numbers make the world go round: using data to drive change may 25th, 2012
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Numbers Make the World Go Round: Using Data to Drive Change May 25th, 2012 Presented by: T. Rollefstad SIA Safer Healthcare Now! , CPSI. We’ve got the data so now what?. Session One. Where are we At and Where are we Going?. Morning. Afternoon. Session 3 - PowerPoint PPT PresentationTRANSCRIPT
Numbers Make the World Go Round: Using Data to Drive Change
May 25th, 2012
Presented by: T. Rollefstad SIA Safer Healthcare Now!, CPSI
We’ve got the data so now what?Session One
Where are we At and Where are we Going?
MorningSession 1
– Describe some methods to drill into the data for a focus
– Identify some next steps to use data for action
– Learn a method for making rapid change
Session 2– Learn to apply a method for
rapid change– Understand how to build
knowledge from testing
AfternoonSession 3
– Understand when to move from testing to implementation
– Create a plan for next steps
Session 4– Explore in dialogue, several
topics relevant to making change
Sourced from: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement (www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)
The improvement process
DP A
S
3Intervention Phase
Diagnostic Phase2
1
Project Phase
4
5
Sustaining Improvement Phase
Impact Phase
Project mission Project team
Conceptual flow of process Customer GridData-Fishbone-Pareto chart-Run charts-SPC charts
2 months
Plan a changeDo it in a small testStudy its effectsAct on the result
2 months
1 month
Annotated run chart SPC charts
DP
AS
DP
AS
D PASD
PA
S
Ongoing monitoring Outcome
Future plans
68% have selected a focus
63% have recruited a team
45-50% have completed a charter and begun testing
Diving into the Issues
What questions & methods did you use in trying to drill into your data to find a focus?
How did you choose the team members to work with you?
How did you gain support for your work?
Getting MORE information
Table Talk – Pick ONEShare with the table next to
you:• What questions & methods did
you use in trying to drill into your data to find a focus?
• How did you choose the team members to work with you?
• How did you gain support for your work?
Debrief
1. Project Phase
• “getting organized”i. decide on process that needs
improvingii. form teamsiii. write an aim statementiv. consider appropriate measures
AIM Statements• Should be SMART
SpecificMeasureableAppropriateResult orientedTime scheduled
To reduce the rate of infections in joint replacement surgery to less than 1% within 12 months
2. Diagnostic Phase
• Collect evidence and diagnose problem
• Determine the cause• Use tools to identify and organize
information
Tools: identify and organize• process flow chart• brainstorming• patient focus group • nominal group technique• tally chart• observation
Organize information• Affinity diagram• Pareto chart• Histogram• Graphs of current data-run and statistical
process control charts (SPC)• Huddles• Cause and effect diagram
Pareto Chart Observations
3. Intervention PhaseModel for Improvement
ACT PLAN
DOSTUDY
Langley, Nolan, Nolan Norman & Provost 1999
What are we trying to accomplish?
How we will know that a change is an improvement?
What change can we make that will result in an improvement?
Test Cycles
Act
• What changes are to be made?• Next cycle?
Plan• Objective• Questions and predictions (why)• Plan to carry out the cycle (who, what, where, when)
Study• Complete the analysis of the data
•Compare data to predictions
•Summarize what was learned
Do• Carry out the plan• Document problems and unexpected observations• Gather key data
How BIG shall we go?
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PDSA cycle
PDSA cycles – single testChanges that result in improvement
Hunches, theories and ideas
AS D
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ASD PA
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Sourced from: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)
From Improvement to Spread
Spreading a change to other
locations
Developing a change
Implementing a change
Testing a change
Act Plan
Study Do
Theory and Prediction
Test under a variety of conditions
Make part of routine operations
Robert Lloyd
Fast Forward PDSASession Two
Pareto Chart Observations
Catheters in too long: Ideas to try• Include catheter
necessity in daily nursing assessments & shift change
• Develop nursing protocols to allow removal if criteria met
• Implement automatic stop orders for 48-72 hrs after insertion
• Place reminders (stickers) in patient order sheets requiring continuation of catheter order
• Use alerts in computerized ordering systems to indicate presence of a catheter & require documentation for continued need
How-To-Guide: Prevent Catheter-Associated Urinary Tract Infections. Cambridge, MA: IHI; 2011. (Available at www,ihi.org)
Test Cycles
Act
• What changes are to be made?• Next cycle?
Plan• Objective• Questions and predictions (why)• Plan to carry out the cycle (who, what, where, when)
Study• Complete the analysis of the data
•Compare data to predictions
•Summarize what was learned
Do• Carry out the plan• Document problems and unexpected observations• Gather key data
Huddle Group in the Fish Bowl
Instructions:1.Choose an idea to test2.Complete the questions for the PDSA planning
on the flip chart3.Discuss result in terms of your unit4.Record answers to the Study of that result5.Record the answers to the Act – change,
adopt, abandon?
Observer Group Outer Ring
Instructions:1.Was the prediction clear?2.Was the plan clear? W53.What did you learn in the study?4.How would you modify the test?
Catheters in too long: Ideas to try• Include catheter
necessity in daily nursing assessments & shift change
• Develop nursing protocols to allow removal if criteria met
• Implement automatic stop orders for 48-72 hrs after insertion
• Place reminders (stickers) in patient order sheets requiring continuation of catheter order
• Use alerts in computerized ordering systems to indicate presence of a catheter & require documentation for continued need
How-To-Guide: Prevent Catheter-Associated Urinary Tract Infections. Cambridge, MA: IHI; 2011. (Available at www,ihi.org)
Fish Bowl Debrief #1•What struck you about the planning portion?•How did the teams study the “do” observations?•What might you measure?•How might you change this test?
Six Outer Ring volunteers for next fishbowl
Observer Group Outer Ring
Instructions:1.Was the prediction clear?2.Was the plan clear? W53.What did you learn in the study?4.How would you modify the test?
Fish Bowl Debrief #2•What struck you about the planning portion?•How did the teams build on their learning?•What might you measure?•How might this testing work in your area?
Session Three
Moving from Testing to Implementation
From Improvement to Spread
Spreading a change to other
locations
Developing a change
Implementing a change
Testing a change
Act Plan
Study Do
Theory and Prediction
Test under a variety of conditions
Make part of routine operations
Robert Lloyd
Power of Testing CHATCLAVARDER
Develop, Test and Implement
Degree of belief that the change
will result in improvement
High
Developing a Change
Testing a Change Cycle 1, 2, 3…
Implementing a Change
A successful change
Change still needs further testing.
There is a risk of implementing at this
stage.
Unsuccessful proposed change
Low
Moderate
Source: Langley, et al. The Improvement Guide
Testing and Implementation
Similarities:• PDSA cycles • Building knowledge • Predictions • Data
Differences:• Testing is temporary,
implementation is permanent
• Support processes • Expectations of failure• Social impacts and
resistance• Balancing measures
IMAGINE 1 YEAR FROM NOW
What does fully implemented look like?
4. Impact and Implementation
Sourced from: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)
Impact and implementation
phase
Implement the changes
Measure impact • Annotated run chart• SPC charts• Other graphs
5. Sustaining Improvement
1. Once an intervention has been introduced, the intervention and any improvements need to be sustained.
2. This may involve:• Standardization of existing
systems and processes• Documentation of policies,
procedures, protocols and guidelines
• Measurement and review of interventions to ensure that change becomes part of ‘standard’ practice
• Training and education of staff
Sustaining Improvement
PhaseSustain the
gains• Standardization• Documentation• Measurement• Training
Sourced from: NSW Department of Health (2002). Easy Guide to Clinical Practice Improvement(www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf)
Leading Your ChangePlanning your next steps
Work Plan Exercise
• Take 30 min to document your next steps and tests using the work sheet provided
• Report out one of your planned next steps or tests
