Reliability nhsiq 2014

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Do our patients consistently receive evidence-based, effective care every time he or she needs it? This presentation discusses the concepts associated with high reliability:

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Reliability nhsiq 2014

  1. 1. © NHS Improving Quality 2014 Reliability Patient Safety Team
  2. 2. © NHS Improving Quality 2014 Insert date/time • Understand / appreciate the concept of reliability in healthcare • Adopt a simple approach to: – Identify & understand reliability defects – Design & implement interventions • Focus is on the methodology, not on specific solutions Objectives
  3. 3. © NHS Improving Quality 2014 What are we trying to achieve? A health care system that ensures every patient consistently receives evidence-based, effective care every time he or she needs it Decreasing the opportunity for variation
  4. 4. © NHS Improving Quality 2014 How hard can that be? McGlynn et al NEJM 2003; 348:2635-2645 – 6712 Medical records examined – Only 55% received ‘scientifically indicated care’ All studies show << 80% reliability in delivery of intended care
  5. 5. © NHS Improving Quality 2014 1 10 100 1,000 10,000 100,000 1 10 100 1,000 10,000 100,000 1million 10million Number of encounters for each fatality Totalliveslostperyear REGULATEDHAZARDOUS (>1/1000) ULTRA-SAFE (<1/100K) Health Care Mountain Climbing Bungee Jumping Driving Chemical Manufacturing Chartered Flights Scheduled Airlines European Railroads Nuclear Power
  6. 6. © NHS Improving Quality 2014 Can we deliver a reliable process? Catastrophic processes Blood transfusion Wrong side surgery Hygiene in neutropenic patients Post-operative counts Highly reliable processes
  7. 7. © NHS Improving Quality 2014 Non-catastrophic processes What do we mean? Failure of the process does not lead to death or severe injury within hours of the failure Very poor reliability < 80% Loss of connection with outcome The resilience of biology The tyranny of small numbers Violation and migration There’s no feedback
  8. 8. © NHS Improving Quality 2014 Example • Every patient on newly started on warfarin therapy should have an INR taken every 24 hours. This result should inform the dose prescribed. • Who has a deliberate and reliable process to achieve this and is confident it happens? • Who doesn’t think it’s really that important? • The policy in hospital is that staff should wash their hands on entry to the ward, between patients and on exiting the ward. • Who thinks this happens reliably in their hospital? • Who doesn’t think it’s really that important? Non Catastrophic Process
  9. 9. © NHS Improving Quality 2014 The consequence of our actions
  10. 10. © NHS Improving Quality 2014 Improvement Concepts Associated with Poor Reliability • Primarily can be described as intent, vigilance, and hard work – Common equipment, standard order sheets, multiple choice protocols, and written policies/procedures – Personal check lists – Feedback of information on compliance – Suggestions of working harder next time – Awareness and training • Does this appear familiar?
  11. 11. © NHS Improving Quality 2014 Improvement Concepts Associated with High Reliability • Focus on human factors • Standardize process based on best available evidence • Minimize variation • Make desired action the easiest / default action • Aids to decision making • Reminders and scheduling built in • Design in failure prevention, identification and mitigation
  12. 12. © NHS Improving Quality 2014 What do we mean by reliability? • Chaos; failure in >20% of opportunities • 80-90% reliability - >1 in 10 times the process fails. • 5 front line users can not easily articulate the process • • 95% reliability - 5 in 100 times the process fails. • 5 front line users can easily articulate the process • 99% reliability - 1 in 100 times the process fails well designed system with low variation and cooperative relationships
  13. 13. © NHS Improving Quality 2014 Level of reliability 1. Get to an 80% reliable process (today’s work) 2. Analyse Failure and re-design 3. Follow up reliability in May • Deal with the remaining 20% • Aim is to resolve 80% of the remaining 20% • Analyse failure and re-design • 80% + 80% of 20 = 96% reliability
  14. 14. © NHS Improving Quality 2014
  15. 15. © NHS Improving Quality 2014 Insert date/time People make mistakes...
  16. 16. © NHS Improving Quality 2014 Insert date/time Making the process more reliable
  17. 17. © NHS Improving Quality 2014 Process Map & Standardisation Identify and Prioritise Risk Barriers and Mitigation Test and Refine Deliberate reliable design
  18. 18. © NHS Improving Quality 2014 System solutions Make it easier to do the right thing Make it harder to do the wrong thing Spot & stop errors

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