Improvement Alliance Europe Year 1 Autumn Meeting Welcome & - - PDF document
November 3 & 4, 2016 November 3 & 4, 2016 Jnkping, Sweden IHI Health Improvement Alliance Europe Year 1 Autumn Meeting Welcome & Introductions Derek Feeley, Gran Henriks, Pedro Delgado & Maureen Bisognano 1 November
November 3 & 4, 2016 1
Year 1 Autumn Meeting
November 3 & 4, 2016
Jönköping, Sweden
Derek Feeley, Göran Henriks, Pedro Delgado & Maureen Bisognano
November 3 & 4, 2016 2
internationally
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spread throughout Europe and globally
capability and innovation to thrive
interest – Alliance wide priorities
Continual Focus on Adding Value
Virtual All Member Meetings In Person All Member Meetings Virtual Topic Meetings Shared Learning within HIAE Shared Learning with US Alliance Actionable Initiatives, Progress within Topic Areas Radical Redesign Principles for Europe Collective Voice of HIAE Sharing Learning Globally and Locally Strong Relationships, Networking Opportunities for All Members
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Some Proposed Principles for the Next 48 Hours…
– Split if you are from same organisation – 2 out of 3 sessions for all – Feedback will be for everyone
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Health Improvement Alliance Europe
Maureen Bisognano Derek Feeley
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The New Health Care Environment?
And in Europe?
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Obesity How Do We Address These Challenges?
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More of the Same?
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Leadership Alliance - Radical Redesign (from the inside out) Radical Redesign Principles Change the Balance of Power
– Co-produce health and wellbeing in partnership with patients,
families, and communities.
Standardize What Makes Sense
– Standardize what is possible to reduce unnecessary variation and
increase the time available for individualized care.
Customize to the Individual
– Contextualize care to an individual’s needs, values, and preferences,
guided by an understanding of “what matters” to the person in addition to “what’s the matter.”
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Radical Redesign Principles Promote Wellbeing
– Focus on outcomes that matter the most to people, appreciating that
their health and happiness may not require health care.
Create Joy in Work
– Cultivate and mobilize the pride and joy of the health care workforce.
Make it Easy
– Continually reduce waste and all non-value-added requirements and
activities for patients, families, and clinicians.
Radical Redesign Principles Move Knowledge, Not People
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Exploit all helpful capacities of modern digital care and continually substitute better alternatives for visits and institutional stays. Meet people where they are, literally.
Collaborate/Cooperate
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Recognize that the health care system is embedded in a network that extends beyond traditional walls. Eliminate siloes and tear down self-protective institutional or professional boundaries that impede flow and responsiveness.
Assume Abundance
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Use all the assets that can help to optimize the social, economic, and physical environment, especially those brought by patients, families, and communities.
Return the Money
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Return the money from health care savings to other public and private purposes.
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Introducing Christian
The Old Way
center.
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2009
2010 2012
Patri k From patient to employed From patient to patient support
The Microsystem Festival March 1–4 2016
plus.rjl.se/microsystemfestivalare on self-dialysis
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patients working”
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400 Teams in 10 Countries
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São Paulo, Brazil
Reablement- Oslo Kommune
with new patients in need of home-based care
– occupational therapists – physiotherapists – nurses – social workers
everyday life, transitioning patients to either:
Thomas Lystad
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Reablement- Oslo Kommune
–
Interests
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Resources
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Limitations
–
Current function
–
Goal
–
Plan
best possible function and a stable need for healthcare
Thomas Lystad
Jarle
Thomas Lystad
History:
– 70 year old man with COPD, type 2 diabetes, and two
previous heart attacks
– Suffered a major stroke, and spent a month in the hospital – Left side paralysis, poor cognitive and physical function
Began prescribed reablement program, which was continuously reassessed; made good progress and entered health rehab Came back to reablement after challenges; they helped him find a new, more accessible apartment Now largely independent, and needs a wheelchair only for long distances
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Breathe Magic
The Breathe Magic Foundation uses intensive occupational therapy to help children with hemiplegia
– Teach magic tricks, juggling, origami, and other creative arts to develop
coordination and self-esteem
Video link: http://breatheahr.org/breathe-magic/
Humanizing Healthcare
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St Ninian’s Primary School Stirling, Scotland
420 Students:
20% of pupils in deciles 1-3 35% of pupils in deciles 4-7 45% of pupils in deciles 8 and 10
At the Start: 45% of Pupils Were Overweight
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St Ninians Primary School Stirling Scotland Ms Elaine Wyllie wylliee48s@stirling.gov.uk
“The Daily Mile”
Three years later, and, of 57 Primary One children, not
Joy is more than the absence of burnout
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A variety of studies have shown association of provider burnout with:
Bodenheimer, T., Sinsky, C.. Annals of Family Medicine, Inc, 2015
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“Workplace safety is inextricably linked to patient
given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams.”
local context
responsibility at all levels
Outcome:
↑ Patient experience ↑ Organizational performance ↓ Staff burnout
approaches to improving joy in your
How to Create a Joyful, Engaged Workforce
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Critical Components for Ensuring a Joyful, Engaged Workforce
Interlocking responsibilities at all levels
Wellness & Resilience Physical & Psychological Safety Daily Improvement Meaning & Purpose Recognition & Rewards Autonomy & Control Participative Management
Happy Healthy Productive People
Camaraderie & Teamwork Real Time Measurement Physical & Psychological Safety:
Equitable environment, free from harm, Just Culture that is safe and respectful, support for the 2nd Victim Meaning & Purpose Daily work is connected to what called individuals to practice, line of site to mission/goals of the/
24 participating
375 rules submitted (and
counting!)
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Rules Surfaced
1.Rules related to policies and regulation 2.Rules related to patient and family experience 3.Rules related to workflow and processes 4.Rules related to staff experience 5.Rules related to culture and mindset
Khoo Teck Puat Hospital, Singapore
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“The sicker the patient, the fewer professionals they’ll need to interact with. We’ll take on the burden of coordination”
Changi General Hospital, Singapore
“We’ll take on the complexity of care”
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PEEK: 10,000 Children Screened per Week by Teachers in Kenya
November 3 & 4, 2016 25 ECHO Treatment Outcomes: Equal to University Medical Center
Hepatitis C Outcome
ECHO UNMH P-value N=261 N=146 Minority 68% 49% P<0.01 SVR (Cure) Genotype 1
50% 46%
NS SVR (Cure) Genotype 2/3
70% 71%
NS SVR=sustained viral response Arora S, Thornton K, Murata G. NEJM 2011; 364:23
Project ECHO
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Promoting Independence
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Radical Redesign Principles
And Now For the Hard Part
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Every Paradigm Needs a Vanguard Let’s Just Start Together on Radical Redesign
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Discussion
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Göran Henriks
Patient Supporters, Region Jönköping County
https://youtu.be/DVjIRlKmE8o
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Critical Components for Ensuring a Joyful, Engaged Workforce
Interlocking responsibilities at all levels
Wellness & Resilience Physical & Psychological Safety Daily Improvement Meaning & Purpose Recognition & Rewards Autonomy & Control Participative Management
Happy Healthy Productive People
Camaraderie & Teamwork Real Time Measurement Physical & Psychological Safety:
Equitable environment, free from harm, Just Culture that is safe and respectful, support for the 2nd Victim Meaning & Purpose Daily work is connected to what called individuals to practice, line of site to mission/goals of thePatient Partnership
Partnership means seeing and meeting the whole person. The person’s story is the starting point for building a relationship, common planning and mutual respect for each other’s knowledge.
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2009 2010 2012
Patrik
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Di DIALYSIS LIFE 1999 Dialysis LIFE 2011 -
Experience day 160412 Marie Steen, Annmargreth Kvarnefors
From Dependency to Autonomy
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Person Centred Care
Mobile Geriatric Team Clinical Microsystems
Learning Cafés
The Esther Network Advanced Access
Patient Stories – ”A Taste of Water”
Person Centred Process Mapping “Together”
“Passion for life”
“The Child Dialogue”
The Patient Law Jan 1st 2015
Swedish Association
and Regions Centre for Person Centred Care – GPCC The National Patient Power Investigation
Recovery Patient Advisory Group
E-Health
Rehabilitation Medicine
1997
National Program for the Elderly
Our Journey from Patient Centred to Person Centred Care
Patient supporters ERAS
Self Dialysis process
Health café
– meeting place for patients, relatives and
Living Library
Decision from the Strategic Board in Region Jönköping County …… Treat me like a fellow human being Give me knowledge Look into my eyes and imagine you are me Listen to me Converse with me, don’t talk to to me Let my family be part of my health care Meet me with respect …… Let me be a part of my own care Don’t diminish me
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Patient in the center Patient in the team
Patient´s need
Changing Perspective
Reference: Ann-Margreth Kvarnefors
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Mobile Geriatric Team
Kitchen table…….
https://www.youtube.com/watch?v=KhojvoZJ4Eg&feature=youtu.be
Department of Oncology
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Person centred process mapping – always the whole journey
Före- byggande Behov uppstår Kontakt Utredning Beslut
behandling Genomför Åtgärd/ behandling Uppföljning
Personcentrerad vård 161027 Mari Bergeling
Care Planning Diary
Of the 36 patients in rows 42-43 left 31 diaries and questionnaires out. 21 responded. 16 very positive and 4 negative 1 partly 2016-11-05
They got irritated when I handed
They do not write anything in the book Do we need to do this
I am not sure if it adds any value
How good anywhere
Difficult to interpret- patient
Helps to remember what the doctor said if you write it down -patient
good initiative
Helps the patient to memorize important information and make sure that information is correctly understood-patient
Reference: Marie Steen
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Personcentrerad vård 161027
http://levforattleva.ringla.nu
Reference: Dag Ström, Ann-Margreth Kvarnefors
Primary care is the entrance – specialty care on demand
Together for best possible health and equal care
Reference: Mats Bojestig
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Time to Improve Our Learning Platforms
2016-11-05
Learning on the away court (within the platform) Learning at home Learning at home and away Tests (acting) Tests (acting) Reflection (dialogues) Reflections (dialogues) Tests (results) Tests (results) Support knowledge development (for examples concept renewal) Results from a patient perspective
Reference: Per-Erik Ellström
How Are We Doing/Working…..
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References and Designers
anna.kvarnefors@rjl.se patrik.blomqvist@rjl.se
Experience day 160412 Marie Steen, Annmargreth Kvarnefors
Derek Feeley
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NICU Memorial Hermann Hospital
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“Breaking the Rules for Better Care” Week 2016
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January 11 – 15 was
the Rules for Better Care” Week
24 participating
375 rules submitted
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79 80
Northern Physicians Organization Palmetto Health Parkview Health Providence Health and Services Roanoke Chowan Community Health Center Sanford Health South Carolina Hospital Association
Texas Children’s Hospital University of Arkansas for Medical Sciences UPMC Women’s College Hospital
Year 2 Members
“Breaking the Rules for Better Care” Week Participating Organizations:
Bellin Health Charleston Area Medical Center Cincinnati Children’s Hospital Medical Center Consulate Health Care GBMC HealthCare System Illinois Hospital Association Kansas Healthcare Collaborative Kittitas Valley Healthcare Memorial Hermann MemorialCare Health System Missouri Hospital Association National Capital Region Enhanced Multi- Service Market
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and family members
staff, and leadership retreats
make meaningful change in their organizations
to make local and national change
begin changing health care more broadly
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that get in the way of optimal patient care, what would it be?
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Rule Type Rule Category Response Example Rules that need clarity Regulation myths or an
the rationale back to the rule Debunk
myths or hear directly from entities to clarify HIPAA call Rules that need redesign Administrative prerogative or habits User-centered design Rule breaking mentors HealthPartners and visiting hours Rules that need advocacy Real regulation
Collective voice Requests to CMS
WIHI: Thursday, April 7
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Breaking the Rules: Lessons from IHI’s Leadership Alliance Thursday, April 7 at 2:00 PM ET
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Presenting to CMS at the Spring Meeting
Alliance members requested specific actions for improvement in the areas of measurement, EHRs and the SNF 3 day rule:
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A Prototyping Workgroup
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Simple Rules for Eliminating Measures
2 years
near perfect performance
lacking in validity for quality)
20
these criteria? Could you eliminate them?
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89 90
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Rooms: Originalet - QI in a financially limited environment Visionen - Joy in Work Balansen – Population Health
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Jason Leitch
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Scores Support
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Rooms: Originalet - QI in a financially limited environment Visionen - Joy in Work Balansen – Population Health
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– 7:50 AM at the Grand Hotel – 8:00 AM at the Vox Hotel
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4th November 2016
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Brilliant hospitality Radical redesign principles Europe Breaking the rules Patients in the room Work stream design sessions A bit of singing and dancing Nice dinner
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Site visit Patients in the room Action planning Short break Collective voice Next steps
Yourself Your Organisation Our HIAE Network Tools Concepts Stories – building will for change
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Maureen Bisognano, Pedro Delgado
4th November 2016
morbilidad
poblacional
Double vaginal deliveries over 18 months (26 hospitals)
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Month/Year Lower is better % of C-section performed without medical justification
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1) Goals Aim Statement 2) Content Theory Driver Diagram or Change Package 3) Execution Theory Logic Model 4) Data Measurement & Learning Measurement Plan 5) Dissemination Dissemination & Spread Plan
Five Core Design Components
Source: Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: Lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016 Jan;11(1):12. Set Up Build Scalable Unit Test Scale Up Go to Full Scale
Phases of Scale-up
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National hub (Einstein and IHI supporting; ANS endorsing)
Cohort hub Cohort hub Cohort hub Cohort hub Cohort hub Cohort hub Cohort hub
Cohort hub
Hospital team Hospital team Hospital team Hospital team Hospital team Hospital team Hospital team Hospital team Hospital team Hospital team Hospital team Hospital team Hospital team Hospital team Hospital team
National and Regional infrastructure Test of scale up: 26 to 150
Source: Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: Lessons from large-scale improvement initiatives in Africa. Implementation Science. 2016 Jan;11(1):12.
Adoption Mechanisms
Set Up Build Scalable Unit Test Scale Up Go to Full Scale
Support Systems Phases of Scale-up
Leadership, communication, social networks, culture of urgency and persistence Learning systems, data systems, infrastructure for scale-up, human capacity for scale-up, capability for scale-up, sustainability
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QI in a Resource Constrained Environment
Move from ‘financially constrained’ to ‘resource constrained’ QI is central to operating in a resource constrained important Being able to articulate ‘why’ QI adds value at all times, especially during resource constraint Need for strategic, operational and individual vision and actions Balance system and process with people and culture The importance of building on the evidence base for QI Positive culture and environment for staff
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To nurture joy in work and joy in life
Embrace new ways of working Trust Meaning Development & mastery Teamwork
Flexible opportunities to keep older workers engaged and vital in the workforce New roles Wellness of the workforce Listening to everyone’s voice Psychological safety Humility Leadership visibility Celebrate Series of open conversations to identify pebbles Leadership at staff
Give compliments Keep the messages simple Stop issuing memos & policies & strategies Take time to explain the need for change Line of sight Improvement priorities that all can align to Regular constructive feedback Share stories regularly Eating & socialising together Multidisciplinary microsystem improvement Provide support when in difficulty or trauma Give permission Ongoing personal development Ongoing role development for individuals Sprinkling calm Freedom to focus on what matters to them Knowing each other as humans QI as whole teams only Facilitated debriefs Local setting of priorities Predictive and proactive workforce planning Pre-hiring Regular fun (Ministry of Fun) Exec WalkRounds & clinical shifts Grrrr board ‘Wandering books’ for new joiners Admit fallibility
“A meaningful and flourishing life for all in a safe and sustainable place” Sense that there is a burning platform and systemic enablers Strong desire to land principles into action Work on the ‘pre’s’ to control intensity of water tap (proactive approach to…) Start with self and own organization? QI perceived as value add of Alliance members – a method to bring will and ideas to implementation
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each work stream (2 weeks)
which work stream they want to work on (4 weeks)
streams (6 weeks)
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We’re here to join together to find new ways and best practices Curiosity and generosity as assets Shared commitment - best health for our populations, best care for our patients…at sustainable costs
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“A truly visionary company embraces both ends
conservatism and progressiveness, stability and revolution, predictability and chaos, heritage and renewal, fundamentals and craziness. And, and, and.”
− Jim Collins
Collins J. “Building Companies to Last.” Inc. Special Issue – The State of Small Business. 1995.
Polarized decision making; painful and false choices between: Short-term OR long-term Cost OR quality Clinical care OR administration Win OR lose Me OR you
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Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.
IHI High-Impact Leadership Framework
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Do you know how good you are? Do you know where you stand relative to the best? Do you know where the variation exists? Do you know the rate of improvement
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Create Vision & Build Will Engage Front Line Person Centered Relentless Focus Transparency Engage Across Boundaries Me Me and my senior team
Health Improvemen t Alliance Europe
Pedro Delgado
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Many assets
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Radical redesign principles Europe
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Workstream connections
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Storytelling
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implementing action plans
Alliance Europe Welcome Reception will take place at the National Forum in Orlando, FL on Monday, December 5th from 5:30 – 7:00 PM
GMT
London from April 26-28, 2017 – exact date coming soon
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Please fill out an evaluation form and return name badges at the registration desk. Thank you!