NoCVA Readmission Collaborative

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NoCVA Readmission Collaborative. October 25, 2012. Session Objectives. Share and discuss what you learned from interviews with patients recently readmitted Understand and apply a model for driving improvement through small scale tests of change - PowerPoint PPT Presentation

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  • NoCVA Readmission Collaborative

    October 25, 2012

  • Session ObjectivesShare and discuss what you learned from interviews with patients recently readmitted Understand and apply a model for driving improvement through small scale tests of changeIdentify one small scale test of change based upon your diagnostic work

  • Learning from Patient InterviewsWhat did you learn?Any surprises?What are you now curious about?

  • IHI FacultyRebecca SteinfieldRebecca Steinfield, MA, has been with IHI since 1996. She currently serves as an Improvement Advisor for IHIs State Action on Avoidable Readmissions (STAAR) initiative, funded by the Commonwealth Fund; sits on the faculty of the Kaiser Permanente Performance Improvement Institute, mentoring Improvement Advisors-in-training; teaches IHI courses on improvement methods; and serves on IHIs internal evaluation team. She is also mother to two children Jacob, 15, and Susie, 12.

  • An Introduction to the Model for Improvement

  • How wonderful it is that nobody need wait a single moment before starting to improve the world Ann Frank

  • What are we trying toAccomplish?How will we know that achange is an improvement?What change can we make that will result in improvement?

  • The Project AIM is:Not just a vague desire to do betterA commitment to achieve measured improvementIn a specific systemWith a definite timelineAnd numeric goalsWhat are We Trying To Accomplish?

  • *The Project AIM is:Not just a vague desire to do betterA commitment to achieve measured improvementIn a specific systemWith a definite timelineAnd numeric goalsHope is not a planSoon is not a timeWhat are We Trying To Accomplish?Some is not a number

  • Shady Oaks Hospital will improve transitions home for all patients as measured by a decrease in the 30-day all-cause hospital readmission rate from 12% to 8% percent or less within 24 months. We will start our improvement work with patients on 4W and 5S with a focus on improving our understanding of patients discharge needs and collaborating with community receivers of patients to ensure they have the information they need to care for the patient post-discharge. We will expect to see a decrease in the readmission rates for patients discharged from those units of at least 10% within 12 months.

    System:Goal:Timeframe:Guidance:Example of an Aim Statement

  • You cant fatten a cow by weighing it- Palestinian ProverbImprovement is NOT about measurementHoweverHow Do We Know if a Change is an Improvement?

  • Some Measurement AssumptionsThe purpose of measurement for improvement is learning not judgmentAll measures have limitations, but the limitations do not negate their value Measures are one voice of the system. Hearing the voice of the system gives us information on how to act within the systemMeasures tell a story; goals give a reference pointMeasurement is Central to the Teams Ability to Improve

  • Improvement Project Measurement GuidanceNeed a balanced set of measures reported each month (at a minimum) to assure that the system is improvedThese measures should reflect your aim statement and make it specificMeasures are used to guide improvement and test changesIntegrate measurement into daily routinePlot data for the measures over time and annotate graph with changes

  • What Changes Can We Make That Will Result in Improvement? The How-to-Guide contains IHIs best thinking on key changes needed to improve transfersUse this change package to identify the changes you want to make to your system to achieve your aim

  • What are we trying toAccomplish?How will we know that achange is an improvement?What change can we make that will result in improvement?

  • The PDSA CycleWhat will happen if we try something different?Lets try it!Did it work?Whats next?

    Plan Objective Questions & predictions Plan to carry out: Who?When? How? Where?

    Do Carry out plan Document problems Begin dataanalysis

    Act Ready to implement? Try somethingelse? Next cycle

    Study Complete data analysis Compare to predictions Summarize

  • Building Confidence for ChangeChange pkg ideas, suggestions, intuitionSystem changes that will result in improvementLearning from data

  • Change Idea: actively include patient and family in assessing needs (specifically, identify the learner on admission, and include them in discharge planning)If we identify the learner on admission, we can engage them in discharge planning and have a better chance of adherence to plan99% ReliabilityLearning from dataCycle 1: Day 1: On next admission, ask nurse to ask the patient to identify the person who should be involved in understanding their care plan after dischargeCycle 2: Day 2: Get information on family caregivers for all patients admitted to Unit ACycle 6: Educate staff on new standardsCycle 5: Standardize and documentMini-measure tracks improvement cyclesCycle 3: Day 3: Unit A is able to get useful information from all patients, continue with Unit A, all admissions, try Unit BCycle 4: Analyze failures, determine plans for patients without family caregivers

  • More Tips for TestingTest with volunteersUse simulation Do not try to get buy-in, consensus, etc.Be innovative to make test feasibleCollect useful data during each testAs cycles proceed, test over a wider range of conditions

  • 1 patient1 day1 admit1 physician

    Start Small ~ 1:3:5:All

  • Why Test?Why Not Just Implement then Spread?

  • Why Test?Why Not Just Implement then Spread?Increase degree of belief in the change ideaDocument expectations and results Build a common understanding Evaluate costs and side-effectsExplore theories and predictionsTest ideas under different conditionsLearn and adapt for the next test

  • What small scale test do you want to run before the next call?

  • Resources: Free On-Demand Streaming Video taught by Dr. Robert LloydAvailable on ihi.org:An Introduction to the Model for Improvement Provides a framework for organizing and guiding a teams improvement journeyBuilding Skills in Data Collection and Understanding Variation Designed to help teams successfully manage the milestones along the quality measurement journeyUsing Run and Control Charts to Understand Variation Addresses the application of statistical process control (SPC) methods, with specific attention given to run and control charts

  • AssignmentUsing the PDSA form, plan and run one small scale test of change within the next two weeks (think 1 patient, 1 staff member, 1 admission)Share your completed PDSA form, with learning from your test, by sending it out on the Collaborative listserv

    * Improvement Science in ActionNWIA Building Improvement Capability Session 3NWIA Building Improvement Capability Session 2Improvement Science in Action April 22-24, 2009**Raise your hands if you use the API Model for Improvement already*This is the collaborative model for executing change 3 questions and PDSAUsing Measurement for Quality Improvement 2010 R. ScovilleUsing Measurement for Quality Improvement April 2009**If you want to climb a wall, first throw your hat over it, then go get your hatUsing Measurement for Quality Improvement 2010 R. ScovilleUsing Measurement for Quality Improvement April 2009**If you want to climb a wall, first throw your hat over it, then go get your hat*Improvement Science in Action* 2010 R. ScovilleUsing Measurement for Quality Improvement April 2009****This is the collaborative model for executing change 3 questions and PDSA*Four parts of the cycle:Plan:Decide what change you will make, who will do it, and when it will be done. Formulate an hypothesis about what you think will happen when you try the change. What do you expect will happen? Identify data that you can collect (either quantitative or qualitative) that will allow you to evaluate the result of the test. Do:Carry out the change. Study:Make sure that you leave time for reflection about your test. Use the data and the experience of those carrying out the test to discuss what happened. Did you get the results you expected? If not, why not? Did anything unexpected happen during the test?Act:Given what you learned during the test, what will your next test be? Will you make refinements to the change? Abandon it? Keep the change and try it on a larger scale?

    *31*31****