What is possible in a hospital getting to zero harm cincinati childrens story (É Possível para Um Hospital Alcançar Meta de Dano Zero? A História do Cincinati Children's Hospital)

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Apresentação de Stephen Muething durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil.

Health & Medicine

What Is Possible In A Hospital?
Getting To Zero Harm
Cincinnati Children’s Story
November 4, 2013
Stephen E. Muething, MD
Vice President for Safety
James M. Anderson Center

SET THE GOAL
ACCEPT THE GAP
CONTINUOUS IMPROVEMENT

Our Safety Goal:
ELIMINATE ALL HARM
Begin With Serious Harm

Serious
Safety
Events
Serious Preventable
Events
Events of Minimal
to Moderate Harm
Near-Miss Events
Pyramid
of Harm

High Reliability Organizations (HROs)
Kathleen M. Sutcliffe, MSN, PhD
Karl E. Weick, PhD
High Reliability Organizations
Environment rich with potential for errors
Unforgiving social and political environment
Learning through experimentation difficult
Complex processes
Complex technology

Characteristics of
High Reliability Organizations
1. Preoccupation with failure
Regarding small, inconsequential errors as a symptom that
something is wrong; finding the half-event
2. Sensitivity to operations
Paying attention to what’s happening on the front-line
3. Reluctance to simplify
Encouraging diversity in experience, perspective, and opinion
4. Commitment to resilience
Developing capabilities to detect, contain, and bounce-back
from events that do occur
5. Deference to expertise
Pushing decision making down and around to the person
with the most related knowledge and expertise

0
2
4
6
8
10 07-052600
09-052433
11-052254
01-062002
03-061734
05-061983
07-062332
09-062355
11-062432
01-072330
03-072604
05-072556
07-073207
09-072603
11-072574
01-082464
03-082224
05-082792
07-082786
09-082447
11-082335
01-092667
03-092835
05-092370
07-092924
09-092625
11-092514
01-102421
03-103045
05-102892
07-103214
09-102790
11-102741
01-112871
03-113111
05-113274
07-113756
09-113552
11-113583
01-123444
03-123695
05-123994
07-124283
09-123504
11-123674
01-133462
Infectionsper100ProcedureDays
Month of Procedure
Procedure Days
Infections
Surgical Site Infections by Procedure Date (Class I & Class II Combined)
Last Updated 02/14/2013 by K. Simon, Anderson Center for Health Systems Excellence Source: Surgical Safety Database
Q2/05 - Individual Anesthesia Follow-up
Q3/05 - Anesth Compensation tied to compliance
Q3/05 - Orange ID Bracelets
Q4/05 - ABX In-pt Implementation
Q2/06 - CHG Wipes by All Services
Q3/06 - Bundle Measure for Limited Ortho & Neuro
Desired
Direction of
Change
40% Reduction

THANK YOU!
QUESTIONS?
stephen.muething@cchmc.org
http://www.cincinnatichildrens.org/research/divisions/j/anderson-center/default/

Apresentação de Carol Haraden durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil. Carol Haraden é PhD, Vice Presidente do Institute for Healthcare Improvement (IHI), é membro do time responsável por desenvolver desenhos inovadores no cuidado ao paciente. Atualmente, ela lidera os trabalhos do IHI na Escócia, Sul da Inglaterra, Dinamarca e Estados Unidos.

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RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.

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1. What Is Possible In A Hospital? Getting To Zero Harm Cincinnati Children’s Story November 4, 2013 Stephen E. Muething, MD Vice President for Safety James M. Anderson Center

4. SET THE GOAL ACCEPT THE GAP CONTINUOUS IMPROVEMENT

5. Our Safety Goal: ELIMINATE ALL HARM Begin With Serious Harm

6. Serious Safety Events Serious Preventable Events Events of Minimal to Moderate Harm Near-Miss Events Pyramid of Harm

7. Began Situation Awareness

8. High Reliability Organizations (HROs) Kathleen M. Sutcliffe, MSN, PhD Karl E. Weick, PhD High Reliability Organizations Environment rich with potential for errors Unforgiving social and political environment Learning through experimentation difficult Complex processes Complex technology

9. Characteristics of High Reliability Organizations 1. Preoccupation with failure Regarding small, inconsequential errors as a symptom that something is wrong; finding the half-event 2. Sensitivity to operations Paying attention to what’s happening on the front-line 3. Reluctance to simplify Encouraging diversity in experience, perspective, and opinion 4. Commitment to resilience Developing capabilities to detect, contain, and bounce-back from events that do occur 5. Deference to expertise Pushing decision making down and around to the person with the most related knowledge and expertise

10. Serious Safety Events Serious Preventable Events Events of Minimal to Moderate Harm Near-Miss Events Pyramid of Harm

11.

12.

13. 75% Reduction

14. 80% Reduction

15. 0 2 4 6 8 10 07-052600 09-052433 11-052254 01-062002 03-061734 05-061983 07-062332 09-062355 11-062432 01-072330 03-072604 05-072556 07-073207 09-072603 11-072574 01-082464 03-082224 05-082792 07-082786 09-082447 11-082335 01-092667 03-092835 05-092370 07-092924 09-092625 11-092514 01-102421 03-103045 05-102892 07-103214 09-102790 11-102741 01-112871 03-113111 05-113274 07-113756 09-113552 11-113583 01-123444 03-123695 05-123994 07-124283 09-123504 11-123674 01-133462 Infectionsper100ProcedureDays Month of Procedure Procedure Days Infections Surgical Site Infections by Procedure Date (Class I & Class II Combined) Last Updated 02/14/2013 by K. Simon, Anderson Center for Health Systems Excellence Source: Surgical Safety Database Q2/05 - Individual Anesthesia Follow-up Q3/05 - Anesth Compensation tied to compliance Q3/05 - Orange ID Bracelets Q4/05 - ABX In-pt Implementation Q2/06 - CHG Wipes by All Services Q3/06 - Bundle Measure for Limited Ortho & Neuro Desired Direction of Change 40% Reduction

16. HIGH RELIABILITY CULTURE

17. Pre-Surgery Time-Out

18. Huddles

19. Increase Reporting

20. Empowering to Stop the Line

21. Frontline Leaders Owning Harm

22. Peer Observation

23. THANK YOU! QUESTIONS? stephen.muething@cchmc.org http://www.cincinnatichildrens.org/research/divisions/j/anderson-center/default/

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