Welcome! Improving Teamwork & Communication in Surgery November 15, 2012.
-
Upload
alison-delbridge -
Category
Documents
-
view
220 -
download
2
Transcript of Welcome! Improving Teamwork & Communication in Surgery November 15, 2012.
Welcome!
Improving Teamwork & Communication in Surgery
November 15, 2012
Agenda
• Table Discussion• Storyboards• World Café• Patient Perspective• Team Planning Time• Learning Systems• Future Directions
Table Discussions
• “Fresh eyes” from everyone at your table• Some questions to get us started…
1. Was there a moment when you said to yourself, “This is why culture is important”?
2. I feel like I’m banging my head against the wall when ____.
3. I laughed when ____ happened. 4. If I could go back in time and do one thing
differently, it would be _____.5. Is there someone in your unit who really
understands the purpose of culture improvement? Tell us about this person and what it’s like to work with them.
Credit: TeamSTEPPS
Theory Burst: A Shared Mental Model is…
The perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication.
“Teams that perform well hold shared mental models.”
(Rouse, Cannon-Bowers, and Salas 1992)
Shared Mental Model?
Credit: TeamSTEPPS
Storyboard review
• Identify two topics to discuss during the World Café
• Worksheet in folder
Theory Burst
Please Use CUS Wordsbut only when appropriate!
Credit: TeamSTEPPS
World Café
• Topic 1• Topic 2• Topic 3• Topic 4• Topic 5
7 minutes per topic
Patient Perspective
Team Planning
• Plan the next steps for when you return to your unit
• Worksheets in the folder• For those without SAQ data, the project
overview is provided for discussion
Confidential & Proprietary
The Components of Learning and Improvement
1. Aims
2. Mapping Strategy and Tactics
3. Small Tests of Change (aka PDSA cycles)
Let us look at each of these in detail and apply them to your work:
Confidential & Proprietary
OUTCOME MAJOR INFLUENCES
AIMAIM
11
22
ACTION
11
22
33
22
How The 3 Relate To Each Other:
Aim Strategy Mapping PDSA’s
11
LET’S EXPLAIN EACH OF THESE:
Confidential & Proprietary
Let’s use David to explain these relationshps:
David comes to America, eats an American diet,
now has a bit of a problem.
He wants to get fit again.
What should he do?
Confidential & Proprietary
New David
OUTCOME
AIM: A new David!
AIM: A new David!
MAJOR INFLUENCES
DietDiet
ExerciseExercise
Confidential & Proprietary
New DavidAim: David weighs 180 lbs in 18 months.
Examples of Healthcare Aims:
Decrease Surgical Site Infection by 25% in one
year.
In this unit, 75% of those surveyed will agree or
strongly agree with the statement “It is easy for
personnel here to ask questions when there is
something that they do not understand” in 5
months.
OUTCOME
AIM: A new David!
AIM: A new David!
Confidential & Proprietary
Produce Aim Statement(s)
Aim Statement:
What by When
Stretch goal
Unambiguous
Numeric
Measurable (Use measures to help clarify Aims)
Think about relative (better) versus absolute goals
Confidential & Proprietary
Getting from Influences to Interventions
OUTCOME MAJOR INFLUENCES
AIM: A new David!
AIM: A new David!
DietDiet
ExerciseExercise
ACTION
Limit daily intake
Limit daily intake
Substitute low calorie foods
Substitute low calorie foods
Avoid alcoholAvoid alcohol
Bike to workBike to work
Hacky Sack in office
Hacky Sack in office
Confidential & Proprietary
Adding In Measurement
OUTCOME MAJOR INFLUENCES
AIM: A new David!
AIM: A new David!
DietDiet
ExerciseExercise
ACTION
Limit daily intake
Limit daily intake
Substitute low calorie foods
Substitute low calorie foods
Avoid alcoholAvoid alcohol
Bike to workBike to work
Hacky Sack in office
Hacky Sack in office
• Weight• BMI• Body Fat• Waist Size • Daily
calorie count
• Avg. calorie daily
• Avg. drinks per week
• Meals off- plan/week
• Sodas/week
• Repetitions/Day
• Percent of days on bike
• Total Exercise calorie count
Confidential & Proprietary
What This Looks Like On A Worksheet
DietLow Calorie Food
Smaller Portion Size
Avoid Alcohol
Bike to Work
Hacky Sack Sitting
Exercise
Exercise
David180 lbswithin 1 year
Weight
Waist Size
See inWorksheet
Confidential & Proprietary
Model for Improvement:Plan Do Study Act (PDSA)
Make a Prediction
PLAN
DO
STUDY
ACT
• What are we trying to accomplish?
• How will we know that a change is an improvement?
• What changes can we make that will result in an improvement?
Confidential & Proprietary
Making a Prediction
• What is your hypothesis?
• What do you think will happen?
• No result is a failure as long as learning occurs
• Think ahead to future tests and how they might be shaped by the current small test.
Confidential & Proprietary
Guidance for Testing a Change Concept
• A test of change should answer a specific question!
• A test of change requires a theory and a prediction!
• Test on a small scale and collect data over time
• Build knowledge sequentially with multiple PDSA cycles for each change idea
• Include a wide range of conditions in the sequence of tests
• Don’t confuse a task with a test!
Confidential & Proprietary
PDSA TESTING: QUESTIONS AND COMPONENTS
What are you trying to accomplish in THIS test?
What change are you testing?
What is your THEORY and what do you PREDICT will happen?
How will you know the effect of the change?
Are there any TASKS to perform prior to the test?
NOTES:
PDSA Testing: Questions and Components
See inWorksheet
Confidential & Proprietary
PDSA TESTING: QUESTIONS AND COMPONENTS
What are you trying to accomplish in THIS test?
What change are you testing?
What is your THEORY and what do you PREDICT will happen?
How will you know the effect of the change?
Are there any TASKS to perform prior to the test?
NOTES:
PDSA Testing: Applied to David riding a bike
David agrees to ride a bike to work.
Design the first and second tests that will get David riding his bike to work.
Think – SMALL tests of change
In putting together each test, answer every question to the right.
Confidential & Proprietary
PDSA Testing: Questions and ComponentsPDSA TESTING: QUESTIONS AND COMPONENTS
What are you trying to accomplish in THIS test?
Find out if David can ride a bike.
What change are you testing?
David rides around the building.
What is your THEORY and what do you PREDICT will happen?
Theory: If David can make it around the building, he knows how to ride a bike. Prediction: He’ll succeed with flying colors.
How will you know the effect of the change?
He’ll head out in one direction and return around the building. Or... he won’t.
Are there any TASKS to perform prior to the test?
Borrow a bicycle. Clear the path of rocks and twigs. Watch out for cars in the parking lot.
NOTES: May need to adjust the seat
Confidential & Proprietary
OUTCOME MAJOR INFLUENCES
AIM: A new David!
AIM: A new David!
DietDiet
ExerciseExercise
ACTION
Limit daily intake
Limit daily intake
Substitute low calorie
foods
Substitute low calorie
foods
Avoid alcoholAvoid
alcohol
Hacky Sack in office
Hacky Sack in office
Incremental Changes in PDSA
• Weight• BMI• Body Fat• Waist
Size
• Total Exercise calorie count
• Daily calorie count
Can David ride a borrowed bike?
1
Can David ride to work one
morning?2
Can David ride to and from work in one
day?3
Can David ride safely at night in
the dark?4
Bike to work
Bike to work
Confidential & Proprietary
Action Planning Worksheet: Linking Aim Statement, Influences, and Interventions
Confidential & Proprietary
PDSA TESTING: QUESTIONS AND COMPONENTS or “Plan”
What are you trying to accomplish in THIS test?
What change are you testing?
What is your THEORY and what do you PREDICT will happen?
How will you know the effect of the change?
Are there any TASKS to perform prior to the test?
NOTES:
Do: Carry out the change or test and collect dataStudy: Analyze data and compare with your predictions; provide a summaryAct: Are we ready to make a change? Plan for the next cycle
Confidential & Proprietary
Test Numbe
r
PDSA Test Person(s) Responsible
Date Results and next steps
PDSA cycles over time
1. Describe the concept– Expand on Allan Frankel’s presentation in June
2. Connection between learning systems and culture improvement– Learning processes can support our culture
improvement work– We can direct our culture improvement efforts
toward creating a learning culture
Learning Systems
Definition
• A learning system is constantly learning about itself and using that information to move toward its goals.
• Some learning systems are learning organizations.
Organizational Layers
Tasks
Organizational Structure
Processes
Culture
Learning System
1. Systems Thinking2. Vision 3. Information Infrastructure4. Team Approach5. Personal Mastery
Systems Thinking
Systems Thinking
• How is catheter insertion in the OR affecting UTIs in the wards?
• How are changes in sterile processing affecting the operating room?
• How discharge might affect readmission
Organizational Layers
Tasks
Organizational Structure
Processes
Culture
VISION
Vision
• Catheters will be removed within 48 hours of insertion 90% of the time.
• It is easy to ask a question if there is something I don’t understand.
• It’s like being a part of a big family.
Tasks
Organizational Structure
Processes
Culture
Organizational Layers
Information Infrastructure
42
Transparency Accountability
PERSONAL MASTERYTEAM APPROACH
People are the basic unit
Organizational Layers
Tasks
Organizational Structure
Processes
Culture
Learning Organization
1. Systems Thinking2. Vision 3. Information Infrastructure4. Team Approach5. Personal Mastery
Tasks
Organizational Structure
Processes
Culture
Tasks
Organizational Structure
Processes
Culture
1
2
We can’t make a learning system without a culture shift
Because we are changing culture, we have the option to make a learning culture
Discussion
• What would tasks and processes that support learning look like in surgery areas?
• What do you think about working toward a culture of learning?
Future Directions
Improve on a specific culture metric
Embed teamwork behaviour
Improve a clinical
outcome(Connect
with NSQIP)
Build a learning
culture & learning system
Timeline
November December February MarchJanuary April
Quality Forum
Re-survey?Or Fall 2013?Continue Improvement
• Can we aim to present our experience in March?• Do we want to repeat the survey? Spring or Fall?
Future Planning
• Planning Group to determine group direction• Staying connected– Webinars – Qexchange– Cohorts– Other ideas?
• Research
Tomorrow
• Dr. Marty Makary• Lizzie Edmondson • Presentations from some of our teams!• Surgical Safety Checklist• Opportunities to connect with NSQIP• and more!