WHO Checklist Its Value & Limitations e: academy@yhahsn.nhs.uk/ - PowerPoint PPT Presentation

Part of the Yorkshire & Humber AHSN WHO Checklist Its Value & Limitations e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshi kshire e & Humber ber AHSN Part of the Yorkshire & Humber AHSN • History & Rationale • Successes • Limitations e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN History • Pronovost (2001) introduced a short checklist for health-care workers who insert central lines. Asking practitioners to confirm that they had performed certain simple actions, such as washing their hands and sterilizing the insertion site, contributed to a dramatic reduction in the risk of life-threatening infections. • Keystone ICU project, Michigan (2003) Within 18 months of checklist introduction the rate of catheter-related bloodstream infections fell by 66%. e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN • ‘Matching Michigan’ 200 ICU Units in the UK 2009 – 2011 • Initial analysis of results published in 2012 – suggested similar reductions in mortality as seen in the US • Later analyses highlighted that it was not possible to separate the effect observed during checklist implementation from pre-existing downward trends in infection- related mortality. e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN • 2007 and 2008, eight hospitals around the world tested the checklist in a pilot study . . • Complications such as infections after surgery fell by more than one-third, and death rates dropped by almost half. • The WHO recommended that all hospitals adopt the checklist or something similar. • NHS immediately required all of its treatment centres to put the checklist into daily practice . e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN Results have not been widely replicable … • An analysis of more than 200,000 procedures at 101 hospitals in Ontario, Canada, for example, found no significant reductions in complications or deaths • Systematic review of implementation - 11 out of 22 studies didn’t even include their ‘health’ outcome data. e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN How do the Airline Industry use checklists? • Checklists are far simpler • Not necessarily designed to stimulate discussion • Team training + complex redesign of processes and work environments + checklists = incident reduction e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN • Where the conditions allow them to be used in a simple way – they work well. • A checklist will support a well-defined procedural task that may be vulnerable to problems with memory, task omissions or order. • Checklists may help teams with a good but not outstanding team interaction to improve their internal dynamics. e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN Example of systems engineering alongside implementation … • “we identified one exemplary ICU, in which a high infection rate fell to zero after Matching Michigan began. The unit was led by a charismatic physician who championed the checklist and rallied others around it. He formed coalitions with his colleagues so everyone was singing the same tune, and they just committed as a whole unit to getting this problem under control” e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN • NATSSIPS – extension of the checklist principle to wider systemic issues such as staffing, skills mix, patient flow etc. • Do we have evidence that checklists can tackle such issues? • What type of training needs to be provided alongside? e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN Can a Theoretical Approach help? e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN • Complexity Science • Management Studies • Clinical studies e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN What is the purpose of checklists? To help us deal with Complexity e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN Checklists through the lens of Complexity Science Snowden (2008) • 4 key domains which describe the way in which human social structures organize themselves • Different domains require different approaches to management e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN ‘Linear’ e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN ‘Complicated’ e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN ‘Complex’ e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN ‘Chaos’ e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN How can leaders start to manage Complexity? e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ

Part of the Yorkshire & Humber AHSN • Decentralistaion of power • Shift in team structures from ‘Hierarchy’ to ‘ Heterarchy ’ • Empowerment of team members e: academy@yhahsn.nhs.uk/ t: 01274 383926 www.improvementacademy.org Or visit our Academy Office: Bradford Institute for Health Research Temple Bank House / Duckworth Lane / Bradford / BD9 6RJ