Presentation Transcript

1. GHA Hospital Engagement Network HAC Learning Collaborative

   Webinar ~ October 17, 2012 Kelley Dotson, GHA Josee Gill, Upson Regional Medical Center
2. Summary of September Telnet Discussion… Discussion focused on the barriers commonly faced with quality improvement efforts Comments led to identifying one common barrier among most hospitals Frontline staff work with limited resources Frontline staff constantly told to “do …” Questions: How do we engage frontline staff in quality initiatives to the point of owning the responsibility and accountability of implementing quality initiatives with limited resources? How do we embed the fact that the initiatives define the care processes found to deliver safe care and quality outcomes?
3. Learning Objectives Discuss methods to engage frontline staff in improvement efforts Review steps to successful engagement of frontline staff at Upson Regional Medical Center. Share ideas related to engaging frontline staff

4. Frontline Staff Engagement

   Kelley Dotson, RN, MSN, CNL, CPHQ Quality / Safety Specialist Georgia Hospital Association
5. Improvement Method: Design for Reliability Points to Remember - Perfection is the enemy of DESIGN - Constant testing of observed defects The design is designed by the people who use the design - Segmentation tests the design (Resar, 2012)
6. Improvement Method: Healthy Work Environment AACN
7. Improvement Method: TCAB
8. Improvement Methods: CUSP
9. Frontline Defect Driven Project Model x Collect Data Identify Defects Suggest Strategies Small Tests Leading To Project Success Non-clinical Clinical Frontline Engagement Frontline Defects Frontline Structured Conversation
10. Improvement Method Reliability Theory (IHI) Healthy Work Environments (AACN) Transforming Care at the Bedside (IHI, RJWF) CUSP (AHRQ) Defect Analysis (Resar) THE NURSE HOLDS THE KEY
11. Improvement Strategy Change Misconception = People RESIST Change “People don’t resist change, they resist being changed.” (Bregman, 2009)
12. RESISTANCE TO CHANGE LEADERS PLAN STAFF
13. How do we AVOID THE RESISTANCE? LEADERS  STAFF PLAN PROCESS
14. The Challenge of Staff Engagement: Improvement Approach
15. Frontline Defect Driven Project Framework x1 Timeline 90 min 2 Days 1 day 60 min 60 min 30 days Design Benefit Frontline Engagement Leadership Engagement Frontline Engagement Tester Engagement Frontline Engagement Surface Defects Scope Defects Validate Select specific work Design Strategy Finish Project Actions Align work Gauge Capacity Articulate Implications Study next defect Conversation Specific Methodology Anchoring Questions Frontline Feedback Y/N Frontline Data Collection Determine frequency Define Boundaries Determine Simple measures Frontline Input Small Tests Design Basics of the Actions (Resar, 2012)
16. The Framework:Initial Meeting Planned Visit with Multidisciplinary Team Preferably the session occurs on the unit Preferably the session occurs when a representative group of the frontline can participate Non-threatening / blame free Introduction to work Identification of “defects” Normalization of Deviation Invite Leadership Representative
17. Initial Meeting:Starting the Conversation Make introductions around the group Take time to allay fears to participants One lead person initiate conversations by asking individual frontline staff to describe their daily routine Others can participate later Don’t question or interrupt description of daily routine
18. Initial Meeting:Anchoring Examples to Surface Defects 1-We all have good and bad days at work. Describe the last difficult day you recall. 2-Things have to be adjusted in work flow to make the day smooth. Describe how you make adjustments to accomplish getting the work done. 3-What clinical diagnoses are most common on this unit? Describe the most difficult cases you work with on this unit. 4-The unexpected is bound to occur from time to time. Describe the last unexpected event that occurred in your work.
19. Initial Meeting:Surfacing the Defects Each anchoring question usually surfaces at least one defect Most 90 minute conversations surface from 12-20 defects Avoid spending time on possible solutions (that will come later) Have a scribe write down each of the defects with as much detail as possible Finish the conversation by listing the defects surfaced Assure the frontline staff one or more of the defects will be solved Thank the team for the time spent during the session
20. Initial Meeting:Common Observations Daily interruptions are commonly viewed as normal, so little or no attempt is currently made to change processes The units function primarily at an artisan level of work. Staff pride themselves in their unique ability to deal with defects or “scrambling” “Victimized”by external factors. Most areas described problems with a system “out there”that are beyond their control—units, physicians, scheduling systems, a physician’s preference
21. Cedars-Sinai: Initial Learnings It became clear that the seeds for the next event have already been sown in the day-to-day missteps described as “normal” by staff. Start small with the creation of small islands of stability. An island of stability represents an area of work that has been reviewed and changed to create a new standardized way to organize workflow. Build unit-based learning, reflection on work, measurement, & change leadership systems to support work at the local level.

22. Frontline Staff Engagement at Upson

    Josee Gill, RN, MSN Chief Clinical Officer Upson Regional Medical Center
23. Impetus to Improve Participated in CUSP, TIPS, STOP BSI, CAUTI, Power Hours, PHA, Better Care, Safer Patients, and we are involved in HEN’s, HAC, HAI, Readmissions, EED. Education, Webinars, Face to face meetings, Hospital Engagement Network Right thing to do for our patients
24. Deliver Quality Care in a Safe Environment To reduce HAIs to a rate of Zero in ICU To sustain the rate of Zero To Reduce HACs To Reduce Readmissions To Zero Early Elective Deliveries To hardwire a culture of safety Ultimate goal is to provide the right care for all of our patients
25. Evidence Based Practices and Standardization Providing Education Learning and Improving from our defects Developing Order Sets/ Check lists and Bundles Transparency Accountability
26. Connect to the “Why” The Patient is the Center of Everythingwe Do
27. Connect desired behaviors to the “why” Traditional Approach: What, how, why Should be: Why, How and What
28. Weakly Leader Huddles, or what get measured, improves
29. Vision

30. Alignment & Consistency

    High Quality of Life 2008 2012+ 2006 This is what occurs when there is no focus on results and individuals randomly implement activities that they think will make things better. Random Acts of Improvement Aligned Acts of Improvement Synergistic Acts of Improvement
31. Top Challenges in ExecutionIs your Hospital a Victim? Accountability/ Accountability and Actions Leaders /others underperforming and still receiving good evaluation Push back by leaders, staff and physicians Alignment: Change is not connected to the WHY Lack of necessary urgency
32. Top Challenges in ExecutionIs your Hospital a Victim? (con’t) Actions: Leaders do not have the skills to assure a solid implementation Too many changes- too soon Not familiar with what “right” looks like Lack of frequency Inability to transfer best practices Poor Processes
33. Culture of Safety Culture of Collaboration Culture of Accountability Culture of Execution Culture of Innovation
34. Incremental Changes Culture of Safety Engaged Infection Preventionist Engaged Leadership Team Dedicated and engaged front line staff Hourly rounding Leader Rounding Bedside Reporting Transparency and Accountability
35. You can Pray!
36. Hourly Rounding Hospital Acquired Conditions Adverse Drug Events Catheter Associated Urinary Tract Infection Central Line Associated Bloodstream Infection Injury from Falls and Immobility Obstetrical Adverse Events Pressure Ulcers Surgery Site Infections Venus Thromboembolism Ventilator Associated Pneumonia Preventable Readmissions
37. TRUST & VERIFYCCO Reviews All Rounding Logs
38. HAC #1 – Reduction in Adverse Drug Events
39. Guardrail % with IV Smart Pumps
40. HAC #4 – Injury from Falls & ImmobilityReduction in falls
41. HAC #4 – Injury from Falls & ImmobilityReduction in falls
42. HACs #3 and #9Annual rate of infection in ICU
43. HAC # 5– Obstetrical Adverse EventsReduction in endometritis
44. Improvement in Aggregate Percentage – All Care Measures
45. It’s not Rocket Science Commit to Excellence Measure the Important things Build a Culture around a service Create and Develop Leaders Focus on Employee Satisfaction Build individual Accountability Align Behaviors with Goals and Value Communicate at all Levels Reward and Recognize Success Walk the talk
46. Conclusion Put the PATIENT first! ALWAYS!! Understanding the WHY State clear goals Develop processes to meet goals Monitor processes Maintain strict adherence to processes (checklist, bundles and standardized order sets) Transparency with outcomes Increase in patient satisfaction
47. Colin Powell “There are no secrets to success. It is the result of preparation, hard work, and learning from failure. “
48. Contact Us Anytime jgill@urmc.org 706-647-8111 ext 1756
49. DISCUSSION AMONG PARTICIPANTS SHARE QUESTIONS
50. To-Do List Submit process data Collect data using the worksheet Email data to kdotson@gha.org Current collection should be the 4th month of process data collection and submission Complete the electronic evaluation Remember…complete & send the sign-in sheet if listening to the recording Join the Georgia HEN Community of Practice on the HealthcareCommunities.org website List Serve is excellent way for hospitals to share information List serve is excellent way for HEN to provide information
51. Educational TELNET/Webinars 3rd Wednesday every month November 21, 2012 11:00 am – 12:00 pm November 21 is Thanksgiving Week When completing the evaluation, make suggestions for the November telnet Next Telnet/Webinar
52. Resource List AACN PEARL: Implementing the ABCDE Bundle at the Bedside. AACN's Healthy Work Environments Initiative PATIENT SAFETY PRIMERS IHI Transforming Care at the Bedside Begman, P. (2009). How to counter resistance to change; Harvard Business Review retrieved on 10/12/12 Refer to website for detailed list.