Innovative Approaches to Prevention of Falls - Positive Deviance and Frontline Ownership


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Description of the Call:
Dr. Gardam will be discussing his pioneering efforts in the use of the behavioral change approaches, including ‘positive deviance’ and ‘front line ownership’ to lead safety improvement work and how this relates to preventing falls. The presentation will include an interactive activity to help you and your teams understand how these approaches can be used in your organization.

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Innovative Approaches to Prevention of Falls - Positive Deviance and Frontline Ownership

  2. 2.  Thank you for joining us. Nous vous remercions de votre participation.  Your line will be muted until the call begins. Les lignes seront soussilence au début de cet appel.
  3. 3. Did you Join the Call Correctly? Êtes-vous connecté à l’appel correctement? You Joined Correctly! There IS a phone icon beside your name. You will be able to join the breakout sessions. You Joined Incorrectly!There is NO phone icon beside your name. You will be Unable to join the breakout sessions. Vous êtes bien connectés! On voit un icône de téléphone près de votre nom. Vous pourrez vous joindre aux salles d’exercise virtuelles (Breakout sessions). Vous êtes bien connectés! On voit un icône de téléphone près de votre nom. Vous pourrez vous joindre aux salles d’exercise virtuelles (Breakout sessions). Login before making phone connection Veuillez vous joindre à la partie vidéo en suivant le lien à l’ordinateur avant de téléphoner pour joindre la partie audio
  4. 4. If there is NO phone icon beside your name: S’il n’y a pas de téléphone noir près de votre nom 1. Hang up and disconnect from Audio WebEx. 2. Click the audio Icon. If needed, rejoin using original link. Enter name & Email & click on Join Now Raccrocher et vous serez déconnecté de la partie Audio de WebEx Cliquer sur l’icône audio. Au besoin, suivre le lien original. Entrer votre nom & courriel puis cliquer sur ¨Join Now¨ 3. A popup will display the phone information./ Une boîte de dialogue offre l’information téléphonique Direct Line Enter number Ligne directe, entrer votre numéro Line with Extension “ I will call in” Ligne avec poste Or/ou
  5. 5. Your Presenters and Faculty Nadine Glenn--CPSI Dr. Michael Gardam Hélène Riverin--CPSI Gina Peck--CPSI Susan McNeill--RNAO Verity White--RNAO
  6. 6. From where are you joining? Use your pointer.
  7. 7. Using Front-Line Ownership to Prevent Falls Michael Gardam University Health Network
  8. 8. “Insanity: doing the same things over and over again and expecting different results.” 8
  9. 9. With which statement do you most agree? A. Improved education can solve most quality and safety issues; B. Healthcare workers generally know what they need to do but for whatever reason, they don’t do it; C. Improving quality and safety invariably requires more money; D. Standardized tools and processes will efficiently bring about change.
  10. 10. Traditional Healthcare Culture • • • • • • Need to get things done immediately Evidence-based practice (scientific proof) Information and data are trusted Culture change is complicated Leaders need to ‘step-up’ Top-down leadership Zimmerman et. al. Healthcare Papers 2013
  11. 11. How we think the healthcare world works: A B How it really works: W BLACK BOX B
  12. 12. In a Linear World • One size can fit all • Copying best practices makes sense • Top down leadership (“develop the program and roll it out”) works • Checklists work
  13. 13. In a Complex World • • • • • • One size never fits all What works here may not work there “this is how we do things here” There is no “one big fix” Bottom up leadership works Social immune response
  14. 14. Safety Strategies ① Prevention ①Resilience
  15. 15. Prevention
  16. 16. Reality
  17. 17. Resilience
  18. 18. RONT INE WNERSHIP Zimmerman et. al., Healthcare Papers, 2013
  19. 19. Ownership
  20. 20. Buy in
  21. 21. How to get here? From here?
  22. 22. Principles • Participation is voluntary – everyone can opt in or opt out • Bottom up, top down and sideways • Make the invisible visible • Include the unusual suspects • Go slow to go fast • Nothing about me without me • Act your way into a new way of thinking
  23. 23. Rebuilding the wheel…
  24. 24. Example: Hand hygiene 25
  25. 25. TRIZ
  26. 26. Nursing engagement
  27. 27. Ideas… different socks change blood draw time Bedside report talking to patients fall monitors “busy” aprons stay with patients while in the bathroom
  28. 28. Current Collaborative Performance shows Falls across 6 hospitals declined by 13% In comparison to the baseline rate, a total of 14 falls have been prevented in 2013
  29. 29. Falls: BOZ total trend 7.0 Falls per 1,000 Patient Days 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Q1 2012 Q2 2012 BOZ Total Q3 2012 Q4 2012 Trend with intervention Q1 2013 Q2 2013 Q3 2013 Trend without intervention
  30. 30. Culture SHIFT • • • • • • Taking time to think Practice-based evidence (social proof) Stories and relationships are trusted Culture change is simple Leaders need to step back Bottom up leadership from the front-line
  31. 31. What we have learned • Rarely are there significant education deficits. • Healthcare workers do know what they need to do. • Remarkable change can occur for no money. • Standardize outcomes but not necessarily processes
  32. 32.
  33. 33. Questions? Raise your hand Or type your question into Chat. Remember to select “All Participants”
  34. 34. “Taking the Pulse” Poll But wait….There’s more! Please do not exit the call without completing the poll 15-Nov13 36
  35. 35. Thank you     Dr. Michael Gardam Registered Nurses’ Association of Ontario CPSI—Technical hosting All attendees who are working diligently to make care safer  Thank you for sharing and learning on the Falls Community of Practise
  36. 36. Mark your Calendars for these Upcoming Calls  Assessing delirium: pragmatics and confounders – November 19, 2013– 12:00 p.m.-1:00 p.m. EST  The ten obstacles to Hand Hygiene – December 10, 2013—2:00 p.m.-3:00 p.m. EST For dial-in information, please go to: