders from around the world will present their strategies for engaging
clinicians in quality improvement training in a Pecha Kucha style format
Please tweet #Quality2014 & #d1
“
After this session, participants will be able to:
• Gain a range of perspectives and insight from leaders of initiatives to engage pre- and post-registration clinical trainees in quality improvement
• Experience the Pecha Kucha presentation method, which massively increases the impact of presentations and retention of ideas by an audience
• Learn as much about strategies to engage trainees in quality improvement in 90 minutes as might take four hours through conventional presentations
• Experience an exhilarating variety of ideas and projects from a worldwide range of viewpoints
Join in!
Please tweet your comments, views and questions with the hashtags #Quality2014 and #d1
We will review your tweets at the end of the presentations
Clarity and brevity in presentations are endangered practices
Source of image: onlignment.com
Source of image: jennifermccrea.com
Source of image: borrowed from www.sha.org
My learning in a nutshell
Talk to the person next to you:
What would it take for you to make a presentation in 6 minutes, 40 seconds?
Our Pecha Kucha presenters
1. Emma Donaldson
2. Sherril Gelmon
3. Imran Qureshi
4. Margriet Schneider
5. Michelle Mello
6. Emma Vaux
7. Damian Roland
8. Kim Oates
#Quality2014 #d1
The holy triad of great presentations
Source of basic image: geospatial.uonibi.ac.ke
Joel Meilleur
The holy triad of great presentations
• Be brief
Joel Meilleur
#Quality2014 #d1
The holy triad of great presentations
• Be brief • Be brilliant
Joel Meilleur
#Quality2014 #d1
Joel Meilleur
The holy triad of great presentations
• Be brief • Be brilliant • Be gone
#Quality2014 #d1
Emma Donaldson
Clinical Lead for Quality Improvement,
Salford Royal NHS Foundation Trust,
England
#Quality2014 #d1
Engaging trainees in Quality
Improvement
Dr Emma Donaldson
Clinical Director of Quality Improvement
Salford Royal NHS Foundation Trust (UK)
@E_arnotsmith
2003
2006
Opportunity
2008
Cardiac Arrests per 1000 Admissions
1.28
0.52
2009
Building capability
Sepsis per 1000 central line days
33.332.3
12.2
26.1
35.7 36.2
0.0
42.0
39.5
7.9
12.8
15.4
29.1
14.5
0.0
16.7
9.3 8.8
0.0 0.00.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov
Se
ps
is p
er
100
0 c
en
tra
l li
ne
da
ys
Median = 29.1
Median = 8.8
Better care for sick babies
Improved access for complex patients
CVC Infection per 1000 Catheter Days
29.1
8.8
0
5
10
15
20
25
30
35
40
45
50
Month
16.4
1.7
DON’T JUST TICK THE BOX
TICkLE it!
Make it easier
Make participation a side effect
Edit don’t create
Reward participation
34
Promote quality contributors
Sherril Gelmon
DrPH, Professor of Public
Health, Portland State University,
USA
#Quality2014 #d1
Improvement for Physicians-in-Training: A Longitudinal Curriculum
Sherril Gelmon, DrPH
Paige Hatcher, MD, MPH
Theoretical Framework
Triple Aim + Model for Improvement
Balancing Needs of Learners
Mastery of improvement
Accreditation
Integration
Competence
Program Curriculum
Year2-ClinicalImprovement
Year3-LeadershipDevelopment
Year4-ResidentsasTeachers
Team-Based
Clinical
Improvement
Year1-PersonalImprovement
Investment in Improvement
Year Curriculum
Time (x 12)
Independent
Work
Clinic
(x 3)
Total
1 7.5/year 300 72 606
2 7/year 180 120 636
3 6/year 0 168 586
1828 Hours!
Foundation: Personal Improvement
Improvement in Clinical Settings
Applying Improvement Tools
0 2 4
6
8
10
12
14
16
18
20
1/2
3/0
7
1/2
5/0
7
1/2
7/0
7
1/2
9/0
7
1/3
1/0
7
2/2
/07
2/4
/07
2/6
/07
2/8
/07
PDSA Cycle #1
27%
13%
20%
13%
13%
7%
7%
# Times
Coaching is Key
Accountability
Systematic Evaluation
• Annual survey, focus groups, regular feedback
• Observations and presentations
Satisfaction with Curriculum
0
10
20
30
40
50
60
70
80
90
100
2012- 20132011- 20122010- 20112009- 20102008- 20092007- 2008
Percent of Learners Satisfied with Teaching of Improvement
Mastery of Concepts
PercentageofResidentsA endingWrap-Ups:Mean73%
Pre
Post
0
2
4
6
8
10
ResidentsFaculty
6.78.75
7.4 7.6
Pre-Test/Post-TestResultsResidents&Faculty
0%
5%
10%
15%
20%
25%
30%
35%SCAP RFHC
Clinic Visit Process
Check in Medical
Assistant Provider Orders Pre-Visit
Making a Difference: Vaccination Rates
54.26% 54.19% 54.39%58.30% 57.61%
64.68%67.94% 66.60% 66.80%
69.96% 70.03%
40.00%
45.00%
50.00%
55.00%
60.00%
65.00%
70.00%
75.00%
Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13
TDaP
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Spread
• Residents Faculty Department
• Clinic Hospital City State
• Other residencies Fellowships
Faculty as Coach/Role Model
• Unique skill set
• Accessible
• Enthusiastic
• Just-in-time tools
Relevance of Topics
Trainees Become Teachers
Conclusions Systematic curriculum
Build competencies
Longitudinal experience
Imran Qureshi
Director General DAPS Global
England
#Quality2014 #d1
Dr Imran Qureshi Founder of DAPS Global DAPS (Doctors Advancing Patient Safety) Microbiology Specialist Registrar Previous BMJ Quality Clinical Lead [email protected] www.dapsglobal.com
2009 - Berlin
10 DAYS Quality
Improvement Projects
1
2
3
DAPS Global Summer School
3 DAYS 30
DELEGATES HEALTHCARE INNOVATION
• Speak Up
• NHS Sleeeeeeep
• Don’t Kill Bill
• Anti-Bullying
CAMPAIGNS & APPS
WORKSHOPS
DEBATES
• Leadership
• Communication
• Human Factors
• Surgeons should full disclose Their mortality & morbidity data
• Foreign patients attending for Emergency care should be charged
AUDITS ESSAYS
THROMBOPROPHYLAXIS HANDOVER ANTIBIOTIC ALLERGIES AWARENESS OF MEDICATIONS PATIENT EXPERIENCE
CHILD PROTECTION ALCOHOL IMPACT SURGICAL SAFETY BULLYING 4-HOUR TARGET
summit.dapsglobal.com
MUST HEALTHCARE INNOVATION BE CONFINED TO HEALTHCARE PROFESSIONALS?
QUEEN MARY UNIVERSITY OF LONDON WHITGIFT SCHOOL – SOUTH CROYDON
The Hobbit
“There is more in you of good than you know, child of the kindly West. Some courage and some wisdom, blended in measure. If more of us valued food and cheer and song above hoarded gold, it would be a merrier world.”
Margriet Schneider
Professor of Internal Medicine & Chair of the Division of Internal
Medicine & Dermatology, University Medical Center,
Utrecht, The Netherlands
#Quality2014 #d1
Michelle Mello Head of
Commissioning (Nursing),
NHS England, England
#Quality2014 #d1
Wonder & Improve an innovative way for training leadership skills
Prof. Dr. Margriet Schneider
Program Director Internal Medicine
Ambassador Quality & Safety Program
Chair of the Division of Internal Medicine and Dermatology,
University Medical Center Utrecht, the Netherlands
“Do you ever wonder why?”
“Should you wonder why?
Wonder & Improve
• Value critical minds and create awareness
• Share, ownership
• Empower by offering tools
Competencies of a medical expert
CanMEDS 2015: Manager = Leader
‘Service’ Leaders
‘Frontline’ Leaders
Basic leadership skills
Wonder & Improve
‘Service’ Leaders
‘Frontline’ Leaders
Wonder & Improve
• Elective 1 hr session
• Residents and Program director
• Supportive staff member
• Update and progress of former projects
• New items
• Items within reach for improvement
Wonder & Improve How does it work I ?
Wonder & Improve How does it work II ?
• Prioritize by scoring 3-2-1 credit points
• Chose 3 items
• Formulate goals
• Appoint residents
A resident wondered ……
Why nurses keep coming to me for
non-urgent questions about their
patients AFTER clinical rounds?
I’m losing focus!!!!
What changed?
Examples of change:
• Read back procedure
• A 2-day ATLS training
• Redesign of clinical rounds
• Uniform dress code
• Upspeeding of admittance procedure
Implementation in The Netherlands
• observations,
• interviews,
• documentanalysis,
• evaluation forms
0 10 20 30 40 50
Resident related
Effective
Patient-centered
Efficient
Timely
Equitable
Safe
Effects Wonder & Improve 114 improvement topics
Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: The National Academies Press; 2001.
Awareness
“though I’m new here, I’m
invited to think out loud -
when a topic arises that I
feel like I could commit to,
I should go for it.”
Residents discovered:
• Their position
• Their responsibility
• Their affinity and skills
Ownership & Empowerment
Residents feel:
• Being heard
• Supported
• Better equipped
‘The simple fact that there is
attention from supervisors for my
problems gives me the courage
to keep on going and keep
improving’
Educational Triangle
Stevens L. 2002; Zin in Leren
Autonomy
Competency Relation/Collaboration
Wonder & Improve
Your mother is here …
Tell her I will be in time, and please give her
some coffee …
Acknowledgements to: UMC Utrecht
Liesbeth van Rensen, PhD
Judith Voogt, medical student
Utrecht School of Governance,
University Utrecht
Prof. Mirko Noordegraaf, PhD
Lieke vd Camp , masterstudent
Thomas Beerhuis, masterstudent
Introducing Care Makers
Michelle Mello Proud Nurse
The Care Makers
Olympic Spirit
Volunteering
Compassion in Practice
Care Makers are born
Selection
Volunteering experience
Commitment to 6Cs
Desire to improve care
Work with and support colleagues
Social Media
Social Media reach
2,000+ 2.5m
600+
Support and development
It will take too long
It can’t be done
Making a difference!
Reasons not to
change It’s
impossible It’s not our problem
It’s too ambitious
It’s too complicated
What Care Makers say
"I've had a fantastic year it's like a magic wand being waved in our organisation, it has put the excitement back in nursing #patientcare“ Lisa Reith, Care Maker
Where are we now
Where are we now
Care Maker App
Care Maker of the year award
Research programme
Impact
Impact
400
The concept grows
Reflections
Reflections
The future
Emma Vaux
Consultant Nephrologist & Director of Quality
Improvement, Royal Berkshire NHS
Foundation Trust, England
#Quality2014 #d1
Making Every Moment Count
“Quality in action: Striving for
excellence”
Emma Vaux
Clinical Lead
Hester Wain
Head of
Patient Safety
Anne McDonald
Head of clinical Quality Improvement
The Royal Berkshire Hospital project team
Background
Aims
• Quality improvement as normal
practice
• High quality training
• Develop supporting resources
What we did….
IMPACT
LEARNING
SATISFACTION
RESULTS
Kirkpatrick Model of Training
Evaluation How
AIM
S
OU
TC
OM
ES
BETTER TRAINING BETTER CARE
Trainee-led ideas Incidents
Simulated learning
Complaints
Project outcomes
Quality improvement projects
Improvement change
New skills Resources
30 trainees
Resources
RBFT Academy
Quality
Improvement
Management
Leadership
Governance
Patient
Multi-disciplinary Board
Project team
Junior doctors
Learning experience
“I realise how good QI is ….it is relevant to
day to day practice… …it’s simple …..makes
a big difference to our patients……… It is
worth giving it high priority in our clinical
duties.”
45 trainees completed 27 projects
Learning experience
“I was very passionate about the experience…….
it was so good to do such a project and be able to
keep monitoring it.”
Gaining of knowledge and skills
“This has been a very
valuable learning experience
into clinical quality
improvement as well as
being brilliant for my CV”
Behaviour change
“My whole outlook has changed…
I now look for situations to improve…”
Organisational change
“The magic is in seeing a
trainee identify a
problem they
encounter and feel
empowered to make a
change”
Hospital Board
74%
projects
achieved
their aims
Practice outcomes
Human Financial
Resources
Learning
Key factors for success
‘You hear about
projects and they
sound really huge
but this has
opened my eyes
to how you can do
little things and
make small
changes that
make a big
difference’
•Core hospital business
•Core team
•Communications strategy
Key factors for success
‘I identified it in my own appraisal as the
best thing I have done all year.’
Consultant supervisor
•Pool of ideas & supervisors
•Multi-disciplinary team & patient involvement
•Showcase
Spread
•Resources Methodology
Experience Learning
Summary
‘I would definitely, definitely do a
quality improvement project
again’
Damian Roland
Consultant and Lecturer in Paediatric Emergency Medicine,
Leicester Royal Infirmary, England
#Quality2014 #d1
-
The largest day of simultaneous action in the history of the NHS
A new method of change...
-
The largest day of simultaneous action in the history of the NHS
Change starts with me..
Maker
...I want to make a difference
Anyone can pledge – It’s personal to you!
Change Starter
I have not failed...
Thomas Edison
Tell a personal story
Be authentic
Practice what you preach…
Support early adopters…
Recognise a different
type of radical…
twitter.com/NHSChangeday
youtube.com/NHSChangeDay
facebook.com/NHSChangeDay
changeday.nhs.uk
Embrace Social Media
nhschangeday.podbean.com
vimeo.com/nhschangeday
Kim Oates
MD Dsc, Director of Undergraduate Quality & Safety Education,
Clinical Excellence Commission, Australia
#Quality2014 #d1
Identifying and nurturing future leaders in patient safety March 2014 – Kim Oates
Kim Oates Paediatrician, medical academic and grandfather
Identifying and nurturing future leaders in patient safety
In Australia, the average age of the best known quality and safety
leaders is 62 Where are the future leaders?
Clinical Excellence Commission
My task: To infiltrate medical schools
How much Patient Safety is taught in Australian Medical Schools?
70% of Deans thought there was a lot
42% of medical educators thought there was a lot less than their Deans thought
78% of medical students thought there was not much at all
The results of infiltration
Four medical Schools
Two nursing schools
One School of Allied Health
First year
Why we make errors
Blame and safe cultures
Using leadership skills to
make patients safer
Listening to patients and their families
Second Year
Human factors Open disclosure
Teams and communication
The patient is part of the team
Clinical documentation
Safe handover
Diagnostic error
Managing fatigue
Coping with disruptive
behaviour
Final year medicine
0
500
1000
1500
2000
2500
3000
3500
4000
4500
2010 2011 2012 2013 2014 andbeyond ??
The program grows
Number of healthcare students taught
LEADERS
ELECTIVES
STUDENTS
POST GRADUATES
ADMISSIONS
24 %
Contact us!
Helen Bevan
Emma Donaldson
Sherril Gelmon
Imran Qureshi
Margriet Schneider
Michelle Mello
Emma Vaux
Damian Roland
Kim Oates
@HelenBevan
@E_arnotsmith
@MSHmello @CaremakersUK
@VauxEmma
@Damian_Roland
#Quality2014 #d1