Session D1 at International Forum for Quality and Safety in Healthcare, Paris 10 April 2014. This is a Pecha Kucha style presentation, which is a series of 20 slides, each running for 20 seconds, a total of 6 minutes and 40 seconds.

1. Welcome to D1
NEW IMPROVERS TRANSFORMING
HEALTHCARE
Eight leaders from around the world will
present their strategies for engaging
clinicians in quality improvement training in a
Pecha Kucha style format
Please tweet #Quality2014 & #d1
“

2. After this session,
participants will be able to:
• Gain a range of perspectives and insight from leaders of
initiatives to engage pre- and post-registration clinical trainees
in quality improvement
• Experience the Pecha Kucha presentation method, which
massively increases the impact of presentations and retention
of ideas by an audience
• Learn as much about strategies to engage trainees in quality
improvement in 90 minutes as might take four hours through
conventional presentations
• Experience an exhilarating variety of ideas and projects from a
worldwide range of viewpoints

3. Join in!
Please tweet your comments, views and
questions with the hashtags #Quality2014 and
#d1
We will review your tweets at the end of the
presentations

4. Clarity and brevity in presentations
are endangered practices
Source of image: onlignment.com

5. Source of image: jennifermccrea.com

7. Source of image: borrowed from www.sha.org
My learning in a nutshell

10. Talk to the person next to you:
What would it take for you to make a
presentation in 6 minutes, 40 seconds?

11. Our Pecha Kucha presenters
1. Emma Donaldson
2. Sherril Gelmon
3. Imran Qureshi
4. Margriet Schneider
5. Michelle Mello
6. Emma Vaux
7. Damian Roland
8. Kim Oates
#Quality2014 #d1

12. The holy triad of
great presentations
Source of basic image: geospatial.uonibi.ac.ke
Joel Meilleur

13. The holy triad of
great presentations
• Be brief
Joel Meilleur
#Quality2014 #d1

14. The holy triad of
great presentations
• Be brief
• Be brilliant
Joel Meilleur
#Quality2014 #d1

15. Joel Meilleur
The holy triad of
great presentations
• Be brief
• Be brilliant
• Be gone
#Quality2014 #d1

16. Emma
Donaldson
Clinical Lead for Quality
Improvement,
Salford Royal NHS
Foundation Trust,
England
#Quality2014 #d1

17. Engaging trainees
in Quality
Improvement
Dr Emma Donaldson
Clinical Director of Quality Improvement
Salford Royal NHS Foundation Trust (UK)
@E_arnotsmith

18. 2003

19. 2006

22. Opportunity
2008

24. Cardiac Arrests per 1000 Admissions
1.28
0.52

25. 2009

26. Building capability

27. Sepsis per 1000 central line days
33.3
32.3
12.2
26.1
35.7 36.2
0.0
42.0
39.5
7.9
12.8
15.4
29.1
14.5
0.0
16.7
9.3 8.8
0.0 0.00.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov
Sepsisper1000centrallinedays
Median = 29.1
Median = 8.8
Better care for sick babies
Improved access for complex
patients
CVC Infection per 1000 Catheter Days
29.1
8.8
0
5
10
15
20
25
30
35
40
45
50
Month
16.4
1.7

30. DON’T JUST TICK THE BOX
TICkLE it!

31. Make it easier

32. Make participation a side effect

33. Edit don’t create

34. Reward participation
34

35. Promote quality contributors

37. Sherril
Gelmon
DrPH,
Professor of Public
Health, Portland State
University,
USA
#Quality2014 #d1

38. Improvement for
Physicians-in-Training: A
Longitudinal Curriculum
Sherril Gelmon, DrPH
Paige Hatcher, MD, MPH

39. Theoretical Framework
Triple Aim + Model for Improvement

40. Balancing Needs of Learners
Mastery of improvement
Accreditation
Integration
Competence

41. Program Curriculum
Year 2- Clinical Improvement
Year 3- Leadership Development
Year 4- Residents as Teachers
Team-Based
Clinical
Improvement
Year 1- Personal Improvement

42. Investment in Improvement
Year Curriculum
Time (x 12)
Independent
Work
Clinic
(x 3)
Total
1 7.5/year 300 72 606
2 7/year 180 120 636
3 6/year 0 168 586
1828 Hours!

43. Foundation: Personal Improvement

44. Improvement in Clinical Settings

45. Applying Improvement Tools
0
2
4
6
8
10
12
14
16
18
20
1/23/07
1/25/07
1/27/07
1/29/07
1/31/07
2/2/07
2/4/07
2/6/07
2/8/07
PDSA Cycle #1
27%
13%
20%
13%
13%
7%
7%
# Times

46. Coaching is Key

47. Accountability

48. Systematic Evaluation
• Annual survey, focus groups, regular feedback
• Observations and presentations

49. Satisfaction with Curriculum
0
10
20
30
40
50
60
70
80
90
100
2012- 20132011- 20122010- 20112009- 20102008- 20092007- 2008
Percent of Learners Satisfied
with Teaching of Improvement

50. Mastery of Concepts
Percentage of Residents A ending Wrap-Ups: Mean 73%
Pre
Post
0
2
4
6
8
10
Residents
Faculty
6.7
8.75
7.4 7.6
Pre-Test/Post-Test Results Residents & Faculty
0%
5%
10%
15%
20%
25%
30%
35% SCAP RFHC

51. Clinic Visit Process
Check in Medical
Assistant
Provider OrdersPre-Visit

52. Making a Difference:
Vaccination Rates
54.26% 54.19% 54.39%
58.30% 57.61%
64.68%
67.94% 66.60% 66.80%
69.96% 70.03%
40.00%
45.00%
50.00%
55.00%
60.00%
65.00%
70.00%
75.00%
Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13
TDaP
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13

53. Spread
• Residents Faculty Department
• Clinic Hospital City State
• Other residencies Fellowships

54. Faculty as Coach/Role Model
• Unique skill set
• Accessible
• Enthusiastic
• Just-in-time tools

55. Relevance of Topics

56. Trainees Become Teachers

57. Conclusions
Systematic curriculum
Build competencies
Longitudinal experience

58. Imran
Qureshi
Director General
DAPS Global
England
#Quality2014 #d1

60. Dr Imran Qureshi
Founder of DAPS Global
DAPS (Doctors Advancing Patient Safety)
Microbiology Specialist Registrar
Previous BMJ Quality Clinical Lead
imran@dapsglobal.com
www.dapsglobal.com

61. 2009 - Berlin

68. 10 DAYS
Quality
Improvement
Projects

69. 1
2
3

71. DAPS Global Summer School
3 DAYS
30
DELEGATES
HEALTHCARE
INNOVATION

72. • Speak Up
• NHS Sleeeeeeep
• Don’t Kill Bill
• Anti-Bullying
CAMPAIGNS & APPS
WORKSHOPS
DEBATES
• Leadership
• Communication
• Human Factors
• Surgeons should full disclose
Their mortality & morbidity data
• Foreign patients attending for
Emergency care should be charged

74. AUDITS ESSAYS
THROMBOPROPHYLAXIS
HANDOVER
ANTIBIOTIC ALLERGIES
AWARENESS OF MEDICATIONS
PATIENT EXPERIENCE
CHILD PROTECTION
ALCOHOL IMPACT
SURGICAL SAFETY
BULLYING
4-HOUR TARGET

75. summit.dapsglobal.com

77. MUST HEALTHCARE INNOVATION BE CONFINED
TO HEALTHCARE PROFESSIONALS?
QUEEN MARY UNIVERSITY OF LONDON WHITGIFT SCHOOL – SOUTH CROYDON

78. The Hobbit
“There is more in you of good than you
know, child of the kindly West. Some
courage and some wisdom, blended in
measure. If more of us valued food and
cheer and song above hoarded gold, it
would be a merrier world.”

79. Margriet
Schneider
Professor of Internal Medicine &
Chair of the Division of Internal
Medicine & Dermatology,
University Medical Center,
Utrecht,
The Netherlands
#Quality2014 #d1

80. Michelle
Mello
Head of
Commissioning
(Nursing),
NHS England,
England
#Quality2014 #d1

81. Wonder & Improve
an innovative way for training leadership skills
Prof. Dr. Margriet Schneider
Program Director Internal Medicine
Ambassador Quality & Safety Program
Chair of the Division of Internal Medicine and Dermatology,
University Medical Center Utrecht, the Netherlands

82. “Do you ever wonder why?”

83. “Should you wonder why?

84. Wonder & Improve
• Value critical minds and create awareness
• Share, ownership
• Empower by offering tools

85. Competencies of a medical expert
CanMEDS 2015:
Manager = Leader

86. ‘Service’ Leaders
‘Frontline’ Leaders

87. Basic leadership skills
Wonder & Improve
‘Service’ Leaders
‘Frontline’ Leaders

88. Wonder & Improve
• Elective 1 hr session
• Residents and Program director
• Supportive staff member

89. • Update and progress of former projects
• New items
• Items within reach for improvement
Wonder & Improve
How does it work I ?

90. Wonder & Improve
How does it work II ?
• Prioritize by scoring 3-2-1 credit points
• Chose 3 items
• Formulate goals
• Appoint residents

91. A resident wondered ……
Why nurses keep coming to me for
non-urgent questions about their
patients AFTER clinical rounds?
I’m losing focus!!!!

92. What changed?

93. Examples of change:
• Read back procedure
• A 2-day ATLS training
• Redesign of clinical rounds
• Uniform dress code
• Upspeeding of admittance procedure

94. Implementation in The Netherlands
• observations,
• interviews,
• documentanalysis,
• evaluation forms

95. 0 10 20 30 40 50
Resident related
Effective
Patient-centered
Efficient
Timely
Equitable
Safe
Effects Wonder & Improve
114 improvement topics
Crossing the Quality Chasm: A New Health System for the 21st
Century. Washington DC: The National Academies Press; 2001.

96. Awareness
“though I’m new here, I’m
invited to think out loud -
when a topic arises that I
feel like I could commit to,
I should go for it.”
Residents discovered:
• Their position
• Their responsibility
• Their affinity and skills

97. Ownership & Empowerment
Residents feel:
• Being heard
• Supported
• Better equipped
‘The simple fact that there is
attention from supervisors for my
problems gives me the courage
to keep on going and keep
improving’

98. Educational Triangle
Stevens L. 2002; Zin in Leren
Autonomy
CompetencyRelation/Collaboration

99. Wonder & Improve
Your mother
is here …
Tell her I will be in time,
and please give her
some coffee …

100. Acknowledgements to:
UMC Utrecht
Liesbeth van Rensen, PhD
Judith Voogt, medical student
Utrecht School of Governance,
University Utrecht
Prof. Mirko Noordegraaf, PhD
Lieke vd Camp , masterstudent
Thomas Beerhuis, masterstudent

101. Introducing Care Makers
Michelle Mello
Proud Nurse

102. The Care Makers

103. Olympic Spirit

104. Volunteering

105. Compassion in Practice

106. Care Makers are born

107. Selection
Volunteering experience
Commitment to 6Cs
Desire to improve care
Work with and support colleagues

108. Social Media

109. Social Media reach
2,000+
2.5m
600+

110. Support and development

111. It will take
too long
It can’t be
done
Making a difference!
Reasons
not to
change
It’s
impossibleIt’s not our
problem
It’s too
ambitious
It’s too
complicated

112. What Care Makers say
"I've had a fantastic year it's like a
magic wand being waved in our
organisation, it has put the
excitement back in nursing
#patientcare“
Lisa Reith, Care Maker

113. Where are we now

114. Where are we now
Care Maker App
Care Maker of the year award
Research programme

115. Impact

116. Impact
400

117. The concept grows

118. Reflections

119. Reflections

120. The future

121. Emma
Vaux
Consultant Nephrologist &
Director of Quality
Improvement,
Royal Berkshire NHS
Foundation Trust,
England
#Quality2014 #d1

122. Making Every Moment Count
“Quality in action: Striving for
excellence”
Emma Vaux
Clinical Lead
Hester Wain
Head of
Patient Safety
Anne McDonald
Head of clinical Quality Improvement
The Royal Berkshire Hospital project team

123. Background

124. Aims
• Quality improvement as normal
practice
• High quality training
• Develop supporting resources

125. What we did….
IMPACT
LEARNING
SATISFACTION
RESULTS
Kirkpatrick Model of Training
EvaluationHow

126. AIMSOUTCOMES
BETTER TRAINING BETTER CARE
Trainee-led ideas Incidents
Simulated learning
Complaints
Project outcomes
Quality improvement projects
Improvement change
New skills Resources
30 trainees

127. Resources
RBFT Academy
Quality
Improvement
Management
Leadership

128. Governance
Patient
Multi-disciplinary Board
Project team
Junior doctors

129. Learning experience
“I realise how good QI is ….it is relevant to
day to day practice… …it’s simple …..makes
a big difference to our patients……… It is
worth giving it high priority in our clinical
duties.”
45 trainees completed 27 projects

130. Learning experience
“I was very passionate about the experience…….
it was so good to do such a project and be able to
keep monitoring it.”

131. Gaining of knowledge and skills
“This has been a very
valuable learning experience
into clinical quality
improvement as well as
being brilliant for my CV”

132. Behaviour change
“My whole outlook has changed…
I now look for situations to improve…”

133. Organisational change
“The magic is in seeing a
trainee identify a
problem they
encounter and feel
empowered to make a
change”
Hospital Board
74%
projects
achieved
their aims

134. Practice outcomes

135. HumanFinancial

136. Resources

137. Learning

138. Key factors for success
‘You hear about
projects and they
sound really huge
but this has
opened my eyes
to how you can do
little things and
make small
changes that
make a big
difference’
•Core hospital business
•Core team
•Communications strategy

139. Key factors for success
‘I identified it in my own appraisal as the
best thing I have done all year.’
Consultant supervisor
•Pool of ideas & supervisors
•Multi-disciplinary team & patient involvement
•Showcase

140. Spread
•ResourcesMethodology
Experience Learning

141. Summary
‘I would definitely, definitely do a
quality improvement project
again’

142. Damian
Roland
Consultant and Lecturer in
Paediatric Emergency Medicine,
Leicester Royal Infirmary,
England
#Quality2014 #d1

148. -
The largest day of simultaneous action in the history of the NHS
A new method of change...

149. -
The largest day of simultaneous action in the history of the NHS

150. Change
starts
with me..
Maker
...I want
to make a
difference
Anyone can pledge – It’s personal to you!
Change
Starter

151. I have not failed...
Thomas Edison

152. Tell a personal
story

153. Be authentic

154. Practice what you preach…

155. Support early adopters…

156. Recognise a different
type of radical…

158. twitter.com/NHSChangeday
youtube.com/NHSChangeDay
facebook.com/NHSChangeDay
changeday.nhs.uk
Embrace Social Media
nhschangeday.podbean.com
vimeo.com/nhschangeday

163. Kim
Oates
MD Dsc,
Director of Undergraduate
Quality & Safety Education,
Clinical Excellence
Commission, Australia
#Quality2014 #d1

164. Identifying and nurturing future leaders in patient safety
March 2014 – Kim Oates
Kim Oates
Paediatrician, medical academic and grandfather
Identifying and nurturing future
leaders in patient safety

165. In Australia, the average age of the
best known quality and safety
leaders is 62
Where are the future leaders?

166. Clinical Excellence Commission
My task: To infiltrate medical schools

168. How much Patient Safety is taught in
Australian Medical Schools?
70% of Deans thought there was a lot
42% of medical educators thought there was a lot less
than their Deans thought
78% of medical students thought there was not much at
all

169. The results of infiltration
Four medical Schools
Two nursing schools
One School of Allied Health

170. First year
Why we make errors
Blame and safe cultures
Using leadership skills to
make patients safer
Listening to patients and their families

171. Second Year
Human factors Open disclosure
Teams and communication
The patient is part of the team

174. Clinical documentation
Safe handover
Diagnostic error
Managing fatigue
Coping with disruptive
behaviour
Final year medicine

175. 0
500
1000
1500
2000
2500
3000
3500
4000
4500
2010 2011 2012 2013 2014 and
beyond ??
The program grows
Number of healthcare students taught

176. LEADERS
ELECTIVES
STUDENTS
POST GRADUATES

182. ADMISSIONS
24 %

184. Contact us!
Helen Bevan
Emma Donaldson
Sherril Gelmon
Imran Qureshi
Margriet Schneider
Michelle Mello
Emma Vaux
Damian Roland
Kim Oates
@HelenBevan
@E_arnotsmith
gelmons@pdx.edu
imran@dapsglobal.com
m.m.e.schneider@umcutrecht.nl
@MSHmello @CaremakersUK
@VauxEmma
@Damian_Roland
Kim.oates@sydney.edu.au
#Quality2014 #d1