This document summarizes Dr. John Boulton's experience as the 2012-13 Quality Improvement Fellow at Sheffield Teaching Hospitals. It discusses his work leading cultural change towards quality improvement, building improvement capability through teaching tools and techniques, analyzing patient data, and achieving results such as reducing wait times for infusions from over 5 hours to the target of 4 hours or less. The document emphasizes the need to understand healthcare systems and how excursions outside the field can provide deep learning opportunities to drive improvement.

1. Operating on the Edge
Dr John Boulton
2012-13 Quality Improvement Fellow
Consultant Rheumatologist, Clinical Lead for Quality
Improvement,
Sheffield Teaching Hospitals

2. Rheumatology

5. ‘Excursions outside of healthcare
have prompted some of the deepest
learning for me’
Maureen Bisognano
IHI President and CEO
October 2013

12. Good
afternoon!

14. Why is
she here?
How are
you?
Really well!

28. Wait

29. Wait

30. Wait
Wait

31. Wait
Wait

32. Wait
Wait
Wait

33. Wait
Wait
Wait

34. Wait
Wait
Wait

35. Wait
Wait
Wait

36. Wait
Wait
Wait

37. 5 Hours waiting for a 4 hour infusion!
And there were 9 other patients that
day

38. ‘Every System is perfectly designed to deliver the
results it gets’
‘So much talk about the system, so little
understanding’

39. Weeks
1/1/2013
11/1/2012
9/1/2012
7/1/2012
5/1/2012
3/1/2012
1/1/2012
11/1/2011
9/1/2011
7/1/2011
5/1/2011
3/1/2011
1/1/2011
11/1/2010
9/1/2010
Patients
700
600
500
400
300
200
Simulated follow-up pool
Follow up pool (actual)
100
0

50. Patients
0
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0
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0
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0
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0
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0
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0
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0
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0
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18:00
0
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0
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17:45
0
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17:30
0
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0
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13:30
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15:15
13:15
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13:00
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14:45
12:45
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14:30
12:30
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14:15
12:15
10
9
8
7
6
5
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12:00
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0
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0
0
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0
0
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0
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0
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0
0
0
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0
0
0
0
0
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0
0
0
0
0
0
0
0
0
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0
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0
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0
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0
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0
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0
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11:45
11:30
11:15
11:00
10:45
10:30
10:15
9:45
10:00
9:30
9:15
9:00
8:45
8:30
8:15
8:00
0
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0
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51. Patients
0
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R
R
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18:00
0
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17:45
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16:30
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16:15
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16:00
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15:45
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12:30
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12:15
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52. So what did I achieve?
• Leadership for improvement
– The need for cultural change
• Improvement capability
– A knowledge of the tools and techniques
– Design, coach, facilitate and test
• Data analysis
• Results

53. Thank you