Unindo forcas implementação e disseminação de programas de seguranca do paciente
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Unindo forcas implementação e disseminação de programas de seguranca do paciente

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Apresentação de Pedro Delgado durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - ...

Apresentação de Pedro Delgado durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil.
Pedro Delgado é MSc, Diretor Executivo do Institute for Healthcare Improvement (IHI), atua a melhoria de sistemas e redes de saúde em larga escala mundialmente e lidera o portifolio do IHI na América Latina. Antes de integrar o IHI, trabalhou para o Serviço Nacional de Saúde da Grã Bretanha na gestão hospitalar e também levou de maneira pioneira esforços de melhoria em larga escala no norte da Irlanda.

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Unindo forcas implementação e disseminação de programas de seguranca do paciente Unindo forcas implementação e disseminação de programas de seguranca do paciente Presentation Transcript

  • Unindo forças: implementação e disseminação de programas de segurança do paciente HIAE-IHI Symposium 3-5 November 2013 Pedro Delgado Diretor Executivo IHI @pedroIHI
  • Congratulations… A brilliant platform! Great work in all of these in some places Just not everywhere
  • An opportunity 1. Pioneers & legacy 2. Implementation & Spread - how 3. New norms -‘Culture eats strategy for lunch’
  • What will you do by this Friday?
  • 1. The content, and its packaging 2. The data: real time, useful, available 3. A segmentation-to-spread plan 4. Pace: testing and learning 5. Leadership commitment Critical success factors
  • CSF 1: The content, and its packaging
  • WEALTH OF CONTENT About 3,720,000 results (0.24 seconds) About 122,000,000 results (0.26 seconds) About 3,380,000 results (0.24 seconds) About 152,000,000 results (0.23 seconds) About 11,200,000 results (0.27 seconds) About 1,970,000 results (0.24 seconds)
  • Adoption is a SOCIAL thing! A better idea… …communicated through a social network… …over time Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press.
  • Relative Advantage Relative Advantage SimpleSimple TrialableTrialable CompatibleCompatible ObservableObservable Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press. Accelerating adoption
  • A system- Everyone knows the connections and their contribution CauseEffect Drives Outcome (aim) Primary drivers Secondary drivers
  • CSF 1: The content, and its packaging • 5 attributes ‘checklist’ • A systemic view • Simple, snappy ‘how to’ guides (evidence, method, stories) * Economies of scale and collaboration
  • CSF 2: The data - real time, useful, available Seek usefulness, not perfection
  • (a esperança não é um plano) A clear aim
  • 56% reduction
  • 7.65 3.46 5.67
  • Real time measurement for learning
  • Rituals to learn (huddles, and other habits) – generative conversation spaces
  • CSF 2: The data: real time, useful, available • A clear aim - process and outcome data (dynamic view) to learn and improve, real time • Rituals to learn • Availability and usefulness to engage * Collaboration to accelerate improvement
  • CSF 3: A segmentation-to- spread plan
  • “Up to 70% of improvement projects never spread.” Eccles R, Miller Perkins K, Serafeim G. How to Become a Sustainable Company. MIT Sloan Management Review 2012; 53(4): 43-50. For the spread of new ideas to happen in a timely fashion, the spread process needs to be managed
  • Start-up: months 1 – 8 Total Pop’n: Under 5 Pop’n: Nov 2007 Wave 1: months 9 – 22 350,000 60,000 Jul 2008 Wave 2: months 23 – 63 5 million 500,000 Sept 2009 Wave 1R: months 58 – 89 11 million 1.7 million Aug 2012 Start Small, Scale up Rapidly with Change Package No of. QI Teams: 30 258 350 369 >1,046 Jan 2013 Wave 3: months 24 – 89 11 million 1.7 million Oct 2009 Wave 4: months 63 – 89 22 million 3.3 million *Referral project launch 41 Referral Teams
  • Where will you start? (unit or units). Where will you go next? What is your timeline for coverage and completeness? Which theatre (s) / OR (s)? General Medical? Fractures, Care of Elderly, Surgical?
  • Are you ready to spread? Intention to spread the work in organization? Topic of interest is a key initiative? Senior Leader responsible and accountable? Initial (pilot) team is relatively self- sufficient?
  • CSF 3: A segmentation-to- spread plan • Defining a starting point / place, and the sequence that follows through coverage and completeness • Diagnosing spread readiness • Manage spread * Collaboration to accelerate improvement
  • CSF 4: Pace - testing and learning “I hear and I forget; I see and I remember; I do and I understand” (Confucius)
  • ‘Montar bici’
  • DESIGN DESIGN DESIGN DESIGN A abordagem típica… IMPLEMENTAÇÃO (fracasso?) Muitas reuniões de planejamento… DESIGN DESIGN DESIGNDESIGNDESIGN APPROVE! O mundo real
  • ¿Qué intentamos lograr? ¿Cómo sabremos que un cambio es una mejora? ¿Qué cambios podemos hacer para obtener mejoras? Actuar Planificar Estudiar Hacer Cuando combinamos las 3 preguntas con … El ciclo PHEA… El Modelo de Mejoramiento (Langley et al, 1996)
  • DESIGN Abordagem de melhoria da qualidade IMPLEMENTAÇÃO (êxito) Poucas reuniões de planejamento… APPROVE O mundo real TEST & MODIFY TEST & MODIFY TEST & MODIFY Learning & Ownership
  • Aim: 50m by end of day Predicciones: • Se va a caer varias veces • Distancias cortas en principio • Confianza progresiva
  • Chinese proverb 不闻不若闻之,闻之不若见之,见之不若知 之,知之不若行之;学至于行之而止矣 “I hear and I forget; I see and I remember; I do and I understand” -Confucius
  • CSF 4: Pace - testing and learning • Build the capacity to improve • Test, fast – and learn along the way • Develop improvement capability – reusable skills
  • CSF 5: Leadership commitment “The responsibility for adopting aims and overseeing measures cannot be delegated”
  • A new kind of leadership • Safety at the top – pragmatic approach • Hierarchies and multidisciplinary teamwork • Its MY responsibility / It’s everyone’s responsibility • Data driven decision making & learning
  • 1. The content, and its packaging 2. The data: real time, useful, available 3. A segmentation-to-spread plan 4. Pace: testing and learning 5. Leadership commitment Critical success factors
  • COLLABORATE Build a learning system for improvement • National • Regional • Local
  • Transparency – the effect… Ejemplo: adopción de la guías para el tratamiento de síndrome coronario agudo 6 5 4 3 2 20092008200720062005 +13% +22% Los 34 hospitales de ‘abajo’ Todos los hospitales (69) +7% RIKS-HIA Quality Index1 1. The quality index from RIKS-HIA measures Swedish hospitals adherence to national guidelines (best practice) regarding Acute coronary syndrome (ACS). The index is based on nine different process metrics which are described in the appendix. 2. Defined as hospitals given the three lowest grades when data became public for 2006 (0,5; 1,0; 1,5). 3. Data on individual hospital performance was first published in the 2006 RIKS-HIA annual report. From 2006 onwards the public and the media could easily access the data and compare individual hospital performance. Source: RIKS – HIA Annual Reports 2005 – 2009, BCG Analysis +40% Prior to 2006 hospitals were not named in public report. Scientists could identify individual hospitals by translating codes3 After 2006 data on individual hospital performance was published triggering significant media and public attention
  • No looking back… Uso de teléfonos celulares Cinturón de seguridad Fumadores pasivos Computadores personales Música
  • (começar antes que você esteja pronto) 5 CSFs and… 1. Collaborate – build a learning system & share 2. Transparency 3. Change norms
  • What will you do by this Friday?
  • What will your legacy be? Less harm for all Brazilians
  • Change starts with you Our conversation in 2014…and the vision to move from 16% to…
  • Obrigado…boa sorte! www.ihi.org pdelgado@ihi.org @pedroIHI