This slides are modified
Original Slides Presented by Akarin Nimmannit MD
Thai initiative that was considerably successful
R2R Made innovation/QI easy for everyone to do
Presentation from NHS Improvement endoscopy workshop held at Ambassadors Hotel, London on 29 January 2013
http://www.improvement.nhs.uk/diagnostics/EndoscopyImprovement/Events.aspx
The case for nurse endoscopists
Harriet Watson, NHS Improvement
Total Joint Replacement- Improving Day of Surgery Efficiency and ThroughputWellbe
Organic growth of total joint replacement volume is growing at 3-4% per year as the number of physicians entering orthopedic residency programs is in decline. Cuts in Medicare reimbursement for total joints is forecast every year producing stressors for the surgeon to perform more surgery just to tread water financially. Increasing surgical volume without increasing time in the day requires a team approach to process improvements. By taking a fresh look at operating room processes, it’s possible to accomplish this goal.
Discussion points include:
• Pre-op patient preparedness
• Resolving inherent conflicts
• Surgical case order
• Tracking case efficiency
• Surgical tray streamlining
About the Speaker:
Sandy Nettrour has specialized in orthopedics for 30 years. She is the Neurosurgery and Orthopedic Service Line Coordinator for Butler Health System, providing oversight of the business aspects of Neurosurgery and Orthopedics, while continuing to first assist in the operating room and provide patient care at the bedside.
Sandy graduated from Alderson Broaddus College in 1980 with a Physician Assistant degree. She has been awarded the Distinguished Fellow Recognition by the American Academy of Physician Assistants, the Hu C. Myers Award for lifetime professional achievement and community service, and the Pennsylvania Society of Physician Assistants Humanitarian of the Year 2013. She was a Round Table Participant in Orthopedics Today June 2012′s “Effective and Efficient Joint Replacement Programs Need Constant Review and Renewal of Processes.”
The Role of Evidence-Based Design | Miron ConstructionMiron Construction
In this overview of evidence-based design in healthcare, Miron Construction takes a look at how the physical environment, along with other factors such as cultural and social, can impact the patient and practitioner experience in giving and receiving care.
- mikael forss - karolinska university hospital - ls10 - 02.11.10 - pptshown at the Lean Summit 2010 - New Horizons for Lean Thinking on 2/3 November 2010
Presentation from NHS Improvement endoscopy workshop held at Ambassadors Hotel, London on 29 January 2013
http://www.improvement.nhs.uk/diagnostics/EndoscopyImprovement/Events.aspx
The case for nurse endoscopists
Harriet Watson, NHS Improvement
Total Joint Replacement- Improving Day of Surgery Efficiency and ThroughputWellbe
Organic growth of total joint replacement volume is growing at 3-4% per year as the number of physicians entering orthopedic residency programs is in decline. Cuts in Medicare reimbursement for total joints is forecast every year producing stressors for the surgeon to perform more surgery just to tread water financially. Increasing surgical volume without increasing time in the day requires a team approach to process improvements. By taking a fresh look at operating room processes, it’s possible to accomplish this goal.
Discussion points include:
• Pre-op patient preparedness
• Resolving inherent conflicts
• Surgical case order
• Tracking case efficiency
• Surgical tray streamlining
About the Speaker:
Sandy Nettrour has specialized in orthopedics for 30 years. She is the Neurosurgery and Orthopedic Service Line Coordinator for Butler Health System, providing oversight of the business aspects of Neurosurgery and Orthopedics, while continuing to first assist in the operating room and provide patient care at the bedside.
Sandy graduated from Alderson Broaddus College in 1980 with a Physician Assistant degree. She has been awarded the Distinguished Fellow Recognition by the American Academy of Physician Assistants, the Hu C. Myers Award for lifetime professional achievement and community service, and the Pennsylvania Society of Physician Assistants Humanitarian of the Year 2013. She was a Round Table Participant in Orthopedics Today June 2012′s “Effective and Efficient Joint Replacement Programs Need Constant Review and Renewal of Processes.”
The Role of Evidence-Based Design | Miron ConstructionMiron Construction
In this overview of evidence-based design in healthcare, Miron Construction takes a look at how the physical environment, along with other factors such as cultural and social, can impact the patient and practitioner experience in giving and receiving care.
- mikael forss - karolinska university hospital - ls10 - 02.11.10 - pptshown at the Lean Summit 2010 - New Horizons for Lean Thinking on 2/3 November 2010
University of Utah Surgical Unit Improves Response to Call LightsUniversity of Utah
University of Utah's Kathy Schumann, RN, CCTN, provides an overview of how a nursing intervention to improve response to call lights improved pain management outcomes, increased patient satisfaction, quality outcomes and patient safety.
Measuring “Culture of Safety” Tawam’s Experience
Discovery:
Tawam Hospital’s Executive leadership realized the need to establish a “Culture of Safety” within the organization and implemented the Johns Hopkins Medicine “Comprehensive Unit based Safety Program” (CUSP). CUSP was introduced as a pilot project in the Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NNU) and Paediatric Oncology Unit (Peds Onc).
Prior to implementation the leadership decided to measure staff perception of safety using evidence based tool.
Solution:
Tawam partnered with Pascal Metrics to implement the Safety Attitude Questionnaire survey. The SAQ was administered to all Tawam Hospital staff in three phases (2008, 2010 and 2011). In 2010 the pilot CUSP units were also resurveyed to determine the status of safety culture since its introduction in 2008.
An email from the CEO was sent to the participants encouraging them to participate in the SAQ survey.
Physicians, nurses, ward-clerks; respiratory therapist, physiotherapist, dieticians etc were included in the survey.
Those who spent at least 50% of their time in the identified units were only included to participate in the survey.
Survey was administered during departmental meetings to increase response rate.
Conducted separate sessions of physicians.
Staff dropped the completed surveys in an envelope.
82% of staff in the patient care areas of the whole hospital participated in the overall 3 phases of SAQ Survey.
The three CUSP pilot units were re-surveyed in 2010.
Anonymity, privacy and confidentiality were maintained from the beginning till the end.
Outcome:
The survey results were graded against percentage positive responses. Responses that were less than 60% mark were graded in the danger zone and anything above the 80% mark were graded in the goal zone. Teamwork climate and Safety climate scale scores are considered to be primary dependent variables, because they are important in preventing patient harm.
The overall hospital score on all the domain scores were in the danger zone, less than 60%. 20 clinical locations in 2010 and 7 clinical locations in 2011 had less than 60% scores in the primary dependent variables.
The SAQ results were disseminated department wise in the presence of a hospital Senior Executive. Every department did an action plan using the SAQ de-briefer tool. The hospital administrators to bring about the change played a facilitators role and helped the departments to come up with their actionable plans.
The hospital leadership in their pursuit to continuing the culture of safety journey, identified six more units for CUSP implementation based on the Phase 2 SAQ scores of 2010. Accordingly the Medical 1, Medical 2, Surgical 1, Surgical 2, Day Case and OBGYN Units were identified for the CUSP roll out. Senior Executive leaders were assigned to each of these new CUSP units to ensure leadership commi
University of Utah Health: Wellness Champion Poster Session 2017University of Utah
Improving Wellness: 40 Champions, 20 Projects and 12-months of Progress: The Wellness and Integrative Health’s Resiliency Center, Accelerate, and the Spencer S. Eccles Health Sciences Library presented a Faculty Wellness Poster Session. Each department in the School of Medicine highlighted the past year’s Wellness Champion projects, which are focused on personal resilience, burden reduction, and team work. The poster session demonstrates work completed so far as the Wellness Champion program is expanded to faculty and staff across U of U Health.
This plenary took place on Tuesday, October 6, at 8:30 am at the International Conference on Communication in Healthcare (ICCH), in Miami Beach, Florida, USA.
The Path to Safe and Reliable Healthcare
Michael Leonard, MD
Michael Leonard, MD, is the Physician Leader for Patient Safety at Kaiser Permanente, a Principal at Pascal Metrics, and a Faculty member at the Institute for Healthcare Improvement (IHI). An Honors graduate of the University of Missouri School of Medicine, Michael did his postgraduate
training in Internal Medicine and Anesthesiology at Harvard’s Beth Israel Hospital in Boston, with fellowship training in cardiac anesthesia. Michael was a practicing anaesthesiologist for 14 years
with the Colorado Permanente Medical Group, where he was Chief of Anesthesia, Chief of Surgical Services, and Chairman of the Board of Directors. In 1999, he helped Kaiser forge a collaborative relationship with Dr. Robert Helmreich’s Human Factors Research Project to work on the application
of human factors teamwork and communication training in medicine.
For the past several years, he has taught extensively throughout the Kaiser system and outside organizations in high-risk areas such as surgery, obstetrics, critical care and others to enhance safety. His relationships with outside organizations include Duke, Baylor, Sloan Kettering, ICSI, Minnesota Children’s, Ascension, Adventist, VHA, Greater New York Hospital Association and
others. At the IHI, he has been active in several domains, including the Patient Safety Officer Training Course, Transforming Care at the Bedside, the Superior Performance Initiative in the United Kingdom, and Patient Safety Scotland.
Engaging service users and healthcare staff in quality improvement: a practic...MS Trust
This presentation by Glenn Robert from the National Nursing Research Unit and King's College London looks at what experience based co-design is, and why do it.
It was presented at the MS Trust Annual Conference in November 2014.
Nursing audit, a tool for providing quality care to patientsGure2
it is a presentation that highlights what makes nursing audit a tool for quality care to patients. it further highlight the challenges and its prospects
University of Utah Surgical Unit Improves Response to Call LightsUniversity of Utah
University of Utah's Kathy Schumann, RN, CCTN, provides an overview of how a nursing intervention to improve response to call lights improved pain management outcomes, increased patient satisfaction, quality outcomes and patient safety.
Measuring “Culture of Safety” Tawam’s Experience
Discovery:
Tawam Hospital’s Executive leadership realized the need to establish a “Culture of Safety” within the organization and implemented the Johns Hopkins Medicine “Comprehensive Unit based Safety Program” (CUSP). CUSP was introduced as a pilot project in the Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NNU) and Paediatric Oncology Unit (Peds Onc).
Prior to implementation the leadership decided to measure staff perception of safety using evidence based tool.
Solution:
Tawam partnered with Pascal Metrics to implement the Safety Attitude Questionnaire survey. The SAQ was administered to all Tawam Hospital staff in three phases (2008, 2010 and 2011). In 2010 the pilot CUSP units were also resurveyed to determine the status of safety culture since its introduction in 2008.
An email from the CEO was sent to the participants encouraging them to participate in the SAQ survey.
Physicians, nurses, ward-clerks; respiratory therapist, physiotherapist, dieticians etc were included in the survey.
Those who spent at least 50% of their time in the identified units were only included to participate in the survey.
Survey was administered during departmental meetings to increase response rate.
Conducted separate sessions of physicians.
Staff dropped the completed surveys in an envelope.
82% of staff in the patient care areas of the whole hospital participated in the overall 3 phases of SAQ Survey.
The three CUSP pilot units were re-surveyed in 2010.
Anonymity, privacy and confidentiality were maintained from the beginning till the end.
Outcome:
The survey results were graded against percentage positive responses. Responses that were less than 60% mark were graded in the danger zone and anything above the 80% mark were graded in the goal zone. Teamwork climate and Safety climate scale scores are considered to be primary dependent variables, because they are important in preventing patient harm.
The overall hospital score on all the domain scores were in the danger zone, less than 60%. 20 clinical locations in 2010 and 7 clinical locations in 2011 had less than 60% scores in the primary dependent variables.
The SAQ results were disseminated department wise in the presence of a hospital Senior Executive. Every department did an action plan using the SAQ de-briefer tool. The hospital administrators to bring about the change played a facilitators role and helped the departments to come up with their actionable plans.
The hospital leadership in their pursuit to continuing the culture of safety journey, identified six more units for CUSP implementation based on the Phase 2 SAQ scores of 2010. Accordingly the Medical 1, Medical 2, Surgical 1, Surgical 2, Day Case and OBGYN Units were identified for the CUSP roll out. Senior Executive leaders were assigned to each of these new CUSP units to ensure leadership commi
University of Utah Health: Wellness Champion Poster Session 2017University of Utah
Improving Wellness: 40 Champions, 20 Projects and 12-months of Progress: The Wellness and Integrative Health’s Resiliency Center, Accelerate, and the Spencer S. Eccles Health Sciences Library presented a Faculty Wellness Poster Session. Each department in the School of Medicine highlighted the past year’s Wellness Champion projects, which are focused on personal resilience, burden reduction, and team work. The poster session demonstrates work completed so far as the Wellness Champion program is expanded to faculty and staff across U of U Health.
This plenary took place on Tuesday, October 6, at 8:30 am at the International Conference on Communication in Healthcare (ICCH), in Miami Beach, Florida, USA.
The Path to Safe and Reliable Healthcare
Michael Leonard, MD
Michael Leonard, MD, is the Physician Leader for Patient Safety at Kaiser Permanente, a Principal at Pascal Metrics, and a Faculty member at the Institute for Healthcare Improvement (IHI). An Honors graduate of the University of Missouri School of Medicine, Michael did his postgraduate
training in Internal Medicine and Anesthesiology at Harvard’s Beth Israel Hospital in Boston, with fellowship training in cardiac anesthesia. Michael was a practicing anaesthesiologist for 14 years
with the Colorado Permanente Medical Group, where he was Chief of Anesthesia, Chief of Surgical Services, and Chairman of the Board of Directors. In 1999, he helped Kaiser forge a collaborative relationship with Dr. Robert Helmreich’s Human Factors Research Project to work on the application
of human factors teamwork and communication training in medicine.
For the past several years, he has taught extensively throughout the Kaiser system and outside organizations in high-risk areas such as surgery, obstetrics, critical care and others to enhance safety. His relationships with outside organizations include Duke, Baylor, Sloan Kettering, ICSI, Minnesota Children’s, Ascension, Adventist, VHA, Greater New York Hospital Association and
others. At the IHI, he has been active in several domains, including the Patient Safety Officer Training Course, Transforming Care at the Bedside, the Superior Performance Initiative in the United Kingdom, and Patient Safety Scotland.
Engaging service users and healthcare staff in quality improvement: a practic...MS Trust
This presentation by Glenn Robert from the National Nursing Research Unit and King's College London looks at what experience based co-design is, and why do it.
It was presented at the MS Trust Annual Conference in November 2014.
Nursing audit, a tool for providing quality care to patientsGure2
it is a presentation that highlights what makes nursing audit a tool for quality care to patients. it further highlight the challenges and its prospects
3 Strategies for Maximizing Service Line Efficiency, Quality and ProfitabilityWellbe
Maximizing service line efficiency, quality and profitability is a hot topic, particularly with rising patient care demands, changing reimbursement models, and estimated physician shortfalls. This webinar takes a look at three solutions beginning in the operating room and expanding to the entire patient care journey.
1st solution: A unique clinical and operational service model focused on the specialization of qualified, reimbursable clinical labor to optimize surgeon involvement and reduce OR costs.
2nd solution: Taking a holistic view of the service line through the patient care journey to produce a value stream map to understand the current state. Assisting staff with comparing this current state to the ideal future state, comparing national benchmarks and clinical best practices helps your staff innovate and co-create an individualized plan to get your service line to a higher level.
3rd solution: Utilizing dashboard metrics of the critical to success factors, to sustain and improve your service line.
As a participant, you will be able to:
• Identify key operational and clinical indicators of orthopedic service line efficiency
• Describe how Surgical First Assists can add value in the OR
• List the steps in developing and/or evaluating or building an orthopedic service line
• Describe how metrics/dashboards assist in sustaining change and improvement of orthopedic service line
About the Speaker:
Miki Patterson, PHD ONP, Senior Director of Orthopedics in Intelligent CareDesign at Intralign
Dr. Patterson is a certified orthopedic nurse practitioner and brings over 25 years of clinical experience in healthcare, consulting, direct advanced orthopedic patient care, teaching, NIH level, qualitative and quantitative research and publishing. She is a past president of the National Association of Orthopedic Nurses (NAON) and continues to be nationally recognized for leadership and advancing orthopedic care.
1. Akarin Nimmannit MD
Manager of Routine to Research (R2R) Project
Assistant Dean for Quality Development
Faculty of Medicine Siriraj Hospital
Mahidol University
2. Definition of R2R Research
Research question:
Originate from routine service/work
Solve the service/work problem
Improve the quality of service/work
Investigator/conductor
The working staff (experiencing the problem)
Might work with the invited expert
Result:
Measure the significant patient health outcome or service
Surrogate outcome might not be relevant e.g. laboratory testing
result
Implementation:
Research result must return to improve the patient care or service
Modified from the concept of Prof. Dr. Vicharn Panich, Chairman of Mahidol
University Council
4. Routine to Research (R2R) Unit
Launched in June 2004
Health Services Research Management Unit
Missions:
Upstream to downstream
Routine work problem Research question
Research proposal development
Research proposal review (IRB-ethical clearance and grant
process)
Research conduction monitoring
Manuscript/ implementation (service improvement)
Knowledge management (KM) for health
services research
5. R2R Management Approach
KM based
R2R is not a “foreign body”, but a further quality
development progression.
Integration of R2R research into common
hospital quality development (CQI-PDCA)
R2R is an investment, not another burden.
R2R is voluntary work.
Overcoming the “unpleasant” experiences and
attitudes towards research
R2R does not have to be very complex.
R2R is not restricted only to the scholars.
6. Medical Institute of the Kingdom
toward International Excellence
Clinical Human Capital Innovation &
Excellence Excellence Publication
Knowledge Routine work Knowledge
Creation Translation
Clinic Support
(Front (Back office)
office)
Quality Criteria e.g. HA, JCIA & TQA
Quality Criteria e.g. HA, JCIA & TQA
7. Research Questions & Quality
Development Topics are from..
1. Workflow: Value Stream Mapping
• Care team: care process
• Laboratory: Specimen collection, preparation, obtain, handling,
storage, process, report
2. Complaints & Occurrence Reports
• What have happened
• What/How factors associated with the incidence
• What should be the solution/ What is the best way to solve the
problem
3. Indicators (process, output, outcome)
• Target, Timing
• Other institute/Best practice
• Standard criteria (HA/JCIA/ISO)
4. Organizational goal (s)
8. Knowledge Management (KM)
for R2R
Do believe R2R projects exists even before
having the term “R2R”
Inspired to learn from real success story
(sometime ‘not’ success story)
Good success story telling needs preparation
(What & Whom to be shared)
More learn, less teach
9. Case: GYN Ultrasonography
Transabdominal ultrasound has been performed for
decades
To obtain good vision, urinary bladder must have some
volume of fluid
What is the appropriate volume?
How much water should patient drink?
How long the patient bladder will be filled?
A Randomized Controlled Study
9
10. 93 GYN Pts with normal
93 GYN Pts with normal
kidney function
kidney function
Randomization
Drink Water Drink Water Drink Water
300 cc. 400 cc. 500 cc.
n =31 n = 30 n = 32
Gynecologist independently perform GYN US when
1. Patients feel incline to urinate or
2. 45 min after drinking water
Redo US every 10 mins until Gynecologists satisfy with
the quality of image
11. Average waiting time and total bladder
volume before transabdominal
ultrasound in each study group
(mean+SD)
Important finding: 300, 400 & 500 cc in 60 mins
12. Work instruction for advising the
patient for GYN US
With appointment No appointment
“an hour” before 1. Do not pass urine
appointment time 2. Drink 300-500 (10-16 oz)
1. Empty bladder cc of fluid
2. Drink 300-500 (10-16 3. Do not pass urine
oz) cc of fluid 4. Wait 45 minutes
3. Do not pass urine until
examination
Patient to the US station
13. Implementation Result
US Success rate (%)
Indicators Before 1 months 3 months
Complete as 50 60.1 89
Appointment
Complete as 70 81.1 94
instruction (No
appointment )
Satisfaction - 75.2 91
17. Hospital Management Asia:
Human Resource Development
Train and benefit a large majority of staff
Allow employees flexibility to learn at their own
time
Improve a lot of the employee by way of effective
professional training and life long learning
Eliminate service defect, reduce waste and
improve communication
Significant result
Good composition of team
“We're Born to Learn, Not to Be Taught”
John Abbott
Author: Overschooled but Undereducated