New improvers transforming healthcare

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Session D1 at International Forum for Quality and Safety in Healthcare, Paris 10 April 2014.
This is a Pecha Kucha style presentation, which is a series of 20 slides, each running for 20 seconds, a total of 6 minutes and 40 seconds.

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New improvers transforming healthcare

  1. 1. Welcome to D1 NEW IMPROVERS TRANSFORMING HEALTHCARE Eight leaders from around the world will present their strategies for engaging clinicians in quality improvement training in a Pecha Kucha style format Please tweet #Quality2014 & #d1 “
  2. 2. After this session, participants will be able to: • Gain a range of perspectives and insight from leaders of initiatives to engage pre- and post-registration clinical trainees in quality improvement • Experience the Pecha Kucha presentation method, which massively increases the impact of presentations and retention of ideas by an audience • Learn as much about strategies to engage trainees in quality improvement in 90 minutes as might take four hours through conventional presentations • Experience an exhilarating variety of ideas and projects from a worldwide range of viewpoints
  3. 3. Join in! Please tweet your comments, views and questions with the hashtags #Quality2014 and #d1 We will review your tweets at the end of the presentations
  4. 4. Clarity and brevity in presentations are endangered practices Source of image: onlignment.com
  5. 5. Source of image: jennifermccrea.com
  6. 6. Source of image: borrowed from www.sha.org My learning in a nutshell
  7. 7. Talk to the person next to you: What would it take for you to make a presentation in 6 minutes, 40 seconds?
  8. 8. Our Pecha Kucha presenters 1. Emma Donaldson 2. Sherril Gelmon 3. Imran Qureshi 4. Margriet Schneider 5. Michelle Mello 6. Emma Vaux 7. Damian Roland 8. Kim Oates #Quality2014 #d1
  9. 9. The holy triad of great presentations Source of basic image: geospatial.uonibi.ac.ke Joel Meilleur
  10. 10. The holy triad of great presentations • Be brief Joel Meilleur #Quality2014 #d1
  11. 11. The holy triad of great presentations • Be brief • Be brilliant Joel Meilleur #Quality2014 #d1
  12. 12. Joel Meilleur The holy triad of great presentations • Be brief • Be brilliant • Be gone #Quality2014 #d1
  13. 13. Emma Donaldson Clinical Lead for Quality Improvement, Salford Royal NHS Foundation Trust, England #Quality2014 #d1
  14. 14. Engaging trainees in Quality Improvement Dr Emma Donaldson Clinical Director of Quality Improvement Salford Royal NHS Foundation Trust (UK) @E_arnotsmith
  15. 15. 2003
  16. 16. 2006
  17. 17. Opportunity 2008
  18. 18. Cardiac Arrests per 1000 Admissions 1.28 0.52
  19. 19. 2009
  20. 20. Building capability
  21. 21. Sepsis per 1000 central line days 33.3 32.3 12.2 26.1 35.7 36.2 0.0 42.0 39.5 7.9 12.8 15.4 29.1 14.5 0.0 16.7 9.3 8.8 0.0 0.00.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Sepsisper1000centrallinedays Median = 29.1 Median = 8.8 Better care for sick babies Improved access for complex patients CVC Infection per 1000 Catheter Days 29.1 8.8 0 5 10 15 20 25 30 35 40 45 50 Month 16.4 1.7
  22. 22. DON’T JUST TICK THE BOX TICkLE it!
  23. 23. Make it easier
  24. 24. Make participation a side effect
  25. 25. Edit don’t create
  26. 26. Reward participation 34
  27. 27. Promote quality contributors
  28. 28. Sherril Gelmon DrPH, Professor of Public Health, Portland State University, USA #Quality2014 #d1
  29. 29. Improvement for Physicians-in-Training: A Longitudinal Curriculum Sherril Gelmon, DrPH Paige Hatcher, MD, MPH
  30. 30. Theoretical Framework Triple Aim + Model for Improvement
  31. 31. Balancing Needs of Learners Mastery of improvement Accreditation Integration Competence
  32. 32. Program Curriculum Year 2- Clinical Improvement Year 3- Leadership Development Year 4- Residents as Teachers Team-Based Clinical Improvement Year 1- Personal Improvement
  33. 33. Investment in Improvement Year Curriculum Time (x 12) Independent Work Clinic (x 3) Total 1 7.5/year 300 72 606 2 7/year 180 120 636 3 6/year 0 168 586 1828 Hours!
  34. 34. Foundation: Personal Improvement
  35. 35. Improvement in Clinical Settings
  36. 36. Applying Improvement Tools 0 2 4 6 8 10 12 14 16 18 20 1/23/07 1/25/07 1/27/07 1/29/07 1/31/07 2/2/07 2/4/07 2/6/07 2/8/07 PDSA Cycle #1 27% 13% 20% 13% 13% 7% 7% # Times
  37. 37. Coaching is Key
  38. 38. Accountability
  39. 39. Systematic Evaluation • Annual survey, focus groups, regular feedback • Observations and presentations
  40. 40. Satisfaction with Curriculum 0 10 20 30 40 50 60 70 80 90 100 2012- 20132011- 20122010- 20112009- 20102008- 20092007- 2008 Percent of Learners Satisfied with Teaching of Improvement
  41. 41. Mastery of Concepts Percentage of Residents A ending Wrap-Ups: Mean 73% Pre Post 0 2 4 6 8 10 Residents Faculty 6.7 8.75 7.4 7.6 Pre-Test/Post-Test Results Residents & Faculty 0% 5% 10% 15% 20% 25% 30% 35% SCAP RFHC
  42. 42. Clinic Visit Process Check in Medical Assistant Provider OrdersPre-Visit
  43. 43. Making a Difference: Vaccination Rates 54.26% 54.19% 54.39% 58.30% 57.61% 64.68% 67.94% 66.60% 66.80% 69.96% 70.03% 40.00% 45.00% 50.00% 55.00% 60.00% 65.00% 70.00% 75.00% Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 TDaP Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13
  44. 44. Spread • Residents Faculty Department • Clinic Hospital City State • Other residencies Fellowships
  45. 45. Faculty as Coach/Role Model • Unique skill set • Accessible • Enthusiastic • Just-in-time tools
  46. 46. Relevance of Topics
  47. 47. Trainees Become Teachers
  48. 48. Conclusions Systematic curriculum Build competencies Longitudinal experience
  49. 49. Imran Qureshi Director General DAPS Global England #Quality2014 #d1
  50. 50. Dr Imran Qureshi Founder of DAPS Global DAPS (Doctors Advancing Patient Safety) Microbiology Specialist Registrar Previous BMJ Quality Clinical Lead imran@dapsglobal.com www.dapsglobal.com
  51. 51. 2009 - Berlin
  52. 52. 10 DAYS Quality Improvement Projects
  53. 53. 1 2 3
  54. 54. DAPS Global Summer School 3 DAYS 30 DELEGATES HEALTHCARE INNOVATION
  55. 55. • Speak Up • NHS Sleeeeeeep • Don’t Kill Bill • Anti-Bullying CAMPAIGNS & APPS WORKSHOPS DEBATES • Leadership • Communication • Human Factors • Surgeons should full disclose Their mortality & morbidity data • Foreign patients attending for Emergency care should be charged
  56. 56. AUDITS ESSAYS THROMBOPROPHYLAXIS HANDOVER ANTIBIOTIC ALLERGIES AWARENESS OF MEDICATIONS PATIENT EXPERIENCE CHILD PROTECTION ALCOHOL IMPACT SURGICAL SAFETY BULLYING 4-HOUR TARGET
  57. 57. summit.dapsglobal.com
  58. 58. MUST HEALTHCARE INNOVATION BE CONFINED TO HEALTHCARE PROFESSIONALS? QUEEN MARY UNIVERSITY OF LONDON WHITGIFT SCHOOL – SOUTH CROYDON
  59. 59. The Hobbit “There is more in you of good than you know, child of the kindly West. Some courage and some wisdom, blended in measure. If more of us valued food and cheer and song above hoarded gold, it would be a merrier world.”
  60. 60. Margriet Schneider Professor of Internal Medicine & Chair of the Division of Internal Medicine & Dermatology, University Medical Center, Utrecht, The Netherlands #Quality2014 #d1
  61. 61. Michelle Mello Head of Commissioning (Nursing), NHS England, England #Quality2014 #d1
  62. 62. Wonder & Improve an innovative way for training leadership skills Prof. Dr. Margriet Schneider Program Director Internal Medicine Ambassador Quality & Safety Program Chair of the Division of Internal Medicine and Dermatology, University Medical Center Utrecht, the Netherlands
  63. 63. “Do you ever wonder why?”
  64. 64. “Should you wonder why?
  65. 65. Wonder & Improve • Value critical minds and create awareness • Share, ownership • Empower by offering tools
  66. 66. Competencies of a medical expert CanMEDS 2015: Manager = Leader
  67. 67. ‘Service’ Leaders ‘Frontline’ Leaders
  68. 68. Basic leadership skills Wonder & Improve ‘Service’ Leaders ‘Frontline’ Leaders
  69. 69. Wonder & Improve • Elective 1 hr session • Residents and Program director • Supportive staff member
  70. 70. • Update and progress of former projects • New items • Items within reach for improvement Wonder & Improve How does it work I ?
  71. 71. Wonder & Improve How does it work II ? • Prioritize by scoring 3-2-1 credit points • Chose 3 items • Formulate goals • Appoint residents
  72. 72. A resident wondered …… Why nurses keep coming to me for non-urgent questions about their patients AFTER clinical rounds? I’m losing focus!!!!
  73. 73. What changed?
  74. 74. Examples of change: • Read back procedure • A 2-day ATLS training • Redesign of clinical rounds • Uniform dress code • Upspeeding of admittance procedure
  75. 75. Implementation in The Netherlands • observations, • interviews, • documentanalysis, • evaluation forms
  76. 76. 0 10 20 30 40 50 Resident related Effective Patient-centered Efficient Timely Equitable Safe Effects Wonder & Improve 114 improvement topics Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: The National Academies Press; 2001.
  77. 77. Awareness “though I’m new here, I’m invited to think out loud - when a topic arises that I feel like I could commit to, I should go for it.” Residents discovered: • Their position • Their responsibility • Their affinity and skills
  78. 78. Ownership & Empowerment Residents feel: • Being heard • Supported • Better equipped ‘The simple fact that there is attention from supervisors for my problems gives me the courage to keep on going and keep improving’
  79. 79. Educational Triangle Stevens L. 2002; Zin in Leren Autonomy CompetencyRelation/Collaboration
  80. 80. Wonder & Improve Your mother is here … Tell her I will be in time, and please give her some coffee …
  81. 81. Acknowledgements to: UMC Utrecht Liesbeth van Rensen, PhD Judith Voogt, medical student Utrecht School of Governance, University Utrecht Prof. Mirko Noordegraaf, PhD Lieke vd Camp , masterstudent Thomas Beerhuis, masterstudent
  82. 82. Introducing Care Makers Michelle Mello Proud Nurse
  83. 83. The Care Makers
  84. 84. Olympic Spirit
  85. 85. Volunteering
  86. 86. Compassion in Practice
  87. 87. Care Makers are born
  88. 88. Selection Volunteering experience Commitment to 6Cs Desire to improve care Work with and support colleagues
  89. 89. Social Media
  90. 90. Social Media reach 2,000+ 2.5m 600+
  91. 91. Support and development
  92. 92. It will take too long It can’t be done Making a difference! Reasons not to change It’s impossibleIt’s not our problem It’s too ambitious It’s too complicated
  93. 93. What Care Makers say "I've had a fantastic year it's like a magic wand being waved in our organisation, it has put the excitement back in nursing #patientcare“ Lisa Reith, Care Maker
  94. 94. Where are we now
  95. 95. Where are we now Care Maker App Care Maker of the year award Research programme
  96. 96. Impact
  97. 97. Impact 400
  98. 98. The concept grows
  99. 99. Reflections
  100. 100. Reflections
  101. 101. The future
  102. 102. Emma Vaux Consultant Nephrologist & Director of Quality Improvement, Royal Berkshire NHS Foundation Trust, England #Quality2014 #d1
  103. 103. Making Every Moment Count “Quality in action: Striving for excellence” Emma Vaux Clinical Lead Hester Wain Head of Patient Safety Anne McDonald Head of clinical Quality Improvement The Royal Berkshire Hospital project team
  104. 104. Background
  105. 105. Aims • Quality improvement as normal practice • High quality training • Develop supporting resources
  106. 106. What we did…. IMPACT LEARNING SATISFACTION RESULTS Kirkpatrick Model of Training EvaluationHow
  107. 107. AIMSOUTCOMES BETTER TRAINING BETTER CARE Trainee-led ideas Incidents Simulated learning Complaints Project outcomes Quality improvement projects Improvement change New skills Resources 30 trainees
  108. 108. Resources RBFT Academy Quality Improvement Management Leadership
  109. 109. Governance Patient Multi-disciplinary Board Project team Junior doctors
  110. 110. Learning experience “I realise how good QI is ….it is relevant to day to day practice… …it’s simple …..makes a big difference to our patients……… It is worth giving it high priority in our clinical duties.” 45 trainees completed 27 projects
  111. 111. Learning experience “I was very passionate about the experience……. it was so good to do such a project and be able to keep monitoring it.”
  112. 112. Gaining of knowledge and skills “This has been a very valuable learning experience into clinical quality improvement as well as being brilliant for my CV”
  113. 113. Behaviour change “My whole outlook has changed… I now look for situations to improve…”
  114. 114. Organisational change “The magic is in seeing a trainee identify a problem they encounter and feel empowered to make a change” Hospital Board 74% projects achieved their aims
  115. 115. Practice outcomes
  116. 116. HumanFinancial
  117. 117. Resources
  118. 118. Learning
  119. 119. Key factors for success ‘You hear about projects and they sound really huge but this has opened my eyes to how you can do little things and make small changes that make a big difference’ •Core hospital business •Core team •Communications strategy
  120. 120. Key factors for success ‘I identified it in my own appraisal as the best thing I have done all year.’ Consultant supervisor •Pool of ideas & supervisors •Multi-disciplinary team & patient involvement •Showcase
  121. 121. Spread •ResourcesMethodology Experience Learning
  122. 122. Summary ‘I would definitely, definitely do a quality improvement project again’
  123. 123. Damian Roland Consultant and Lecturer in Paediatric Emergency Medicine, Leicester Royal Infirmary, England #Quality2014 #d1
  124. 124. - The largest day of simultaneous action in the history of the NHS A new method of change...
  125. 125. - The largest day of simultaneous action in the history of the NHS
  126. 126. Change starts with me.. Maker ...I want to make a difference Anyone can pledge – It’s personal to you! Change Starter
  127. 127. I have not failed... Thomas Edison
  128. 128. Tell a personal story
  129. 129. Be authentic
  130. 130. Practice what you preach…
  131. 131. Support early adopters…
  132. 132. Recognise a different type of radical…
  133. 133. twitter.com/NHSChangeday youtube.com/NHSChangeDay facebook.com/NHSChangeDay changeday.nhs.uk Embrace Social Media nhschangeday.podbean.com vimeo.com/nhschangeday
  134. 134. Kim Oates MD Dsc, Director of Undergraduate Quality & Safety Education, Clinical Excellence Commission, Australia #Quality2014 #d1
  135. 135. Identifying and nurturing future leaders in patient safety March 2014 – Kim Oates Kim Oates Paediatrician, medical academic and grandfather Identifying and nurturing future leaders in patient safety
  136. 136. In Australia, the average age of the best known quality and safety leaders is 62 Where are the future leaders?
  137. 137. Clinical Excellence Commission My task: To infiltrate medical schools
  138. 138. How much Patient Safety is taught in Australian Medical Schools? 70% of Deans thought there was a lot 42% of medical educators thought there was a lot less than their Deans thought 78% of medical students thought there was not much at all
  139. 139. The results of infiltration Four medical Schools Two nursing schools One School of Allied Health
  140. 140. First year Why we make errors Blame and safe cultures Using leadership skills to make patients safer Listening to patients and their families
  141. 141. Second Year Human factors Open disclosure Teams and communication The patient is part of the team
  142. 142. Clinical documentation Safe handover Diagnostic error Managing fatigue Coping with disruptive behaviour Final year medicine
  143. 143. 0 500 1000 1500 2000 2500 3000 3500 4000 4500 2010 2011 2012 2013 2014 and beyond ?? The program grows Number of healthcare students taught
  144. 144. LEADERS ELECTIVES STUDENTS POST GRADUATES
  145. 145. ADMISSIONS 24 %
  146. 146. Contact us! Helen Bevan Emma Donaldson Sherril Gelmon Imran Qureshi Margriet Schneider Michelle Mello Emma Vaux Damian Roland Kim Oates @HelenBevan @E_arnotsmith gelmons@pdx.edu imran@dapsglobal.com m.m.e.schneider@umcutrecht.nl @MSHmello @CaremakersUK @VauxEmma @Damian_Roland Kim.oates@sydney.edu.au #Quality2014 #d1

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