Dr. David Vaughan

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Collaboratiive Networks for Quality Improvement & Patient Safety in the Irish Health Service

Collaboratiive Networks for Quality Improvement & Patient Safety in the Irish Health Service

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  • 1. Building Knowledge Networks for Quality Improvement & Patient Safety in the Irish Health Service
    • Dr. David Vaughan,
    • Consultant Respiratory Paediatrician,
    • DQCC, HSE
  • 2.
    • “ If you can't explain it simply, you don't understand it well enough”
    • Albert Einstein
  • 3.  
  • 4. Dunning-Kruger Effect. "Overestimation occurs, in part, because people who are unskilled in these domains suffer a dual burden: Not only do these people reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the metacognitive ability to realize it
  • 5. Networks
    • What are networks?
      • A group of people who exchange information, contacts and experience for professional or social purposes
  • 6.  
  • 7. Text Christakis NA; NEJM 357;4 1997
  • 8. A system is a network of interdependent components that work together to try to accomplish the aim of the system. A system must have an aim. Without the aim, there is no system. W. Edwards Deming
  • 9. The Aim Better Quality Better Access Less Cost
  • 10. IHI
    • The Ultimate Network
    • Began as a collaboration between 9 clincians/ scientists with a passion and/ or expertise in systems improvement, quality improvement, and patient safety
    • Paul Batalden, Gene Nelson, Don Berwick founded the Birthday Club in 1988
  • 11. Berwick, DM. JAMA.  2003;289:1969-1975
  • 12. Berwick, DM. JAMA.  2003;289:1969-1975
  • 13.
    • 2.5% Innovators = 2,500 innovators in HSE
    • 13.5% Early adopters = 13500 in HSE
    It’s a lonely place
  • 14. Recipe
    • Innovators
    • Early adopters
    • Knowledge & expertise
    • Leadership, clinical and non-clinical
    • Communication between like minded individuals
    • Early visible success
    • Develop internal expertise ab initio
    • Sustainability
    • Dissemination
    • External pressures
    • Culture
  • 15. IHI Framework
    • Will
    • Ideas
    • Execution
  • 16. The secret of success
    • How to disseminate innovation
    • How to provide support and education between separated individuals
    • This is the role of networks
  • 17. How to begin; start small
  • 18. Don’t reinvent the wheel
  • 19. What is available?
    • Identify those who have interest, expertise, knowledge and enthusiasm
    • Self select in many cases
    • Identify those locations who support such initiatives
    • Support from leaders
    • Mentor
    • What network tools/ resources exist
  • 20. Existing Knowledge
    • Very poor data at the requisite granularity
    • Poor IT systems
    • Reducing resources
    • Rigid HR environment
    • Poor Morale
  • 21. Traditional Social Networks
  • 22. Clinical Programmes
    • Chronic disease
      • COPD/ Asthma
      • Acute coronary disease
      • Cardiac failure
      • Diabetes
      • Stroke
      • Emergency Function
        • Acute medicine
        • ED
        • Critical Care
        • Surgery
  • 23. Programmes
    • Obstetrics
    • Paediatrics
    • Mental health
    • Pharma
    • Costing/ coding
    • Quality Improvement/ patient safety
  • 24. What is available
    • IHI AMI Bundle, 11 hospitals with good evidence of improvement
      • Pre-existing cadre of clincians who have bought into this type of change
      • Geographical and resource spread widely
    • Vermont Oxford Database for neonatal ICUs
    • Surgical audit
    • Maternity Hospitals Annual Reports
  • 25. What is available
    • Health Atlas
    • HSELand
    • International links
      • Scotland, Northern Ireland
      • Like minded professionals meeting formally and informally
    • Research funding, (HRB)
  • 26. Other Resources
    • NHSIII
      • Webinars
      • Networking sites
    • IHI
      • Open School
      • Podcasts
      • Webinars
  • 27. Legislative Framework
    • Medical Council requirements
    • HIQA
    • CPS
  • 28. Priorities
    • Hospital Care
      • HAI
      • Medication Safety
      • ICU care
      • Deteriorating Patient
  • 29. Other Areas
    • Social Services
    • Mental Health
    • Primary Care
  • 30. Safety = QI?
    • Safety is easier to tackle first; it engages clinicians and managers
    • QI uses the same methods as safety improvement
    • QI is part of safety
  • 31. Suggestions
    • Area of major concerns
    • Feasible
    • Cheap
    • High impact
  • 32.
    • Quality
    • Access
    • Cost
  • 33. Leadership & Culture
    • Numerous exemplar sites, KP, VHA, Virginia Mason
    • Unclear how applicable the lessons from these organisations may be in other contexts
    • Can culture be created from the ground up?
  • 34. “ It is not necessary to change. Survival is not mandatory.”
  • 35.
    • A small group of thoughtful people could change the world. Indeed, it's the only thing that ever has.
  • 36. Recommended Reading
    • The Best Practice; Charles Kenney
    • Connected; Nicholas Christakis
    • Switch; How to Change Things When Change is Hard. Chip Heath