Safer Healthcare Now! Atlantic Node

RECOMMENDED TOOLKIT: SPREAD & SUSTAINABILITY OF BEST PRACTICES

Sujani JayanettiSeptember 9th, 2009

Introduction2

Patient safety is an international, national, and local issue

The range of adverse events that occur in healthcare facilities are astonishing.

Adverse events are unintentional unfavorable events that are due to healthcare management rather than the patient’s disease which may lead to extended hospital stay, disability, or even death (Baker et al. 2004).

Introduction

Adverse events may occur due to many reasons including; infections, medical errors, dangerous omission, incorrect procedures, incorrect diagnosis, and lack of effective team communication.

USA- Hospital Acquired Infections cause 90,000 deaths annually; costing $ 5 billion (Vincent 2006)

Canada- 70,000 adverse events (37%-51% are preventable) (Baker et al. 2004)

3

Introduction

Canadian Patient Safety Institute (CPSI)- 2003

Safer Healthcare Now! (2005)- Based on 100,000 Lives Campaign in the US

Ten evidenced based interventions

4

SHN! Ten Evidence Based Interventions

1. Deploy Rapid Response Teams/ Quick Response Teams (RRT/ QRT)

2. Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarctions (AMI)

3. Prevent Adverse Drug Events (ADEs) 4. Prevent Central Line Infections 5. Prevent Surgical Site Infections (SSI) 6. Prevent Ventilator-Associated Pneumonia 7. Prevent harm from antibiotic resistant organisms 8. Medication Reconciliation in long term care to reduce adverse drug

events in long term care settings 9. Prevent harm resulting from falls in long-term care settings 10. Prevent Venous Thromboemoblism (VTE)

5

Why participate in spread of best practices

Patients’ and carers’ [service] expectations are increasing Wide variation in outcomes and processes between practitioners

and organizations is no longer acceptable New technology is available to improve care and delivery processes What worked in the past won’t necessarily work in the future Shortages of resources, notably time, to invent own solutions If your neighboring colleagues and organizations are improving by

copying and re-inventing good practice, why aren’t you?

Source: Fraser 2002, p. viii

6

Make it Happen!!! 7

Source: Greenhalgh et al. 2004, p.593

IHI Spread Framework8

Source: Massoud et al. 2006; IHI n.d.

Sustainable Organizations9

The IHI Get it Started Kit lists 6 properties that exist in organizations that have shown sustainability of interventions:

1. Supportive Management Structure

2. Structures to “Foolproof” Change

3. Robust, Transparent Feedback Systems

4. Shared Sense of the Systems to Be Improved

5. Culture of Improvement and a Deeply Engaged Staff

6. Formal Capacity-Building Programs

Source: 5 Million Lives Campaign 2008

Focus Group10

May 22, 2009 WebEx 6 Participants Atlantic Provinces: Nova Scotia, New

Brunswick, Newfoundland Aim: To understand the barriers and success

factors to spread and sustainability of best practices in Atlantic Node SHN!

Focus Group- Emerging themes11

Necessity for a culture change towards patient safety Need for proper leadership & champions Need for clinician involvement Necessity for adequate communication The need for monitoring, measuring, and providing

feedback of interventions The need for more resources (staffing, measurement

resources, training) The false perception that patient safety alone is a good

enough incentive

Survey 12

Created using themes from focus group

34 questions

Sent to 53 key stakeholders in Atlantic Canada: NB, NL, NS, & PEI

45% response rate

Survey Results- Respondents13

Survey Results- Culture

Majority responded- Organizational structure supports patient safety and quality improvement work

Two third responded - quality improvement is nonnegotiable

Two third responded- has a history of sustaining quality improvement work

54% responded- structures in place to sustain and hardwire quality improvement work.

14

Survey Results- How important is patient safety work to:

15

Survey Results- Within your organization there are patient safety

champions among:

16

Survey Results- Education & Training

54% of direct care providers see a positive change

33% of the time physician champions involved in SHN! interventions

50% agreed roles and responsibilities are clearly defined; 25% some progress is being made

95% agreed there needs to be more training continued education

17

Survey Results- Communication

58% responded patient and family perspectives guides quality work; additional 12% said these perspectives were used

Need to be considered since they are clients and contributes to system and behavioural change.

Staff surveys used third of the time; ½ of the organizations use leadership walkabouts

18

Survey Results- Monitoring and Improvement measures

75% of respondents use measurements 42% reported quality improvement data are

displayed in easy to read charts and posted in clinical areas

Only 54% understand what the results of the collected data mean

19

Survey Results- Incentives

96% reported the intrinsic value in providing safer care and was a good incentive to get staff on board

Critical element to improving care However, insufficient for change in behaviour Rewards and recognition necessary Note: Calgary Health Region found physician

buy in difficult without financial incentives (Baker et al. 2008)

20

Survey Result- Resources21

Eleven Recommendations

1. Steering Committee for SHN! interventions

2. Develop and use a formal improvement spread plan

3. Monitoring, measuring, and feedback

4. Closer integration, engagement, communication among healthcare providers

5. Physician champions for all SHN! interventions

22

Eleven Recommendations

6. Champions not only at the frontline, but also senior leaders

7. Staff and healthcare provider input is needed

8. Training and education

9. Safety Competency Framework by CPSI

10. Recognition and rewarding achievers

11. Compiling and sharing how patient and family perspectives are brought to organizational and provincial decision tables

23

Take home message:

The whole organization from the Board of Directors to the point of service teams and individuals must be aligned in their efforts towards patient safety improvement and great outcomes. There is a need to take a holistic approach in strengthening all components of the system to maximize patient safety outcomes.

A chain is only as strong as its weakest link!

24

Tips &Tools

New Idea Scorecard Adoption Exercise Project Charter Team Charter PDSA Cycles Quality Improvement and Change Implementation Quality Tools Improvement Tracker Dr. Jan Davies as a consultant Walkabouts Patient Safety Rounds Physician Quality Officers Spread planner Spread Check List Checklist for Readiness to Spread

25

Questions26

Acknowledgement

Theresa Fillatre: Theresa.Fillatre@cdha.nshealth.ca

Dannie Currie: curried@cbdha.nshealth.ca

Pauline MacDonald Focus Group Participants Survey Respondents

27

References

Baker, G. R., Norton, P. G., Flintoft, V., Blais, R., Brown, A., Cox, J. Etchells, E., Ghali, W. A., Majumdar, S.R., O’Beirne, M., Palacios-Derflingher, L., Reid, R.J., Sheps, S., Tamblyn, R. (2004). The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. JAMC, 170(11), 1678-1686.

Baker, G. R., MacIntosh-Murray, A., Porcellato, C., Dionne, L., Stelmacovich, K., & Born, K. (2008). High Performing Healthcare Systems Delivering Quality by Design. Toronto: Longwoods Publishing Corporation.

Fraser, S. W. (2002). Accelerating the Spread of Good Practice. A Workbook for Health Care. United Kingdom: Kingsham Press.

Greenhalgh, T., Robert, G., MacFarlene, F., Bate, P., Kyriakidou, O. (2004). Diffusion of Innovation in Service Organizations: Systematic Review and Recommendations. Milbank Quarterly, 82(4), 581-629.

IHI. (nd). Case for Improvement. Retrieved on July 4, 2009, from http://www.ihi.org/IHI/Topics/Improvement/SpreadingChanges/SpreadCaseforImprovement.htm.

28

References

Massoud, M.R., Nielsen, G.A., Nolan, T., Schall, M.W., Sevin, C. (2006). A Framework for Spread: From Local Improvements to System-Wide Change. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement. Retrieved on July 21, 2009, from http://www.ihi.org/NR/rdonlyres/661BCB93-1FED-4ADB-86FE-4DDD84445AFD/0/AFrameworkforSpreadWhitePaper2006.pdf

5 Million Lives Campaign. (2008). Getting Started Kit: Rapid Response Teams. Cambridge, MA: Institute for Healthcare Improvement. Retrieved on July 21, 2009, from http://www.saferhealthcarenow.ca/EN/Interventions/RRT/Documents/RRT%20Getting%20Started%20Kit.pdf.

Vincent, C. (2006). Patient Safety. Toronto: Elsevier Limited.

29