WQD2011 – INNOVATION – BRONZE WINNER – Tawam Hospital - Innovative Approaches in JCIA Training


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Innovation case study – Bronze Prize winning submission by Tawam Hospital during 3rd Continual Improvement & Innovation Symposium organized by Dubai Quality Group's Continual Improvement Subgroup to celebrate World Quality Day 2011.

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WQD2011 – INNOVATION – BRONZE WINNER – Tawam Hospital - Innovative Approaches in JCIA Training

  1. 1. Innovative Approaches in JCIA TrainingTawam Hospital in Affiliation with Johns Hopkins International
  2. 2. About Tawam Hospital• 477-bed tertiary hospital in Al Ain• Highly specialized and well trained doctors and nurses.• In affiliation with Johns Hopkins Medicine from 2006• JCI accredited since 2006 and reaccredited in 2009.• Recognized as Baby Friendly Hospital.• An educational hospital and training center for faculty of medicine and health sciences- UAE University
  3. 3. Mission Vision & Values• Mission: To provide a continuum of quality health care which meets the needs and expectations of the UAE population and the surrounding GCC countries. Vision: Tawam Hospital believes in treating all Patients, Visitors and Employees with Respect, Dignity and Equality, guided by UAE laws and respect for patients rights. Values: Tawam Hospital will provide high quality, affordable medical services delivered in a friendly, safe and caring environment which meets JCIA Standards of Care.
  4. 4. Team Members• Dr. Mahyar Sadeghi , Chair Dental Center• Azhar Atlal , Pharmacist• Dr. Manjula Duhan, Dentist• Sumaya Al Meqbali, Senior Quality Officer• Margaret A. Lambert, Senior Risk Officer• Judy Warren, Infection Control Nurse• Bachar Mamich, Clerk and Graphic Designer• Patient Safety Team• Janelle Quijano, Medication Safety Officer• Team leader: Mervat Mansour, Section Head , Quality
  5. 5. ChallengeA big challenge of educating non interestedstaff on important and new topics in a shortperiod of time
  6. 6. How was the Innovative Approach created?• Intrinsically motivated multidisciplinary team – Pharmacist , dentist , nurse , 2 quality officers and graphic designer• Given both the tools and the incentives to produce creative work11/27/2011 6
  7. 7. Innovation Development- PreparationUnderstanding the problem: • Low number of attendants for Joint Commission International Accreditation lectures • Ineffective traditional lecturing approaches (dissatisfied attendants ) • JCIA Mock Survey results: Areas of concern: • Incomplete documentation • Environmental risks • Incomplete Medication Prescriptions – Many newly introduced concepts (sentinel events, Patient Safety Goals, new PPGs ) • Under reporting of incidents • Loads of new information11/27/2011 7
  8. 8. 4 Phases of Idea Creation ‘ (Wallas, The Art of Thought)– Preparation– Incubation– Illumination– Verification
  9. 9. 4 Phases of Idea Development (Wallas, The Art of Thought)– Preparation– Incubation– Illumination– Verification
  10. 10. Innovation Development – Preparation & Information Gathering • Explored different practices used in other hospitals as Sheikh Khalifa Medial City , Rashid Hospital and Johns Hopkins /USA • Studied attendants feedback from previous training sessions • Mock survey results  areas of concern • Literature reviews for best practices • Identified stakeholders interests11/27/2011 10
  11. 11. Innovation Development - Incubation:• Several meetings were held• Idea generation techniques used • Active search, research • Brainstorm • Critique • Role Playing • Sketching • Attributes listing 11/27/2011 11
  12. 12. Free flow of ideas without deliberate concentration. The attributes wanted: • Violate previous approaches, assumptions, and conventions • Grasp attendants attention • Memorable • Respects adult learning experiences and help them correlate
  13. 13. Illumination• A flash of light and joy overwhelmed when innovative ideas have been generated as: • Lecture- Hall wide snake and ladder game • Tropical zoo with hanging fruits of knowledge • House of horror • Sport games and fun • Role play as a JCIA assessor for environmental risks and document review11/27/2011 13
  14. 14. Verification/Evaluation of Ideas• Anonymous voting• Cost benefit analysis• Criteria Weighting Technique• Objectives Hierarchy• Prioritization matrix – Impact – Ease of implementation – Attraction – # of objectives met – Innovation Idea Impact Attraction Ease of Objectives Innovation Implemen met tation A B11/27/2011 14
  15. 15. Strengths/Weakness of the Approaches Used Tool Strengths Weaknesses Allows a large volume of ideas to be generated in a while suspension of judgment and going for quantity is short period of time. Also strives to ensure all necessary for creative thinking, this is not sufficientBrainstorming of Mind parties are involved Brainstorming sessions naively assume that no priorShowering No ideas are discounted initially (later evaluation preparation is needed and filtering undertaken) List pros and cons. List actions and reactions. List strengths and weaknesses. Subjective, not quantitativeForced field analysis Compare ideal situations and reality. Difficulty of change is not identified In negotiation, compare the perceptions of opposing parties. Offers numerical criteria with which to prioritize. Mathematical process (this is a weakness for some.)Criteria Weighting Objective; may be best in situations where this is Can become a prolonged and complicated exercise competition among the issues. Allows group toTechnique weight criteria differently.
  16. 16. People Involvement• How was the stakeholder buy-in acquired? – Cross representation from different disciplines – Stakeholders analysis : needs and expectations – Sketch drawing of the creative ideas – Open discussion – Forced field analysis – Plan and budget approval
  17. 17. Who Sponsored The Project?• Minimal costs of the sports games < AED 500• Department Performance Innovation
  18. 18. How Concept was Developed Into A Detailed Plan• Objectives highlighted and made visible to all.• Decision tree was depicted• General theme of “sports day” or fun city• All possible formats for each topic to be presented were considered with the educational topic owner• Framework drawn , staff flow sketched
  19. 19. Process• How was the feasibility of the solution evaluated? – Sketch of the workflow – Simulation – Role playing – Breakdown of work activities determine staffing, time and resources needed
  20. 20. Risk Assessment• FMEA , possible failures were identified and counter measures taken to prevent: – Low attendance  Strong marketing plan , prizes, word of the mouth , idea supporters – Crowdedness  timed attendance , proper staffing, U-shape flow, clear instructions – Physicians resistance : Adult learning techniques and variety of approaches• Discussion with the senior management• Piloting on a small number of staff• Team walk through
  21. 21. Implementation• The training program included 4 parts:• Clinic Simulation Room and Role Play• Document Review• Sports club• Room of Horror
  22. 22. Role Play & Simulation RoomA simulation room of “A Dental Clinic “ was prepared with allpossible environmental and medication risks.Playing the role of a JCIA surveyor, the staff has to assess 36different environmental aspects and safety practices using aprinted checklist for compliance with JCIA requirements.
  23. 23. Department of Performance Innovation Dear Staff , Please read the scenario and enter simulated patient room to discover all compliant and noncompliant areas with the JCIA requirements; Surprises are hidden… Mark this sheet then check your observations posted on answer sheet. Scenario: Non Observation Compliant compliant Environment of Care1 No electric hazards could be identified2 There is no potential risk of injury for patient or staff3 Eye wash is available to use when needed4 Instrument Cabinet is used only for instruments5 Sharp boxes are correctly utilized , and locked6 Fire exit is clear and safe to use Extinguishers are available / ready to use when needed (After you finish the7 tour , check extinguishers in the waiting area) Infection Control8 Red bags are used for medical wastes9 Black bags are used for non medical, non hazardous wastes11 Contaminated instruments are properly stored12 Suction equipments and water lines are flushed through13 Used single use disposable consumables are disposed properly14 The patients room is clean ;body fluid spills are properly cleaned15 Personal protection equipments, as gloves, are available to use when needed16 Personal protection equipment, gloves and gowns are available to use when needed Medication Safety17 Medications are stored in their specified cabinet/drawer Medications used for external use are stored separately from those18 for internal use19 Dental drug box is appropriate20 Dangerous abbreviations are not used in the medication prescriptions21 As needed "PRN" prescriptions are written correctly. Assessment of Patient22 Patient is identified correctly23 "Medical History Form: is filled properly24 "Medical History Form " is complete25 Patient pain is assessed and reassessed when needed Care of Patient /PFR26 Patients file/information is kept confidential27 General Consent Form is properly filled28 Specific Consent Form is properly filled29 Time out is documented before procedures30 Treatment Plan is properly filled31 Name and signature are written for each entry32 Referral Form is properly filled33 X- ray is verified for the name and Health Card Number Patient and Family Education ( PFE)34 Patient and family needs were assessed and addressed35 Patient and Family Education Record is multidisciplinary Name, signature and designation of staff providing the education are36 documented
  24. 24. Part 2 :Document Review• The simulation room is followed by document review for a medical file that has copy of real progress notes, x rays and medication prescriptions with errors ( details of patients and physician were deleted) = staff identify 10 different errors.  Learning by doing.
  25. 25. Part 3 Mini- Sports Club– The lecture hall was turned into a mini-sports club hall for 3 days: 6 different sport games including basket ball, shooting, Boling , cricket , darts ,etc– To participate in each game, staff has to answers 4- 6 different questions related to the topic.
  26. 26. Part 3 Mini- Sports Club– The information were presented in posters , take away leaflets , question & answer quizzes , videotapes broadcasting and JCIA Q&A booklet.– “ Fishing your prize” after finishing all the games.
  27. 27. Room of Horror• Underreporting of incidents: fear of blame• 3 incidents only reported in 3 months• Room of Horror – Anonymous reporting of incidents – Dual objectives: Education about the 28 different types of error that should be reported – Based on Trianti’s Thoery of constraints – Analogy: fear of error, ease when reporting it
  28. 28. Trianti’s Theory of Constraints• Based on Triantis’ Behavioral Modeling Theory, probability of behaving in a particular situation is governed by the following equation:• Probability of act = [habit + intention *] x [motivation x facilitating condition]
  29. 29. Heinreich’s Ratio1For each 1 major incident reported , it is expected to have 29 minor injuries and300 no –injury accidents 2.  1 Major injury 1  29 Minor injuries 29  300 No-injury 300 accidents 1. Heinreich HW Industrial Accident Prevention, NY And London 1941 2. An Organization With a Memory, A report of an expert group on learning from adverse events in the NHS chaired by the Chief Medical Officer, The Stationary Office, London 2000
  30. 30. Room of Horror• A small room (1m x 1m ) that has no light• Covered ceilings with black textile• Hanged scary masks• Played scary music and sounds• Provided a small lantern• “Do you dare to enter?”
  31. 31. Room of Horror• A2 size check sheet of the common incidents with clear instructions on how to fill and a message: “By reporting Incidents, you Might Save live “We posted the check sheet in the room.• At the entrance one staff for instructions• One staff at a time was allowed to enter.• In a confidential and exciting way staff reported any accident he/she had experienced in the last 3 months by ticking the incident/s from a list of possible incidents that could happen at the Dental Center.
  32. 32. Results• Dazzling results• 85 % of Dental Center staff attended voluntarily• Happy and satisfied clients -92% overall staff satisfaction with the JCIA Fair• # of reported incidents increased by 125 times• Idea replicated at Tawam Hospital JCIA Fair and other satellites• Substantial increase in documentation compliance• Reduction in the number of rejected medication prescriptions
  33. 33. Indirect Benefits• Increased patients and staff safety• Less medication errors• Reduction in the number of rejected mediations prescriptions• More awareness about environmental risks• A more realistic estimate of the number of incidents• Memorable experience• Satisfied staff
  34. 34. Way Forward• Recognition : – Party for all staff involved – Thank you letters• The idea was replicated in Tawams JCIA Fair, simulating a patient room – Patient had pressure ulcer and wound scoring was required from the visitors in addition to identifying all risks in the room – More topics included• No intellectual property, everyone is encouraged to replicate 
  35. 35. Lessons LearntNever get afraid of thinking outside the box.It is always nice to see life from a different perspective
  36. 36. A Final ThoughtInnovation is both art and science… It feeds onbig challenges, sharing of information,collaboration , freedom to explore, andendless flow of ideas.
  37. 37. Q&A
  38. 38. Thank you