slide # 48 - nova scotia health...
TRANSCRIPT
slide # 48
The customer with a defective
product is 100% dissatisfied
(The other 999 good products are invisible)
slide # 49
Leveled Production
JUST IN TIME
What is needed
In the amount needed
At the time needed
At the place needed
JIDOKA
One-by-one detection and response to every abnormality: “Stopping the line”
Materials
Machines
People
ConstantImprovement
ConstantImprovement
Virginia Mason Production System
Elimination of Waste
slide # 50
Theory of “Stopping the Line”
• Mistakes are inevitable…but reversible
• Defects are mistakes that were not fixed soon enough…and are now relatively permanent
• If you fix mistakes soon enough, your work will have zero defects
• Mistakes are least harmful and easiest to fix the closer you get to the time and place they arise (the reverse is also true)
slide # 51
The Basic Strategy for
Stopping the Line
• Inspect, stop, and fix at the source
• Every employee is an inspector
• Every employee can stop the line
• When you can’t fix on-the-spot: STOP
slide # 52
Level 1: Customer Inspects and Finds Defect
(OIG, DOH, Malpractice Suit)
Feedback
Suppliers 1 2 3 4 Customers5
Customer finds defect
MistakeOccurs
slide # 53
Level 2: Company Inspects at End of Process
(QA, Audit, Narcotic Count)
Feedback
Suppliers 1 2 3 4 Customers5
Inspector finds defect
MistakeOccurs
slide # 54
Level 3: Work Unit Inspects and Corrects
(Needle and sponge count)
Feedback
Suppliers 1 2 3 4 Customers5
Worker finds defect
MistakeOccurs
slide # 55
Level 4: Self-Inspection and Correction
(Patient ID, Surgery Site Check)
Suppliers 1 2 3 4 Customers5
Mistakedetected and
corrected
slide # 56
Level 5: Process redesign to eliminate mistakes
(CPOE)
Suppliers 1 2 3 4 Customers5
slide # 57
OR gas hoses are color codedand have unique connectors
Level 5 Inspection
slide # 58
Zero Defects – For Industry
• What the customer really wants
• Distinguishes mistakes from defects
• Essential elements:Check each product (one-by-one)Check at the sourceStop and fix at the source
• Applies to any product made by a defined process
slide # 59
Zero Defects - for Healthcare Safety
Healthcare is defined as a product having
safety in every step
Every safety mistake should be corrected
as soon as possible
as close as possible to its point of origin
You can stop the line for safety
The goal is zero safety defects in healthcare
slide # 60
Patient Safety Alert Results as of 12/31/04
• 347 Patient Safety Alerts• Diagnosis/Treatment 31
• Medication Errors 53
• Systems 196
• Equipment/Facilities 45
• Conduct 22
• Average # of PSAs/month is increasing
2002- 3/month
2003- 10+/month
2004- 17/month
• Average days to completion – 14
• Individuals taken off-line – 25
• Processes/Equipment taken off-line – 13
slide # 61
Case Studies
Case Study 1:
Numbers and Abbreviations
slide # 63
Case 1: Numbers and Abbreviations
slide # 64
Case 1: Numbers and Abbreviations
Day 1-2 (Issues Identified)
• The physician writes an order that retrospectively was unclear, the intended 2 looked like a 7
• The physician wrote an order using an unacceptable abbreviation (QD)
• The physician did not discuss the plan of care with the nurse prior to leaving the floor
• The HUC submitted the order with an unacceptable abbreviation
slide # 65
Case 1: Numbers and Abbreviations
• DAY 1-2 (Issues Identified)
• The pharmacist processed an order with an unacceptable abbreviation.
• Nursing did look at the order sheet and believed the 2 was a 7 but did not sign off the order on the Physician’s Order Sheet.
• Nursing gave the medication even though it had an unacceptable abbreviation.
• Nursing had not had a chance to review the care plan in the Progress Notes.
slide # 66
Case 1: Numbers and Abbreviations
Day 2-3 (Improvement)
Corrective Action Plan in development:Require number 7 be crossed on medication orders and audit.
Improved communication between caregivers with plan and safety concerns highlighted
Re-educate and audit staff on following standard work for unacceptable abbreviations and signing off orders.
slide # 67
Case 1: Numbers and Abbreviations
Day 3 (Improvement Continued)
Corrective Action Plan in development:
Multidisciplinary case review
Ultimately, mistake proofing will occur with the implementation of CPOE in 3/2005
slide # 68
VMPS Patient Safety Alert
Summary
• A key component of Lean (Jidoka)
• A process for producing safe healthcare
• Goal = zero defects
• Based upon Lean Production methods
• Source inspection
• One-by-one inspection
• Stop and fix at the source
slide # 69
Virginia Mason Results
• The Cost of Error
• Mistake Proofing and Improvement
• FTE Trends
• Learnings from Production Preparation
Process (3P)
• Cost Avoidance and Savings
• RPIW Roll Up
slide # 70
The Cost of Error
Ventilator Acquired Pneumonia
• 2002 Cases 34 Est. Deaths 5
• 2002 Cost $ 500,000
Professional Liability Expense
• Claims Paid ² $ 4.6 Million
• Claims Paid ³ $ 4.5 Million
² 1999 - 2003 Average ³ Projected 2004
slide # 71
Mistake Proofing
Ventilator Acquired Pneumonia
• 2002 Cases 34 Est. Deaths 5
• 2002 Cost $ 500,000
• 2004 Cases * 4 Est. Deaths <1
• 2004 Cost * $ 60,000
* Projected 2004
slide # 72
Staffing Trends
Full Time Equivalents
1996: 2890
1997: 3264
1998: 3467
1999: 3528
2000: 3612
2001: 3647
2002: 3656
2003: 3581
2004: 3562
slide # 73
3P’s: Production, Preparation, Process
• Cancer
• Hospital
• Dermatology
• GI
• Hyperbarics
slide # 74
Cost Avoidance• 1M Capital Savings for Hyperbaric Chamber from 3P
• 1-3M Endoscopy Suites now staying in current location
• 6M Surgery Suites budgeted and planned - now not
building
• Hospital 3P
• Lead Time, Staffing, Space
• Cancer 3P
• Same amount of space 120 pts per day to 188 pts per
day
(57% increase)
• Patient Travel -1600 ft to 375 ft. (76% reduction)
slide # 75
Virginia Mason RPIW Activity
0
50
100
150
200
250
300
2000 2001 2002 2003 2004 2005 2006
To
tal
slide # 76
Total Kaizen ResultsTotal Results 2002-2004
175 RPIW’s thru 3/31/04
Inventory $1,350,000 Down 53%
Productivity 158 FTE’s 36% Redep.
Floor Space 22,324 SQ. Ft. Down 41%
Lead Time 23,082 Hours Down 65%
People Distance Traveled 267,793 Feet Down 44%
Product Distance Traveled 272,262 Feet Down 72%
Setup Time 7,744 Hours Down 82%
slide # 77
Validated Industry Averages
Direct Labor/Productivity Improved 45-75%
Cost Reduced 25-55%
Throughput/flow Increased 60-90%
Quality (Defects/Scrap) Reduced 50-90%
Inventory Reduced 60-90%
Space Reduced 35-50%
Lead Time Reduced 50-90%
Summarized results, subsequent to a 5-year evaluation, from numerous companies (over 15
aerospace-related). Companies ranged from 1 to >7 years in lean principles application/execution.
slide # 78
Performance of Virginia Mason
• Leapfrog
• Top 100 Hospitals - Solucient
• Healthgrades
• Economic
• 2001 - $ 22,239,000
• 2002 - $ 22,917,000
• 2003 - $ 22,000,000
• 2004 - $ ?
• BBB+ to A-
slide # 79
Leapfrog
Leapfrog 2003 Survey Results
Leapfrog
StandardCPOE ICU Volumes
CABG
CABGOutcomes
RankPCI
PCIOutcomes
RankAAA Esophagectomy
PancreaticResection
Virginia MasonAbove
national
average
Above
national
average
Evergreen n/a n/aDid not
participate n/a
NorthwestAbove
national
average
Did not
participate
OverlakeDid not
participate
Did not
participate
Swedish - 1st HillDid not
participate
Did not
participate
Swedish - ProvDid not
participate
Did not
participate n/a
UWAbove
national
average
Above
national
average
Valley Medical n/a n/a n/a n/a
~ Fully implemented Leapfrog's recommended safety practice
~ Good progress in implementing Leapfrog's recommended safety practice
~ Good early stage effort in implementing Leapfrog's recommended safety practice
~ Willing to report publicly; did not yet meet Leapfrog's criteria for a good early stage effort
N/A ~ Not applicable (e.g., IPS standard does not apply because hospital does not have an ICU.)
slide # 80
To Change Medicine…..
Change Your Mind
• Provider First
• Waiting is Good
• Errors are to be Expected
• At-risk Employment
• OTJ Training
• Diffuse Accountability
• Add Resources
• Reduce Cost
• Retrospective Quality Assurance
• Management Oversight
• We Have Time
• Patient First
• Waiting is Bad
• Defect-free Medicine
• Guaranteed Employment
• Explicit Training
• Rigorous Accountability
• No New Resources
• Reduce Waste
• Real-time Quality Assurance
• Management On Site
• We Have No Time
slide # 81
Commitment and Deployment
• Leadership and management
• Introduction to Lean
• Certification Track
• Lean Mastery
• Japan Gemba
• Kaizen Fellowship
slide # 82
Ongoing Challenges
• Culture Change
• Professional Autonomy
• “People are Not Cars”
• Belief in Zero Defects
• Rigor, Alignment, Execution
slide # 83
“This Day brings a lot of
Rearrangement”
Pastor Paul Stoot, Sr.
November 27,2004
slide # 84
EXECUTIVE LEADERSHIP GOALS - 2004
QUALITY SERVICE STAFF EFFICIENCY
1. JCAHO
2. CPOE
3. PATIENT ID
4. PUBLICIZE QUALITY
OUTCOMES
5. APPOINTMENT
ACCESS
6. PHONE
ACCESS
7. SERVICE
RECOVERY
8. FACILITIES
PLANNING
9. COMMUNICATION
WITH STAFF
10. PACMED
TRANSITION
11. CANCER MODEL
LINE
12. 5S ADMIN.
PROCESSES
EFFICIENCY
BY 5%
13.
slide # 85
EXECUTIVE LEADERSHIP GOALS - 2005 Proposed
1.
QUALITY
OUTCOMES
5.
SERVICE
RECOVERY
3.
INPATIENT
ADMISSION
ACCESS
4.
OUTPATIENT
APPOINTMENT
ACCESS
2.
PATIENT
SAFETY
Executive Leadership Goal - 2005
Ensure the Safety of our Patients
“You Can’t Cross the Sea
Merely by Staring at the Water”
Rabindranath Tagore
1
Th
ed
aC
are
Syste
m fo
r Imp
rovem
en
t
Rem
ovin
g w
aste
, gettin
g le
an,
and p
reparin
g fo
r our fu
ture
IHI C
all to
Actio
n S
erie
s: D
rivin
g o
ut W
aste
B
eco
me
s th
e S
trate
gy fo
r He
alth
ca
re
Org
an
iza
tion
s
Fe
bru
ary
16
, 20
05
2
Sessio
n G
oals
It is n
otour g
oal to
day to
“teach le
an”
or
to “c
heer le
ad”
partic
ula
r pro
jects
.
Rath
er, it is
to d
efin
e, fo
r all m
anagers
, th
e T
hedaC
are
Syste
m o
f Impro
vem
ent
Most im
porta
ntly
, we n
eed to
cre
ate
dia
logue a
mong m
anagers
regard
ing
the
em
beddin
g o
f this
Syste
m in
to th
e
ThedaC
are
Cultu
re
3
Our S
yste
m G
oals
Th
e g
oals
rem
ain
the s
am
e. W
e m
ust
sim
ulta
neo
usly
…
Impro
ve th
e q
uality
of w
hat w
e d
o to
world
cla
ss le
vels
(95
thperc
entile
).
Becom
e th
e H
ealth
care
Em
plo
yer o
f C
hoic
e –
Fortu
ne 1
00 L
ist o
f Best
Em
plo
yers
.
Low
er o
ur c
osts
so w
e c
an lo
wer th
e p
rice
paid
for o
ur s
erv
ices
4
This
is a
bout h
ow
we a
re g
oin
g
to s
ecure
our fu
ture
…
By b
ein
g p
roactiv
e, n
ot re
activ
e, to
in
cre
asin
g d
em
and fo
r hig
h q
uality
/low
cost h
ealth
care
.We c
annot c
ontin
ue
incre
asin
g o
ur c
osts
to th
e d
etrim
ent o
f our c
usto
mers
.
By a
ctiv
ely
engagin
g c
usto
mers
, sta
ff, and p
rovid
ers
in th
e im
pro
vem
ent
effo
rts.
5
Ou
r Ove
rall M
etric
s h
ave
no
t ch
an
ge
d…
Qu
ality
Em
plo
ye
e
En
gag
em
en
tB
usin
ess
C
$10 M
illion/Y
ear
Pro
ductiv
ity/S
avin
gs
World
Cla
ss
Clin
ical a
nd S
erv
ice
Qu
ality
95
thP
erc
en
tile o
r G
rea
ter
Fortu
ne 1
00 L
ist o
fB
est E
mplo
yers
Consum
er’s
C
hoic
e
6
Th
ed
aC
are
’sM
issio
nth
e re
aso
n w
e a
re to
ge
the
r
“ThedaC
are
’s m
issio
n is
to im
pro
ve th
e
health
of o
ur c
om
munitie
s.”
7
Th
ed
aC
are
’sV
isio
na
pic
ture
of th
e id
ea
l sta
te to
be
ach
ieve
d
“To a
lways s
et a
nd d
eliv
er th
e h
ighest
sta
ndard
of h
ealth
care
perfo
rmance in
m
easura
ble
and v
isib
le w
ays s
o o
ur
custo
mers
are
confid
ent th
ey a
re m
akin
g
the rig
ht d
ecis
ion in
choosin
g u
s.”
8
Th
ed
aC
are
’sP
urp
ose
We e
xis
t to s
erv
e o
ur c
usto
mers
.
Our g
oal is
to p
rovid
e w
orld
cla
ss
clin
ical a
nd s
erv
ice q
uality
.
9
This
is n
ot a
“hors
e ra
ce”
but ra
ther a
contin
uous im
pro
vem
ent p
rocess.
10
Th
ed
aC
are
’sC
ultu
re
Cultu
re o
f consta
nt im
pro
vem
ent.
Most im
porta
nt a
ttribute
is th
e th
inkin
g
capability
of o
ur p
eople
.
Consta
ntly
impro
vin
g p
rocesses to
deliv
er a
perfe
ct e
xperie
nce fo
r custo
mers
will b
e a
never-e
ndin
g
journ
ey.
11
Pro
ductiv
ity :
It’s a
Matte
r of L
ife a
nd D
eath
“C
om
pan
ies that are m
ore efficien
t than
their co
mpetito
rs in p
rovid
ing cu
stom
ers
with
hig
h q
uality
goods an
d serv
ices will
thriv
e.C
om
pa
nies th
at a
re less efficient
than th
eir com
petito
rs will p
erish.”
Source: T
he T
oyota P
roductio
n S
ystem
, Toyota
Mo
tor C
orp
.
12
Th
e T
he
da
Ca
re
Impro
vem
ent S
yste
m
The 3
tenets
for c
hange:
Respect fo
r people
.
Teachin
g th
rough e
xperie
nce.
Focus o
n w
orld
cla
ss p
erfo
rmance.
13
Re
sp
ect fo
r Pe
op
le
Wh
at it is
:
Erro
r-free p
ractic
e
Tim
ely
serv
ice
No
wa
ste
No la
y-o
ff philo
sophy
Pro
fessio
na
ls w
ho
wo
rk
togeth
er to
impro
ve
perfo
rmance
Wh
at it is
no
t:
Lo
ng
wa
it time
s
Cre
atin
g/d
oin
g n
on-
va
lue
-ad
de
d w
ork
Waste
d tim
e
Waste
d m
ate
rials
People
focused o
n
tasks ra
ther th
an p
atie
nt
outc
om
es
14
Te
ach
ing
Th
rou
gh
Exp
erie
nce
We
will le
arn
by d
oin
g!
“Dirty
Hands”
appro
ach to
learn
ing
Rapid
, real tim
e d
ecis
ions
Focus o
n le
arn
ing fro
m s
ignific
ant
changes in
pro
cesses
Bia
s fo
r takin
g a
ctio
n n
ow
Not ju
st fo
r a fe
w “c
hosen”
em
plo
yees –
all w
ill be e
ngaged o
ver tim
e.
15
Fo
cu
s o
n W
orld
Cla
ss
Pe
rform
an
ce
Pa
st a
cco
mp
lish
me
nts
do
no
t pre
dic
t the
fu
ture
Ne
ce
ssa
ry to
sta
y c
om
pe
titive
ove
r time
Evid
en
ce
-ba
se
d a
nd
da
ta-d
rive
n, a
nd
cu
sto
me
r focu
se
d
Co
mm
itme
nt to
pu
blic
rep
ortin
g o
f resu
lts
Cre
atin
g s
tan
da
rd w
ork
in b
oth
ad
min
istra
tive
an
d c
linic
al p
roce
sse
s
16
Improvem
ent
FirefightingInnovation
FirefightingIm
provement
The O
ldT
he N
ew
Th
e 3
–L
eg
ged
Sto
ol o
f the
Th
ed
aC
are
Imp
rov
em
en
t S
yste
m
Impro
ved
Sta
ffM
ora
le
Impro
ved
Pro
du
ctiv
ity
Impro
ved Q
uality
(re
du
ctio
n o
f de
fects
)
18
Lean
too
ls a
nd
prin
cip
les c
an
an
d d
o
wo
rk e
very
wh
ere
…in
clu
din
g
health
care
. We w
ill be u
sin
g th
ese
too
ls a
s o
ne v
ery
imp
orta
nt a
pp
roach
in
ou
r cu
ltura
l ch
an
ge p
rocess.
19
Th
e N
ew
Cu
lture
will b
e
Counte
r –In
tuitiv
e fo
r aw
hile
….
Reducin
g w
aste
and n
on-v
alu
e a
dded
work
will c
om
e b
efo
re a
ddin
g
technolo
gy, b
uild
ing a
nd m
anpow
er.
Redeplo
y th
e b
estem
plo
yees, n
ot th
e
poor o
r marg
inal p
erfo
rmers
.
20
Th
is w
ill req
uire
ne
w b
eh
avio
rs…
Sm
alle
r, “right-s
ized”
gro
ups o
f work
ers
or te
chnolo
gie
s in
“cells
”ra
ther th
an
larg
e, c
um
bers
om
e p
rocesses.
Stro
ng, s
om
etim
es d
irectiv
e le
aders
hip
, augm
entin
g m
ore
traditio
nal te
am
appro
aches.
Less b
atc
hin
g o
f work
, in fa
vor o
f “right
now
”, real tim
e a
ctio
n.
21
All D
ivis
ion
s
DE
C 2
004
YT
D
# o
f Valu
e S
tream
s3
16
# o
f Even
ts-F
irst P
ass
10
68
# o
f Even
ts-S
eco
nd
Pass
12
# o
f Even
ts-T
hird
Pass
00
# o
f Pro
jects
948
QU
AL
ITY
Sig
nific
an
t Qu
ality
Imp
rovem
en
ts2
21
Sig
nific
an
t Serv
ice Im
pro
vem
en
ts12
60
EM
PL
OY
EE
EN
GA
GE
ME
NT
To
tal E
mp
l En
gag
em
en
t85
859
New
Em
pl E
ng
ag
em
en
t58
606
FIN
AN
CIA
LF
TE
Red
uctio
n2.9
33.5
5
Lab
or/B
en
efit S
avin
gs
219,1
77
$
1,4
85,8
57
$
AR
(3.5
% o
f cash
flow
)5,0
00
$
365,3
50
$
Cap
ital A
vo
idan
ce
-$
-$
Reven
ue
1,0
00
$
1,0
00
$
Su
pp
lies
8,2
15
$
356,9
65
$
Oth
er S
avin
gs
+45,0
00
$
1,1
30,1
40
$
To
tal S
avin
gs
278,3
92
$
3,3
39,3
12
$
ThedaC
are
Month
ly T
rackin
g S
um
mary
22
Som
e e
xam
ple
s o
f our
expe
rience s
o fa
r….
Saved $
154,0
00 in
the C
ath
Lab s
upply
pro
cure
ment p
rocesses.
In 2
004, w
e re
duced A
/R fro
m 5
6 to
44
days e
quatin
g to
about $
12M
in c
ash
flow
.
Redeplo
yed s
taff in
severa
l are
as
am
ountin
g to
the e
quiv
ale
nt o
f appro
xim
ate
ly 3
3+
FT
Es.
*d
ata as of 1
/21
/05
23
Som
e e
xam
ple
s o
f our
expe
rience s
o fa
r…
Imp
rove
d T
CP
ph
on
e tria
ge
time
s b
y 3
5%
, re
du
cin
g h
old
time
from
89
to 5
8 s
eco
nd
s.
Re
du
ce
d T
CP
ph
on
e tria
ge
ab
an
do
nm
en
t ra
tes b
y 4
8%
from
11
.6%
to 6
.0%
.
Ra
dic
ally
red
uce
d th
e H
osp
ital a
dm
issio
n
clin
ica
l do
cu
me
nta
tion
cycle
time
(50
%).
AM
C M
ed
/Su
rgd
ecre
ase
d m
ed
ica
tion
d
istrib
utio
n tim
e fro
m 1
5 m
in/m
ed
pa
ss to
8
min
/me
d p
ass im
pa
ctin
g 4
.1 F
TE
s o
f sta
ff tim
e.
*d
ata as of 1
/21
/05
24
If we a
re to
be th
e b
est a
t what w
e d
o,
we m
ust h
ave th
e a
bility
to c
hange
ours
elv
es ra
pid
ly, e
limin
ate
waste
, re
duce e
rrors
, and im
pro
ve m
easura
ble
re
sults
dra
matic
ally
.
25
Nu
mb
er o
f Wis
co
nsin
Co
llab
ora
tive
Me
asu
res M
ee
ting
th
e 9
5th
Pe
rcentile
Perfo
rmance
27
Go
ing
Le
an
in H
ea
lth C
are
HO
W T
O P
AR
TIC
IPA
TE
:S
tep
1: L
og
on
to th
e IH
I.org
we
bsite
at h
ttp://w
ww
.ihi.o
rg/ih
i. If yo
u h
ave
no
t ye
t re
gis
tere
d w
ith th
e IH
I.org
site
, yo
u c
an
do
so
by g
oin
g to
the
Re
gis
tratio
n P
ag
e (lin
k to
h
ttp://w
ww
.ihi.o
rg/ih
i/use
rs/re
gis
ter.a
sp
x).
Ste
p 2
: Fro
m th
e IH
I.org
we
bsite
ho
me
pa
ge
, clic
k o
n C
om
mu
nity
/Dis
cu
ssio
n G
roup
s,
loca
ted
on
the
left h
an
d s
ide
of y
ou
r scre
en
(http
://ww
w.ih
i.org
/ihi/fo
rum
s/D
efa
ult.a
sp
x).
Ste
p 3
: Clic
k th
e T
he
Co
mm
on
sD
iscu
ssio
n G
rou
p.
Ste
p 4
: Se
lect T
he
Ca
lls to
Ac
tion
Dis
cu
ss
ion
Gro
up
s lin
k, s
ele
ct th
e G
oin
g L
ea
n in
H
ea
lth C
are
dis
cu
ssio
n.
PO
ST
A N
EW
CO
MM
EN
T O
R Q
UE
ST
ION
: S
tep
1: C
lick C
rea
te a
Ne
w T
hre
ad
.
Ste
p 2
: En
ter a
top
ic n
am
e in
the
Su
bje
ct fie
ld, a
nd
the
n e
nte
r yo
ur c
om
me
nt o
r q
ue
stio
n in
the
Me
ss
ag
e fie
ld.
Ste
p 3
: Clic
k P
rev
iew
to re
vie
w y
ou
r me
ssa
ge
.
Ste
p 4
: Clic
k P
os
tto
po
st y
ou
r me
ssa
ge
.
AD
D C
OM
ME
NT
S T
O T
OP
IC:
Ste
p 1
: Clic
k th
e T
hre
ad
title.
Ste
p 2
: Clic
k R
ep
ly.
Ste
p 3
: Ag
ain
, en
ter y
ou
r co
mm
en
t in th
e M
es
sa
ge
field
.
Ste
p 4
: Clic
k P
rev
iew
to re
vie
w y
ou
r me
ssa
ge
.
Ste
p 5
: Clic
k P
os
t to p
ost y
ou
r me
ssa
ge
.
28
HO
W T
O C
OM
PL
ET
E A
CO
NF
ER
EN
CE
EV
AL
UA
TIO
N A
ND
RE
CE
IVE
CO
NT
INU
ING
E
DU
CA
TIO
N C
RE
DIT
S:
Ca
lls to
Actio
n p
artic
ipan
ts c
an
ea
rn c
on
tinu
ing
ed
uca
tion
co
nta
ct h
ou
rs fo
r pa
rticip
atin
g in
th
e a
ud
io c
on
fere
nce
ca
ll on
Go
ing
Le
an
in H
ea
lth C
are
: Driv
ing
Ou
t Wa
ste
Be
co
me
s th
e
Stra
teg
y fo
r He
alth
Ca
re O
rga
niz
atio
ns b
y c
om
ple
ting
an
on
line
co
nfe
rence
eva
lua
tion
. To
co
mp
lete
the
eva
lua
tion
s:
1.
Go
to: h
ttp://w
ww
.ihi.o
rg/c
ertific
ate
ce
nte
r an
d lo
gin
if ne
ce
ssa
ry.
If y
ou
are
no
t reg
iste
red
with
the
IHI w
eb
site
, clic
k “E
nro
ll No
w” a
nd
co
mp
lete
the
req
uire
d in
form
atio
n. R
ep
ea
t Ste
p 1
. O
R
Clic
k o
n “G
en
era
te a
nd
Vie
w E
ve
nt C
ertific
ate
s”
2.
Typ
e in
the
ap
pro
pria
te c
od
e u
nd
er “C
on
firm E
ve
nt A
tten
da
nce
”
Nu
rse
s, M
ed
ica
l Do
cto
rs, a
nd
oth
er h
ea
lth p
rofe
ssio
na
ls: L
ea
n-c
all3
3.
Co
mp
lete
an
d s
ub
mit th
e o
nlin
e s
urv
ey th
en
follo
w th
e p
rom
pts
to re
qu
est a
ce
rtifica
te fo
r co
ntin
uin
g e
du
ca
tion
co
nta
ct h
ou
rs.
In o
rde
r to b
e e
ligib
le fo
r a c
on
tinu
ing
ed
uca
tion
ce
rtifica
te, a
tten
de
es m
ust c
om
ple
te th
e
on
line
eva
lua
tion
with
in th
irty d
ays o
f the
co
ntin
uin
g e
du
ca
tion
activ
ity. If c
ircu
msta
nce
s
pre
ve
nt y
ou
from
co
mp
letin
g th
e s
urv
ey b
y th
e s
pe
cifie
d d
ea
dlin
e, p
lea
se
em
ail
info
@ih
i.org
<m
ailto
:info
@ih
i.org
> b
efo
re th
is p
erio
d e
xp
ires. A
fter th
is p
erio
d, y
ou
will
be
un
ab
le to
rece
ive
a c
ertific
ate
.
PH
YS
ICIA
N C
RE
DIT
S A
VA
ILA
BL
E:
Th
e In
stitu
te fo
r He
alth
ca
re Im
pro
ve
me
nt is
accre
dite
d b
y th
e A
ccre
dita
tion
Co
un
cil fo
r C
on
tinu
ing
Me
dic
al E
du
ca
tion
(AC
CM
E) to
pro
vid
e c
on
tinu
ing
me
dic
al e
du
ca
tion
for
ph
ysic
ian
s. T
he
Institu
te fo
r He
alth
ca
re Im
pro
ve
me
nt ta
ke
s re
sp
on
sib
ility fo
r the
co
nte
nt, q
uality
, an
d s
cie
ntific
inte
grity
of th
is C
ME
activ
ity.
IHI d
esig
na
tes th
is c
on
tinu
ing
me
dic
al e
du
ca
tion
activ
ity fo
r a m
axim
um
of, 1
.5 G
en
era
l C
on
fere
nce
cre
dit h
ou
rs in
Ca
teg
ory
1 o
f the
Ph
ysic
ians R
eco
gn
ition
Aw
ard
of th
e
Am
eric
an
Me
dic
al A
ssocia
tion
. Ea
ch
ph
ysic
ian
sh
ou
ld c
laim
on
ly th
ose
ho
urs
of c
red
it h
e/s
he
actu
ally
sp
en
t in th
e e
du
ca
tion
al a
ctiv
ity.
NU
RS
ING
CR
ED
ITS
AV
AIL
AB
LE
:
Th
e In
stitu
te fo
r He
alth
ca
re Im
pro
ve
me
nt is
ap
pro
ve
d a
s a
pro
vid
er o
f co
ntin
uin
g
ed
uca
tion
in n
urs
ing
by th
e M
assa
chu
se
tts A
ssocia
tion
of R
eg
iste
red
Nu
rse
s w
hic
h is
a
ccre
dite
d a
s a
n a
pp
rove
r of c
on
tinuin
g e
du
ca
tion
in n
urs
ing
by th
e A
me
rica
n N
urs
es
Cre
de
ntia
ling
Ce
nte
r’s C
om
mis
sio
n o
n A
ccre
dita
tion
. Th
is c
on
tinu
ing
edu
ca
tion
activ
ity
ca
rries 1
.8 C
on
tact H
ou
rs.