[PPT] - 2016 IHI Webinar Series Rhonda Dickman, RN, MSN, CPHQ Rhonda PowerPoint Presentation

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2016 IHI Webinar Series

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Rhonda Dickman, RN, MSN, CPHQ

Rhonda Dickman is a Quality Improvement Specialist with the Tennessee Hospital Association’s Tennessee Center for Patient Safety, supporting hospitals in their quality improvement work, particularly in the area of

readmissions. She is also the clinical manager of the

Tennessee Center for Patient Safety’s PSO (patient safety organization). Rhonda has worked in the field of hospital quality management since 2006 and has a clinical background in trauma, critical care, oncology, and organ donation.

rdickman@tha.com 615-401-7404

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THA Webinar Series

Exclusive program for clinical leaders in hospitals that are part of the Tennessee Hospital Association Hospital Engagement Network (HEN) Focused on supporting clinical leaders who supervise front-line staff 18 webinars in total 1.5 contact hours for each webinar Transitioned to new webinar platform

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Coming Soon- Invite your Colleagues!

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Kathy Duncan, RN

Kathy D. Duncan, RN, Director, Institute for Healthcare Improvement (IHI), oversees multiple areas of content, directs multiple virtual multiple learning webinar series. Currently she serves as Faculty for the AHA/HRET Hospital Engagement Network (HEN) 2.0 Improvement Leadership Fellowship

Ms. Duncan also directed content development and spread

expertise for IHI’s Project JOINTS, an initiative funded by the Federal Government to study adoption of evidenced-based

practices. In 10 US States, Project JOINTS spread three

evidence-based pre-and perioperative practices to reduce the risk

f surgical site infections in patients undergoing total hip or knee

replacement. Previously, she co-led the 5 Million Lives Campaign National Field Team and was faculty for the Improving Outcomes for High Risk and Critically Ill Patients Innovation Community. She has also served as a member of the Scientific Advisory Board for the American Heart Association’s Get with the Guidelines Resuscitation, NQF’s Coordination of Care Advisory Panel and NDNQI’s Pressure Ulcer Advisory Committee. Prior to joining IHI, Ms. Duncan led initiatives to decrease ICU mortality and morbidity as the Director of Critical Care, Orthopedics and Neuro for a large community hospital.

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Transitions Task Force Brenda Hogan- Maury Regional

History – 1/2013 “Transitions Task Force, 2014 Charter signed CEO, VP of Quality, Director of AAAD, N Manager developed front line committee with local SNF Workgroup reports – 1) DC Process 2) Communication 3)Education 4)ADE/Med Safety 5) Foley Cath Currently meet every other month with focus on one topic Actions to date

– Education to providers from the hospital face to face – Handoff Form – Post Discharge Order sets for SNF and HH (CHF and COPD) – “Electronic Resource Guide” – Scorecard with readmission rates and O/E for each SNF and HH

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Action Period Assignment

List two ideas from this session that they are putting to work in their organization/unit.

– Why did you choose these two? – Why is this important to you? – What can you predict they can accomplish? Take care of yourself: Resiliency 3 Good Things

Active Constructive Responding: Eye contact, Smile, Touch, Laugh

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Using Measurement for Learning and Strategies to Achieve Results

Kathy Duncan

This presenter has nothing to disclose

May 11, 2016

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Session Objectives

Participants will be able to:

Describe strategies for getting results in over

burdened care delivery systems

Apply strategies and tools for creating an action

plan to coordinate and leverage all initiatives to improve care transitions

Explain the recommended measurement strategy

and rationale for using outcome, process and process measures to guide learning and assess progress

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“Results”

Achieving Desired Results

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Strategies for Getting Results

Building will for change Using the Model for Improvement Clarifying needs for implementation and reliability

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Strategies for Getting Results

Building will for change

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Strategies for Getting Results

Building will for change

– Scoping clear aims – Focusing the aims on the Greater Good – Having the aims on the organization’ strategic plan – Clarifying the gap: reinforcing why change is important – Engaging frontline ideas and involvement – Starting with small tests of changes - PDSA

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Engaging Frontline Clinicians

Include them in:

– Identifying the problems – Understanding problem from the patients’ perspectives – Testing their ideas on how to improve – Seeing the impact of changes they make – Using observations to learn the real work – Honor their work

Consider the work burden of change and new processes Test potential changes well in a small unit before expanding

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Seeing the Impact of Changes We Make

Annotated run charts, give us feedback on the relationship between

Our theory

(the changes we are making) and the

Outcomes for our

patients (readmissions and overall experience)

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Observing the Actual Processes

Go see the real process
Check assumptions: what really happens

compared to what is described?

−

Observe and ask “Why?” five times to get to the root causes of current performance

Identify process failures you can change
Discuss changes that your team would like to test

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How Do You Build Will for Change?

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Strategies for Getting Results

Using the Model for Improvement

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For more information, please visit the IHI Open School Course - QI 102: The Model for Improvement: Your Engine for Change at www.IHI.org

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Plan

Plan 1 small

change to test

Predict what will

happen

Decide on data

to evaluate test

Do

Run the test
Document

problems and

bservations
Begin data

analysis

Study

Analyze the data
Compare results

to predictions

Summarize

what was learned

Act

Determine
Plan for next test

if change(s) should be made

Act to hold gains,

continue to improve

Plan-Do-Study-Act (PDSA) Cycle [action-oriented learning]

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A P S D

PDSA Worksheet

Team Name:__________________

Cycle start date:_________ Cycle end date:__________

PLAN: Describe the change you are testing and state the question you want this test

to answer (If I do x will y happen?) What do you predict the result will be? What measure will you use to learn if this test is successful

r has promise?

Plan for change or test: who, what, when, where Data collection plan: who, what, when, where

DO: Report what happened when you carried out the test. Describe observations,

findings, problems encountered, special circumstances.

STUDY: Compare your results to your predictions. What did you learn? Any

surprises?

ACT: Modifications or refinements for the next cycle; what will you do next?

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Strategies for Getting Results

Clarifying needs for implementation and reliability

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Implementation

The change is a specified part of daily work - need to develop all support infrastructure to maintain change High expectation to see improvement (Eagerness to continue testing to achieve reliability) Increased scope will lead to increased resistance (Value of evidence from successful tests)

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Sequence for Improvement and Spread

Spreading a change to other locations Developing a change Implementing a change

Testing a change

Act Plan Study Do

Theory and Prediction Test under a variety of conditions Make part

f routine
perations

Slide by Robert Lloyd

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Implementation Requires . . .

PDSA: Testing implementation steps
Established buy–in & consensus building
Communication
Training
Policies & Procedure
Supportive infrastructure including

assigned accountability

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U6 U5 U4 U3 U2

Medication Reconciliation Scheduled Visits

Tracking Progress in Changes

100% 100%

Coverage

Enhanced Assessment Real-Time Handovers Follow-up Appointments Using Teach Back

CHANGES

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# of Hospitals

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Strategies and Tools for Building an Action Plan

Using charters Planning/tracking progress of changes Tracking/exploring connections to other initiatives Using balanced measures Specifying the measurement plan for collection, analysis and reporting for the frontline to the boardroom

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Signal strategic work

across the organization and attract resources

Frame and enable

strategic initiatives

Keep the team focused

through regular review

f the aim, timeline,

and measures

Using Charters to Drive Results

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CHARTERS?

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Include Connections to Other Initiatives

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Measures to Evaluate Impact and Progress

Outcome

Measures directly relate to the aim of an initiative (the “So what?”)

Process

Measures reflect how well processes in the work get done around key changes

Balancing

Measures to help avoid causing detriment to another outcome or part of the system, e.g., processes, safety, satisfaction, equity, or costs

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Examples?

Outcome Measure Process Measure Balancing measure

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V. System of Measures

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V. System of Measures

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V. System of Measures

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V. System of Measures

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V. System of Measures

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V. System of Measures

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V. System of Measures

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Reflections

What ideas did you hear that you might

apply?

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Management Essentials Course

Format

– Week 1 Reflect – Call - Week 2 Practice – For Example:

– Week of June 1 Reflect (video, discussion question, assignment) – Call June 8 (Learn, discussion) – Week of June 8 Practice (assignment, test, etc.) – Week of June 15 Reflect (video, discussion question, assignment) – Call June 22……..

Open School Videos and Resources

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Accessing the IHI Open School online courses

Step 1: Log in to IHI.org

Go to www.IHI.org/Login to log in. If you are not yet registered on the IHI website, please click the “register now” button to do so.

Step 2: Enter your passcode and join the subscription

After you have successfully logged in, go to www.IHI.org/EnterPasscode You will notice a box to enter your passcode. Enter “B70583EE” and then click the “get access” button. After clicking the “get access” button, you will see a confirmation pop-up appear, indicating that you have successfully joined the subscription.

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IHI Open School online courses and videos

Step 3: Begin your first course

Go directly to the course website at www.IHI.org/ProfessionalCourses. You can bookmark this link for easy access during future visits. Click the “online learning” tab to begin your first course.

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Get Registered!

Rhonda need help with this

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