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Dr.  David Vaughan
 

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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    Dr.  David Vaughan Dr. David Vaughan Presentation Transcript

    • Building Knowledge Networks for Quality Improvement & Patient Safety in the Irish Health Service
      • Dr. David Vaughan,
      • Consultant Respiratory Paediatrician,
      • DQCC, HSE
      • “ If you can't explain it simply, you don't understand it well enough”
      • Albert Einstein
    •  
    • 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
    • Networks
      • What are networks?
        • A group of people who exchange information, contacts and experience for professional or social purposes
    •  
    • Text Christakis NA; NEJM 357;4 1997
    • 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
    • The Aim Better Quality Better Access Less Cost
    • 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
    • Berwick, DM. JAMA.  2003;289:1969-1975
    • Berwick, DM. JAMA.  2003;289:1969-1975
      • 2.5% Innovators = 2,500 innovators in HSE
      • 13.5% Early adopters = 13500 in HSE
      It’s a lonely place
    • 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
    • IHI Framework
      • Will
      • Ideas
      • Execution
    • The secret of success
      • How to disseminate innovation
      • How to provide support and education between separated individuals
      • This is the role of networks
    • How to begin; start small
    • Don’t reinvent the wheel
    • 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
    • Existing Knowledge
      • Very poor data at the requisite granularity
      • Poor IT systems
      • Reducing resources
      • Rigid HR environment
      • Poor Morale
    • Traditional Social Networks
    • Clinical Programmes
      • Chronic disease
        • COPD/ Asthma
        • Acute coronary disease
        • Cardiac failure
        • Diabetes
        • Stroke
        • Emergency Function
          • Acute medicine
          • ED
          • Critical Care
          • Surgery
    • Programmes
      • Obstetrics
      • Paediatrics
      • Mental health
      • Pharma
      • Costing/ coding
      • Quality Improvement/ patient safety
    • 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
    • What is available
      • Health Atlas
      • HSELand
      • International links
        • Scotland, Northern Ireland
        • Like minded professionals meeting formally and informally
      • Research funding, (HRB)
    • Other Resources
      • NHSIII
        • Webinars
        • Networking sites
      • IHI
        • Open School
        • Podcasts
        • Webinars
    • Legislative Framework
      • Medical Council requirements
      • HIQA
      • CPS
    • Priorities
      • Hospital Care
        • HAI
        • Medication Safety
        • ICU care
        • Deteriorating Patient
    • Other Areas
      • Social Services
      • Mental Health
      • Primary Care
    • 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
    • Suggestions
      • Area of major concerns
      • Feasible
      • Cheap
      • High impact
      • Quality
      • Access
      • Cost
    • 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?
    • “ It is not necessary to change. Survival is not mandatory.”
      • A small group of thoughtful people could change the world. Indeed, it's the only thing that ever has.
    • Recommended Reading
      • The Best Practice; Charles Kenney
      • Connected; Nicholas Christakis
      • Switch; How to Change Things When Change is Hard. Chip Heath