Dr. David Vaughan


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Collaboratiive Networks for Quality Improvement & Patient Safety in the Irish Health Service

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Dr. David Vaughan

  1. 1. Building Knowledge Networks for Quality Improvement & Patient Safety in the Irish Health Service <ul><li>Dr. David Vaughan, </li></ul><ul><li>Consultant Respiratory Paediatrician, </li></ul><ul><li>DQCC, HSE </li></ul>
  2. 2. <ul><li>“ If you can't explain it simply, you don't understand it well enough” </li></ul><ul><li>Albert Einstein </li></ul><ul><li>“ </li></ul>
  3. 4. Dunning-Kruger Effect. &quot;Overestimation occurs, in part, because people who are unskilled in these domains suffer a dual burden: Not only do these people reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the metacognitive ability to realize it
  4. 5. Networks <ul><li>What are networks? </li></ul><ul><ul><li>A group of people who exchange information, contacts and experience for professional or social purposes </li></ul></ul>
  5. 7. Text Christakis NA; NEJM 357;4 1997
  6. 8. A system is a network of interdependent components that work together to try to accomplish the aim of the system. A system must have an aim. Without the aim, there is no system. W. Edwards Deming
  7. 9. The Aim Better Quality Better Access Less Cost
  8. 10. IHI <ul><li>The Ultimate Network </li></ul><ul><li>Began as a collaboration between 9 clincians/ scientists with a passion and/ or expertise in systems improvement, quality improvement, and patient safety </li></ul><ul><li>Paul Batalden, Gene Nelson, Don Berwick founded the Birthday Club in 1988 </li></ul>
  9. 11. Berwick, DM. JAMA.  2003;289:1969-1975
  10. 12. Berwick, DM. JAMA.  2003;289:1969-1975
  11. 13. <ul><li>2.5% Innovators = 2,500 innovators in HSE </li></ul><ul><li>13.5% Early adopters = 13500 in HSE </li></ul>It’s a lonely place
  12. 14. Recipe <ul><li>Innovators </li></ul><ul><li>Early adopters </li></ul><ul><li>Knowledge & expertise </li></ul><ul><li>Leadership, clinical and non-clinical </li></ul><ul><li>Communication between like minded individuals </li></ul><ul><li>Early visible success </li></ul><ul><li>Develop internal expertise ab initio </li></ul><ul><li>Sustainability </li></ul><ul><li>Dissemination </li></ul><ul><li>External pressures </li></ul><ul><li>Culture </li></ul>
  13. 15. IHI Framework <ul><li>Will </li></ul><ul><li>Ideas </li></ul><ul><li>Execution </li></ul>
  14. 16. The secret of success <ul><li>How to disseminate innovation </li></ul><ul><li>How to provide support and education between separated individuals </li></ul><ul><li>This is the role of networks </li></ul>
  15. 17. How to begin; start small
  16. 18. Don’t reinvent the wheel
  17. 19. What is available? <ul><li>Identify those who have interest, expertise, knowledge and enthusiasm </li></ul><ul><li>Self select in many cases </li></ul><ul><li>Identify those locations who support such initiatives </li></ul><ul><li>Support from leaders </li></ul><ul><li>Mentor </li></ul><ul><li>What network tools/ resources exist </li></ul>
  18. 20. Existing Knowledge <ul><li>Very poor data at the requisite granularity </li></ul><ul><li>Poor IT systems </li></ul><ul><li>Reducing resources </li></ul><ul><li>Rigid HR environment </li></ul><ul><li>Poor Morale </li></ul>
  19. 21. Traditional Social Networks
  20. 22. Clinical Programmes <ul><li>Chronic disease </li></ul><ul><ul><li>COPD/ Asthma </li></ul></ul><ul><ul><li>Acute coronary disease </li></ul></ul><ul><ul><li>Cardiac failure </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Stroke </li></ul></ul><ul><ul><li>Emergency Function </li></ul></ul><ul><ul><ul><li>Acute medicine </li></ul></ul></ul><ul><ul><ul><li>ED </li></ul></ul></ul><ul><ul><ul><li>Critical Care </li></ul></ul></ul><ul><ul><ul><li>Surgery </li></ul></ul></ul>
  21. 23. Programmes <ul><li>Obstetrics </li></ul><ul><li>Paediatrics </li></ul><ul><li>Mental health </li></ul><ul><li>Pharma </li></ul><ul><li>Costing/ coding </li></ul><ul><li>Quality Improvement/ patient safety </li></ul>
  22. 24. What is available <ul><li>IHI AMI Bundle, 11 hospitals with good evidence of improvement </li></ul><ul><ul><li>Pre-existing cadre of clincians who have bought into this type of change </li></ul></ul><ul><ul><li>Geographical and resource spread widely </li></ul></ul><ul><li>Vermont Oxford Database for neonatal ICUs </li></ul><ul><li>Surgical audit </li></ul><ul><li>Maternity Hospitals Annual Reports </li></ul>
  23. 25. What is available <ul><li>Health Atlas </li></ul><ul><li>HSELand </li></ul><ul><li>International links </li></ul><ul><ul><li>Scotland, Northern Ireland </li></ul></ul><ul><ul><li>Like minded professionals meeting formally and informally </li></ul></ul><ul><li>Research funding, (HRB) </li></ul>
  24. 26. Other Resources <ul><li>NHSIII </li></ul><ul><ul><li>Webinars </li></ul></ul><ul><ul><li>Networking sites </li></ul></ul><ul><li>IHI </li></ul><ul><ul><li>Open School </li></ul></ul><ul><ul><li>Podcasts </li></ul></ul><ul><ul><li>Webinars </li></ul></ul>
  25. 27. Legislative Framework <ul><li>Medical Council requirements </li></ul><ul><li>HIQA </li></ul><ul><li>CPS </li></ul>
  26. 28. Priorities <ul><li>Hospital Care </li></ul><ul><ul><li>HAI </li></ul></ul><ul><ul><li>Medication Safety </li></ul></ul><ul><ul><li>ICU care </li></ul></ul><ul><ul><li>Deteriorating Patient </li></ul></ul>
  27. 29. Other Areas <ul><li>Social Services </li></ul><ul><li>Mental Health </li></ul><ul><li>Primary Care </li></ul>
  28. 30. Safety = QI? <ul><li>Safety is easier to tackle first; it engages clinicians and managers </li></ul><ul><li>QI uses the same methods as safety improvement </li></ul><ul><li>QI is part of safety </li></ul>
  29. 31. Suggestions <ul><li>Area of major concerns </li></ul><ul><li>Feasible </li></ul><ul><li>Cheap </li></ul><ul><li>High impact </li></ul>
  30. 32. <ul><li>Quality </li></ul><ul><li>Access </li></ul><ul><li>Cost </li></ul>
  31. 33. Leadership & Culture <ul><li>Numerous exemplar sites, KP, VHA, Virginia Mason </li></ul><ul><li>Unclear how applicable the lessons from these organisations may be in other contexts </li></ul><ul><li>Can culture be created from the ground up? </li></ul>
  32. 34. “ It is not necessary to change. Survival is not mandatory.”
  33. 35. <ul><li>A small group of thoughtful people could change the world. Indeed, it's the only thing that ever has. </li></ul>
  34. 36. Recommended Reading <ul><li>The Best Practice; Charles Kenney </li></ul><ul><li>Connected; Nicholas Christakis </li></ul><ul><li>Switch; How to Change Things When Change is Hard. Chip Heath </li></ul>