ideas that change health and care | the king's fund ......a poster presentation by clare rees...
TRANSCRIPT
Where? • Paediatric surgery department of
large tertiary trauma centre • Expanded to whole trust
Scissors that cut: Improving quality of instruments to ensure safe surgery for children
Clare M Rees MD MRCS1,2 & Ashwini Joshi MS FRCS(Paed)1 1Dept of Paediatric Surgery, Barts Health NHS Trust, London, UK & 2NHS Leadership Academy, UK
@doccmr
What? Service improvement project : • Quality assessment of instruments • Process for identifying problems • Tray rationalisation to remove
unnecessary instruments • Communication & staff education • Scissor sharpening programme
Why? Significant problem with instruments in 64% of operations:
Who? New relationships
How? 1. Clinical audit over 1 month to quantify problem 2. Staff satisfaction survey 3. Standards identified: BSI, WHO checklist, CQC Outcomes 4. Stakeholder analysis defined who was involved 5. Quality improvement methodology including
• Root cause analysis (5 Whys) • Lean principles • Force field analysis • PDSA cycles
6. Audit repeated 1 year later to measure change
Well…? • Audit - problems with instruments in 58/91 (64%) of operations • Patients at risk of definite or possible harm in 19 cases (21%) • Staff did not feel that the situation was satisfactory:
So what? • Patient safety improved • Scissors sharpened – ongoing programme established
• Staff benefit – improved working environment and team relationships
What have I learned? • Leadership for improvement is complex, requires authenticity and understanding
• Seemingly simple problems can be ‘wicked’ problems requiring culture change
• Front-line clinical engagement is essential
This project was supported by the NHS Leadership Academy as part of the Clinical Leadership Fellowship 2011-2012
0 10 20 30 40 50
Other
Wrong size
No bipolar
Not available
Damaged
Faulty
Blunt scissors
Number of instruments
Sum it up in a Haiku?
“I have equipment to do my job”
After change programme: • Reaudit: problems in 33/116 (28%) operations p<0.0001 • Risk of harm to 12/112 patients (11%) p=0.009
3247 pairs of scissors entered sharpening programme so far
58% sharpened 29% passed
13% irreparable
AIM Right instruments Right operation Right time Right patient Safe surgery