Modified R2R slides
-
Upload
ttshnursingresearch -
Category
Documents
-
view
611 -
download
6
description
Transcript of Modified R2R slides
Akarin Nimmannit MDManager of Routine to Research (R2R) Project
Assistant Dean for Quality Development Faculty of Medicine Siriraj Hospital
Mahidol University
Definition of R2R Research
Research question: Originate from routine service/workSolve 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 service
Modified from the concept of Prof. Dr. Vicharn Panich, Chairman of Mahidol University Council
3
Routine to Research (R2R) Unit
Launched in June 2004Health Services Research Management UnitMissions:Upstream to downstream
Routine work problem Research questionResearch proposal development Research proposal review (IRB-ethical clearance and
grant process)Research conduction monitoringManuscript/ implementation (service improvement)
Knowledge management (KM) for health services research
R2R Management Approach
KM basedR2R 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 researchR2R does not have to be very complex.R2R is not restricted only to the scholars.
Routine work
Clinic (Front office)
Support (Back office) Quality Criteria e.g. HA, JCIA &
TQAQuality Criteria e.g. HA, JCIA &
TQA
Knowledge Creation
Knowledge Translation
Medical Institute of the Kingdom toward International Excellence
Clinical Excellence
Innovation & Publication
Human Capital Excellence
Research Questions & Quality Development Topics are from..
1. Workflow: Value Stream Mapping• Care team: care process • Laboratory: Specimen collection, preparation, obtain,
handling, storage, process, report
2. 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 problem
3. Indicators (process, output, outcome)• Target, Timing• Other institute/Best practice• Standard criteria (HA/JCIA/ISO)
4. Organizational goal (s)
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
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
Redo US every 10 mins until Gynecologists satisfy with the quality of image
93 GYN Pts with normal kidney function
93 GYN Pts with normal kidney function
Randomization
Drink Water 400 cc.n = 30
Gynecologist independently perform GYN US when 1. Patients feel incline to urinate or 2. 45 min after drinking water
Drink Water300 cc. n =31
Drink Water 500 cc.n = 32
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
Work instruction for advising the patient for GYN US
With appointment
No appointment
“an hour” before appointment time
1. Empty bladder 2. Drink - 300500
(10-16 oz) cc of fluid
3. Do not pass urine until examination
1. Do not pass urine2 . Drink 300-500 (10-16
oz) cc of fluid3 . Do not pass urine4 . Wait 45 minutes
Patient to the US station
Implementation Result
Indicators
US Success rate (%)
Before1
months3
months
Complete as Appointment
50 601. 8 9
Complete as instruction (No appointment )
70 811. 9 4
Satisfaction - 7 5 .2 9 1
Waste Elimination: Defect Rework, Overproduction, Waiting, Motion, Excessive Processing
14
• 220 R2R projects• 130 Finished• >80% return to
improve services
Train and benefit a large majority of staffAllow employees flexibility to learn at their
own timeImprove 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
Hospital Management Asia: Human Resource Development
“We're Born to Learn, Not to Be Taught”John Abbott Author: Overschooled but Undereducated