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The Challenges of Implementation (Will, Ideas, Execution)

The Challenges of Implementation (Will, Ideas, Execution). Dr Elizabeth Haxby Royal Brompton and Harefield NHS Foundation Trust. Traditional Approach. Overwhelming number of issues to be addressed Large audits ie 100s of patients telling us what we already knew Time consuming committees

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The Challenges of Implementation (Will, Ideas, Execution)

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  1. The Challenges of Implementation(Will, Ideas, Execution) Dr Elizabeth Haxby Royal Brompton and Harefield NHS Foundation Trust

  2. Traditional Approach • Overwhelming number of issues to be addressed • Large audits ie 100s of patients telling us what we already knew • Time consuming committees • Profusion of policies – average 50 pages long • Assumption that policy = practice • Lack of Engagement

  3. Approve Design Design Design Design Conference Rooms Real World Implement

  4. Trust wide VTE prophylaxis compliance

  5. Reasons for Failure • Lack of clear goals or timeframes • Failure to frame the policy and provide context • Elements of the policy impractical • Failure to engage with the people who will implement the policy • Feedback intermittent, not directed

  6. New ApproachSurgical Site Infection

  7. New Approach Set context Set clear aim and timeframe Engage with front line staff Listen to their concerns and ideas Try small tests of change Establish measures and feedback

  8. SSI - cost to patients, cost to healthcare • Patients with a superficial infection had an extra LOS of 20days (P<0.0000) and cost an extra £9,735 (P<0.0098) • Patients with a deep or organ space infection had an extra LOS of 54.5 days (P<0.0098) and cost an extra £40,726 (P<0.0098) Difference in Median LOS Difference in Median Cost

  9. Driver diagram SSI prevention

  10. E X E C s S U R G E O N S O D A s M A N E G E R S A N A E S T H E T I S T S Tribal Non-alignment N U R S E S P O R T E R S

  11. Aims Strategy & Tactics Leadership Alignment Structure Language Staff

  12. Multiple small changes • SSI data review at monthly CG day • Cross site multi disciplinary WIP group • Care bundle measurement with feedback to theatre staff • Changes to; • Theatre access • Hand hygiene / scrub up • Surgical prep • Dressings • Wound management • Vein harvest • Re-enforced antibiotic policy • Feedback to individual surgeons on SSI with RCA and bundle compliance for each patient • Board level reporting • Local CQUIN indicator

  13. Small test of change

  14. SSI Prevention Care Bundle

  15. Conference Rooms Approve (if necessary) Design Test and Modify Test and Modify Test and Modify Implement Real World

  16. The Challenge of Implementation • Clear Aim • Start small • Engage all the right people • Expect failure and respond promptly • Measure • Don’t underestimate anyone • Give information / feedback frequently • Seek additional drivers

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