Modified R2R slides

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Original Slides Presented by Akarin Nimmannit MD
Thai initiative that was considerably successful

R2R Made innovation/QI easy for everyone to do

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Modified R2R slides

  1. 1. Akarin Nimmannit MDManager of Routine to Research (R2R) Project Assistant Dean for Quality Development Faculty of Medicine Siriraj Hospital Mahidol University 
  2. 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 serviceModified from the concept of Prof. Dr. Vicharn Panich, Chairman of MahidolUniversity Council
  3. 3. 3
  4. 4. Routine to Research (R2R) UnitLaunched in June 2004Health Services Research Management UnitMissions: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 healthservices research
  5. 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. 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. 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, report2. 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 problem3. Indicators (process, output, outcome) • Target, Timing • Other institute/Best practice • Standard criteria (HA/JCIA/ISO)4. Organizational goal (s)
  8. 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. 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. 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 waterRedo US every 10 mins until Gynecologists satisfy with the quality of image
  11. 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. 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 fluid2. Drink 300-500 (10-16 3. Do not pass urine oz) cc of fluid 4. Wait 45 minutes3. Do not pass urine until examination Patient to the US station
  13. 13. Implementation Result US Success rate (%) Indicators Before 1 months 3 monthsComplete as 50 60.1 89AppointmentComplete as 70 81.1 94instruction (Noappointment )Satisfaction - 75.2 91
  14. 14. Waste Elimination: Defect Rework, Overproduction, Waiting, Motion, Excessive Processing 14
  15. 15. • 220 R2R projects• 130 Finished• >80% return to improve services
  16. 16. 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 “Were Born to Learn, Not to Be Taught” John Abbott Author: Overschooled but Undereducated

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