big hairy audacious goals · 10/29/2018 · (bhags) • smallpox was eradicated in 1980. • the...
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Big Hairy Audacious Goals (BHAGs)
• Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of
certain forms of cancer, such as breast, prostate, and colorectal, were 75%, 69%, and 51%, respectively. In 2007, survival rates increased to 90%, 100%, and 67%, respectively.
• And the incidence of polio has gone down dramatically since 1988, when over 350,000 cases were reported. In 2014, that number plummeted to only 359 reported cases, a 99% decrease.
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“Over the decades, individual [mental
health] clinicians have made heroic efforts to
save lives… but systems of care have
done very little.”
MYTH: HEALTHCARE CANNOT MAKE A DENT
MYTH: HEALTHCARE CANNOT MAKE A DENT
REALITY: 80% OF INDIVIDUALS WHO DIE OF SUICIDE WERE SEEN IN THE HEALTHCARE SYSTEM IN THE PRIOR 12 MONTHS
MYTH: WE DON’T SEE THOSE AT GREATEST RISK
MYTH: THERE’S JUST NOT MUCH WE CAN DO TO STOP SOMEONE “TRULY INTENT”
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Prominent suicidologists, argued successfully, albeit erroneously, that this is not a healthcare issue. They kept suicide out of the mental health Bible, the DSM, stating, “suicide is, by definition, not a disease, but a death that is caused by a self-inflicted intentional action or behavior.”
Not a Healthcare Issue?
Many/Most Suicides Tragically Inevitable5
1
34
2
Some Suicides Tragically Inevitable
Some Suicides Preventable, But Only in Advance of Acute Risk
Every Suicide Preventable, But Only in Advance of Acute Risk
Suicide is preventable… but… Likert
Every Suicide Preventable, Even Up Until the Last Moment
BIG IDEA #1REJECT THE MYTHS AND ASPIRE FOR ZERO
Suicide is a CHOICE
No light; but rather darkness visibleWhere peace and rest can never dwell, hope never comes
That comes to all, but torture without end
The Physical Pain Physiological Response
People have succumbed when all their strength was fully,
completely gone.
Not a Choice
Someone who died by hanging with their hands bound behind their back and feet tied together was probably a murder, not a suicide.
A.TrueB.False
BIG IDEA #2START YOUR GOAL FROM THE OTHER END
BIG IDEA #3INCLUDE LIVEDEXP IN YOUR DESIGN PROCESS, LEADERSHIP AND DELIVERY
1987
1990
1997
2005
2011
2014
2016
2017
2017
BIG IDEA #4TAKE THE LEAD & JOIN A GLOBAL LEARNING COMMUNITY
We are Sparta!
WE CANNOT DO THIS ALONE
EDUCATIONBuilding the capacity for change through
knowledge exchange and training
EDUCATION
Errors Are Costly
1986
CROSSING THE QUALITY CHASM
Better Care = Patient ExperienceSafe EffectivePatient-Centered TimelyEfficient Equitable
Triple Aim of Healthcare ImprovementBetter Health Better Care Better Value
1986
Don Berwick (USA)
Errors Are Costly
19861986
Don Berwick (USA)
1996
Going to War with Suicide
David Litts
(USA)“[At the start] there was a lot of debate about whether or not it was even possible to reduce suicide through this type of an effort,” according to David Litts. “A lot of people, including mental health practitioners, were skeptical. But over a six-year period, the suicide rate dropped by one-third.”
US Air Force Initiative
2001
What if care were perfect?
20012001
Ed Coffey (USA)
100
80
60
40
20
02000 2010
2004
What was actually
different?
Henry Ford Clinical ProtocolPackage of Discrete Research-based Interventions Known to Be EffectiveRoutine Screening & Assessment
PsychosocialTreatment
Collaborative Safety Planning
Follow-Up
2004
Justin Coffey (USA)
Zero Suicide Healthcare that believes no one should die alone and in despair. Healthcare that’s safer.
ZeroSuicide.org for global learning community. ZeroSuicide.com for fidelity toolkit/resources.
A Simple Emergency Room Intervention Can Help Cut Suicide Risk
Standard Crisis Care
2005
John Draper(USA)
The Clinician
Viewpoint
20092009
David Covington
(USA)Magellan Health Surveys 30,000 in Workforce
Lived Expertise
Voice
2010
Eduardo Vega(USA)
REDESIGNMoving beyond best practice to innovative
designs based on novel concepts
EDUCATION REDESIGN
2010“Over the decades, individual [mental health] clinicians
have made heroic efforts to save
lives… but systems of care have done
very little.”
Forgotten Patients
Richard McKeon (USA)
Gotta Have a Model
2011
Suicide Care in Systems Framework
Michael Hogan (USA)
2011
2012
Systems Models
2012
Nav Kapur (UK)
2013
Website & Seven
Elements
2013
Julie Goldstein
(USA)
Implementation Academies
2013
Julie Goldstein
(USA)
MOVEMENTUnifying the industry around the common
cause of improving health care for all
EDUCATION REDESIGN MOVEMENT
2014
1st
Int’l ZS Summit
Jerry Reed (USA)
Oxford
2015
A Whole Nation
Discussion
2015
Norman Lamb, MP
(UK)Suicide Prevention in Ontario Hospitals
2015
2nd
Int’l ZS Summit
Jo Smith (UK)
SEA #56
Michael Hogan (USA)
2016
2017
ZERO APPLIED
Sydney
From International Declaration to Local Action
3rd
Int’l ZS Summit
2017
Sue Murray
(Australia)
2018
London
1st
Int’l Crisis Summit
2018
Caroline Dollery
(UK)
2018Rotterdam
4th
Int’l ZS Summit
2018
Jan Mokkenstorm (Netherlands)
FULL SCALEChanging mainstream practice standards
by ensuring widespread deployment
EDUCATION REDESIGN MOVEMENT FULL SCALE
2013
US News & World Report
2013
Becky Stoll
(USA)
2014
SUPRA-NET Care &
Community
2014
Jan Mokkenstorm (Netherlands)
4th
Int’l ZS Summit
2017
Jan Mokkenstorm (Netherlands)
October 2017
2015
Social Movement
2015
Joe Rafferty
(UK)
2017
Joe Rafferty
(UK)
2016
Speed to Market
Gold Coast Health
2016
Kathryn Turner
(Australia)
2017
Gaining Momentum
2017
Ian Dawe (Canada) Suicide Prevention in
Ontario Hospitals
2018
MD & MBA
2018
Steve Duffy
(N. Zealand)
2018
NIMH 5-Year Grant
Brian Ahmedani
(USA)
JENNA HEISETexas, USA
JAN ULRICHKentucky, USA
VIRNA LITTLENew York, USA
FRED MESERVEY New York, USA
PAUL SCHYVEJoint Commission,
USA
DAVID JOBESCatholic University,
USA
KATE COMTOISSeattle, USA
THOMAS JOINERFlorida State
University, USA
CHRIS DAMLEPhoenix, Arizona
GREGOR HENDERSONLondon, UK
HELEN GARNHAMLondon, UK
PAUL YIPHong Kong, China
ADRIAN JAMESExeter, UK
SALLY SPENCER-THOMAS
Denver, USA
KEVIN HINESAtlanta, USA
URSULA WHITESIDESeattle, USA
CrisisNow.com
washdc201802
england202005
ZeroSuicide.org
zerosuicideinternational
For quality,
NASABerwick went to
davidwcovington.com
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