“everything is impossible until someone does...
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“Everything is impossible until
someone does it”
Frank Federico
Institute for Healthcare Improvement
We Exist Because…
“Between the health care we have
and the care we could have lies
not just a gap, but a chasm.”- Institute of Medicine, Crossing the Quality Chasm, 2001
Some of Our
Groundbreaking Initiatives…
100,000 and 5 Million Lives Campaigns
IHI Open School for Health Professions
The IHI Triple Aim
The Improvement Map & Passport
STAAR (STate Action on Avoidable Rehospitalizations)
TCAB (Transforming Care at the Bedside)
Safer Patients Initiative (UK)
Ko Awatea
Scottish Patient Safety Programme
Chronic Care Initiative (Indian Health Service)
WIHI
Model for Improvement
What changes can we make that will result in an improvement?
What are we trying to accomplish?
How will we know that a change is an improvement?
Act Plan
Study DoPDSA
Associates in Process Improvement
Definition of Harm
World Health Organization (WHO) Collaborating Centers
for International Drug Monitoring defines an adverse
drug event as follows:
“Noxious and unintended and occurs at doses used
in man for prophylaxis, diagnosis, therapy, or
modification of physiologic functions.”
• The IHI Trigger Tool methodology includes these PLUS
any
Noxious or unintended event occurring in association
with medical care.
Eliminating Harm/Defects
Weak
Strong
Juran Trilogy
Does this ever happen?
Two patient care units are working on reducing
patient pressure ulcers on their units.
Unit A has reduced their rate by 60%, Unit B by
12%.
You ask the staff on Unit B about their work, and
they say, “Our patients are different”.
9
We understand the importance of interactions of people
We look for assumptions and beliefs that are behind
decisions and actions we take
We will rely more on intrinsic motivation and less on
extrinsic motivation
We appreciate differences in people and the importance of
attribution error
We understand that we have bad systems, not bad people
An Understanding of Psychology in
Improvement Work
Three Necessary Ingredients for
Improvement
Building Will
– Motivating health care provider organizations to think beyond the status quo and imagine a better system
Harvesting Ideas
– Finding, cultivating, or inventing new approaches for better patient care
Getting Results
– Providing the support, methods and tools for teams to take action
Health Care Benchmarking
“Benchmarking studies are perishable and time sensitive.
What is a standard of excellence today may be the
expected performance of tomorrow. Improvement is a
continuous process, and benchmarking should be
considered as a part of that process. As a result,
although different authors have defined benchmarking
in different ways, all these definitions have a common
theme, namely: the continuous measurement and
improvement of an organization's performance against
the best in the industry to obtain information about new
working methods or practices in other organizations.”
(Kozak, 2004).http://www.fmshk.org/database/articles/06mbdrflkay.pdf
You can benchmark against the average:
there are those who perform better and
those who perform worse than the average
Or, you can benchmark against the
best
0.80
0.85
0.90
0.95
1.00
1.05
Jan-M
ar 2
008
Apr
-Jun
2008
Jul-S
ep 2
008
Oct
-Dec
200
8
Jan-M
ar 2
009
Apr
-Jun
2009
Jul-S
ep 2
009
Oct
-Dec
200
9
Jan-M
ar 2
010
Apr
-Jun
2010
Jul-S
ep 2
010
Oct
-Dec
201
0
Jan-M
ar 2
011
Apr
-Jun
2011
Jul-S
ep 2
011
Oct
-Dec
201
1
Jan-M
ar 2
012
Apr
-Jun
2012
p
NH Scotland HSMR; Jan 2008 – June 2012
1.03
0.887521 less than expected deaths
James M. Anderson Center
for Health Systems Excellence
80% Reduction
Serious Safety Events per 10,000 Adj. Patient Days
Rolling 12-Month Average
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
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FY2005 FY2006 FY2007 FY2008 FY2009 FY2010
Ev
en
ts p
er
10
,00
0 A
dj.
Pa
tie
nt
Day
s
SSEs per 10,000 Adj. Patient Days Baseline [ 1.0 (FY05-06) ]
Fiscal Year Goals (FY07=0.75 / FY08=0.50 / FY09=0.20) Threshold for Significant Change
** The narrowing thresholds in FY2005-FY2007 reflect increasing census. Adjusted patient days for FY07 were 27% higher than for FY05.
** Each point reflects the previous 12 months. Threshold line denotes significant difference from baseline for those 12 months (p=0.05).
aSSERT Began
July 2006
Chart Updated Through 31Aug09 by Art Wheeler, Legal Dept. Source: Legal Dept.
Desired Direction
of Change
0
2
4
6
8
10
12
14
16
18
20
Jan-
08
Apr
-08
Jul-0
8
Oct-0
8
Jan-
09
Apr
-09
Jul-0
9
Oct-0
9
Jan-
10
Apr
-10
Jul-1
0
Oct-1
0
Jan-
11
Apr
-11
Jul-1
1
Oct-1
1
Ventilator Associated Pneumonia Rate (per thousand ventilator days)
9.11
3.54
61% reduction
Central Line Bundle Compliance
65
70
75
80
85
90
95
100
Jan-0
8
Apr
-08
Jul-0
8
Oct
-08
Jan-0
9
Apr
-09
Jul-0
9
Oct
-09
Jan-1
0
Apr
-10
Jul-1
0
Oct
-10
Jan-1
1
Apr
-11
Jul-1
1
Oct
-11
Jan-1
2
Apr
-12
9.5% improvement
87%
96.5%
0
0.5
1
1.5
2
2.5
3
3.5
4
Jan-
08
Apr
-08
Jul-0
8
Oct-0
8
Jan-
09
Apr
-09
Jul-0
9
Oct-0
9
Jan-
10
Apr
-10
Jul-1
0
Oct-1
0
Jan-
11
Apr
-11
Jul-1
1
Oct-1
1
Central Line Infection Rate (per thousand line days)
2.8
0.84
70% reduction
Næstved Sygehus24
Sepsis Reduction
Days Between
Dage siden sidste VAP Længste periode uden cvk
26
421 638
Best Care Always
The IHI Open School (All HMC staff)
IHI Foundations Training Program(~500 staff)
HMC Local FellowshipProgram (12 – 36 staff)
IHI IAs and Fellows (1-5 staff)
Building Improvement Capability
Day-to-day leadership
Strategic Guidance and Operations
Knowledge from the field: Success and Challenges
Corporate Delivery Team(HMC and IHI)
Campaign Operations Team(HMC and IHI)
Campaign Leadership Team
Defining Needs, Managing
Operations
Qatar National Health
Strategy
HMC Academic
Health System
Human Resources
IT
The Hamad Medical Corporation Campaign
Collaborative Work streams
Campaign Ops Director
Program Managers
Fellows and Local Fellows
Multidisciplinary Improvement
Teams
Local Improvement
Improvement Capability
What We Plan to Accomplish
Reduce harm
Focus will be in prototype areas
Specific harms will be reduced
Time line: 1 year for pilot units
Aim
50% improvement in measures associated with the set
change packages in the participating teams by
September 2014
50% improvement in measures associated with the set
change packages across HMC by September 2015
How Will We Know
Measures
– Process and Outcome measures per change package
Participating Teams
– Year 1: prototyping with 40 teams
– Teams from Perioperative area, Med/Surg, General Ward,
Intensive Care
Year 2: Spread
HMC’s Best Care Always Collaborative
General Ward
Med/Surg
Critical Care
Peri-operative Care
VTE
CAUTI, MRSA, CDiff,
Sepsis
Pressure Ulcers
CLBSI
CAUTI, MRSA, CDiff
Sepsis
Ventilator Acquired
Pneumonia
Surgical Safety
Checklist
VTE
Surgical Site
Infections
VTE
Work-stream
Change PackagesWith TestedChanges
Our Journey Begins Today
Know where you are– Baseline Process and Outcome measures
Know where we want to go– Best Care Always, Safest Care First
Know how to get there– Change Packages
– Use an improvement method
Know when we arrive– Measures
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