seeing a way forward
DESCRIPTION
Seeing a Way Forward. Peter Pronovost, MD, PhD Johns Hopkins University. Bilateral cued finger movements. Translation Superhighway. Pronovost . The Safety of Healthcare 2000 -2005. Median Improvement : 2000-2005 All Selected Measures (117)1.9% Heart Disease (n= 16) 5.6% - PowerPoint PPT PresentationTRANSCRIPT
Seeing a Way Forward
Peter Pronovost, MD, PhDJohns Hopkins University
Bilateral cued finger movements
Translational Research Model
UnderstandingDisease Biology
T1Translating to Humans
ImprovedHealth
Outcomes
Identifying andComparing Effective
TherapiesT2
Translating to Practice
Implementing,Disseminating and
Sustaining Research,Monitoring Outcomes
Summarizingevidence andunderstanding
if and howthese therapieswork in practice
Formulating,Analyzing, and
TestingPre-Clinical
Models
Figure 1
Translation Superhighway
Pronovost
The Safety of Healthcare 2000 -2005
Median Improvement : 2000-2005
All Selected Measures (117) 1.9%
Heart Disease (n= 16) 5.6%
Cancer (n=15) 3.6%
Maternal & Child Health (n=12) 1.5%
Safety (n=25) 1.0%
Diabetes (n=9) 0.6%
National Healthcare Quality Report 2008
Disparities in Healthcare Quality are
Staying the Same or Increasing
n=number of core measuresNational Health Disparities Report 2008
Will you commit to eliminate preventable harm and suffering in
your unit, organization, state, or nation?
Are the citizens of Tennessee less likely to
harmed?
How do we know?
ICU Safety Dashboard2007 2008
How often did we harm (BSI)
How often do we do what we shouldHow often did we learn from mistakes% Needs improvement in Safety climateTeamwork climate
Pronovost JAMA 2007
Comprehensive Unit-based Safety Program (CUSP)
1. Educate staff on science of safety http://www.jhsph.edu/ctlt/training/patient_safety.html
2. Identify defects3. Assign executive to adopt unit4. Learn from one defect per quarter and implement
teamwork tools
Pronovost J, Pronovost J, Patient Safety,Patient Safety, 20052005
Translating EvidenceInto Practice
* Envision the problemwithin the larger health
care system
* Engage collaborativemulti-disciplinaryteams centrally(stages 1,2,&3)
and locally(stage 4)
1. Summarize the Evidence
Convert interventions to behaviors
2. Identify local barriers toimplementation: understandthe process and context of
work
3. Measure Performance
4. Ensure all patientsreceive the interventions
Identify Interventions associatedwith improved outcomes
Select interventions with the largestbenefit and lowest barriers to use
Enlist all stakeholders to shareconcerns and identify potentialgains/losses associated withintervention implementation
Observe staff performing theinterventions
"Walk the process" to identifydefects in each step of intervention
implementation
Measure Baseline Performance
Develop and pilot test measures
Select Measures(process and/or outcome)
Engage
Explain why the interventions are
important
Execute
Design an intervention “toolkit” targeted to barriers employing standardization,
independent checks and reminders, and learning from mistakes
Educate
Share the evidence supporting the interventions
Evaluate
Regularly assess performance
measures
Interventions to prevent Blood Stream Infections:
5 Key “Best Practices”
• Remove Unnecessary Lines• Wash Hands Prior to Procedure• Use Maximal Barrier Precautions• Clean Skin with Chlorhexidine • Avoid Femoral Lines
MMWR. 2002;51:RR-10
Seniorleaders
Teamleaders
Staff
Engage How does this make the world a better place?
Educate What do we need to do?
Execute What keeps me from doing itHow can we do it with my resources and culture?
Evaluate How do we know we improved safety?
Pronovost: Health Services Research 2006
Ensure Patients Reliably Receive Evidence
Ideas for ensuring patients receive the interventions
• Engage: stories, show baseline data• Educate staff on evidence• Execute
– Standardize: Create line cart– Create independent checks: Create BSI checklist– Empower nurses to stop takeoff– Learn from mistakes: review infections
• Evaluate– Feedback performance– View infections as defects
Break Through Idea
• Technical versus Adaptive• I thou versus I it• Material versus relationship