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Transcript of Create a Change
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HOW-TO GUIDE:STARTING A STUDENT RUN QUALITYIMPROVEMENT PROJECT
TMIT Student Projects QuickStart Package �
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Objectives
� List overarching global aims of improvement
� Form a multi-disciplinary team
�Begin to innovate, design, and implement astudent-run quality improvement project
� Use Plan-Do-Study-Act cycles for improvementinitiatives
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Outline
I. Introduction to Quality Improvement
II. From Innovation to Design
III. The PilotIV. Implementation
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Outline
I. Introduction to Quality Improvement
1) Aims for improvement
2) Multi-professional teamwork
3) Students role
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So You Want To Create Change?
´While all changes do not lead to improvement, all
improvement requires change.µ
- Institute for Healthcare Improvement
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From Theory to Practice:´Check a Box. Save a Life.µ The First Global Student Sprint
to Improve Healthcare
� We will use this exampleto illustrate how students
can design, pilot, andimplement a project
� The Innovation-
y Students taking the lead
with efforts in spreadingtheWHO Surgical SafetyChecklist
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Aims for Improvement
We need healthcare that is:
� Safey Avoid injuries to patients from the care that is intended to help them.
� Effectivey Match care to science; avoid overuse of ineffective care and underuse of effective
care.
� Patient-Centeredy Honor the individual and respect choice.
� Timelyy Reduce waiting for both patients and those who give care.
� Efficienty Reduce waste.
� Equitabley Close racial and ethnic gaps in health status.
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Safer Patient Care
BusinessSchool
PublicPolicy
Nursing
Medical
Pharmacy
Public HealthHealth Admin
Multi-Professional Teamwork
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Students Role
� There are hundreds of processes that can beimproved in a system.
� What you can do?
y Gain Knowledge Raise awareness and share knowledge of the System
y Be Active
Pilot and implement a safe practice
y Use Evidence Research latest evidence-based improvement strategies
Collect data before and after improvement strategy
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Pharmacy: Track antibiotic use and costs for surgical patients.
Engineering: Examine patient flow and fit checklistintoOR processes.
Health Admin: Determine the cost savings in yourhospitals from the checklist.
Public Health: Track patient outcomesand measure impact.
MD//DO/RN: Engage your classmatesto learn it, use it, and
seek advice from others.
Safe Surgery Student Sprint
Example:
Multi-Disciplinary Student Involvement
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Outline
I. Introduction to Quality Improvement
II. From Innovation to Design
III. The PilotIV. Implementation
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Outline
II. From Innovation to Design
1. Forming Your Team
2. Setting Aims
3. Creating a Strategy
4. Change Concepts
5. Project Proposal
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Innovating, not reinventing
� If you are talking to the right people, chances are you willstumble across someone who has had similar thoughtsabout changing the current system
� Connect early and discuss methods that are already inplace or being researched
� Your greatest barrier can be your attempt to do this onyour own
� Get a team on board and work together!
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Forming Your Team
� Collaborative Partners
y Multi-disciplinary team
y Each member with different expertise
� Recruit key opinion leaders and advisors
y Find a mentor who is connected to your projectthrough a department affiliation or quality
improvement committee
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Example:
Recruiting Key Opinion Leaders Safe Surgery Student Sprint
� A student used anevidence-basedimprovement strategy
such as theWHO
Surgical Checklist
� Introduced checklist tokey opinion leaders of hospitals, including:
y Superintendant of Hospitaly Chair of Surgery
y Chief of Quality Assurance
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Forming Your TeamLeadership
� Responsibility Charting
y Distinguish individual roles with listed activities
y Using this tasking method gives the whole team a
global view of the project·s evolution
� Logistics
y Create short deadlines
y Have frequent update meetings� T eam work!T eam work!T eam work!
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Example:
Responsibility Charting
Safe Surgery Student Sprint
Steps/Actions Tasks Deadline Status Owner Notes
Creating aVision/Strategy
Project Proposal
Action Plan
3/12/2009
3/15/2009
Complete
Pending
Sarah
John
Submitting toadvisor
Will email
Pilot Studies Case studies 4/5/2009 Pending Sarah JohnMichael
Draft #2
Deliverables StudentPowerPoint
5/1/2009 Pending Michael Draft #1completed
Publications Poster session 5/1/2009 Pending John Will emailcommittee
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Setting Aims
1. State your aim clearly
2. Identify the population and system to be improved
3. Set numerical goals
y To better measure outcomes
4. Set Stretch Goals
y Give yourself a timeline
Ex: R
educe infections by 50% in 6 months5. Avoid Aim Drift
y Focus on your goal and try not to steer away
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Creating an Improvement
Strategy
1. Critical thinking about the current system
2. Benchmarking
3. Using technology
4. Creative thinking
5. Using change concepts
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Change Concepts
An approach to change that has been useful indeveloping ideas for improvement efforts:
EliminateWaste
ImproveWork Flow
Manage Time
Focus on Variation
Change theWork Environment
Error Proofing
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Example:
Using a Change ConceptChanging the work environment
� Building a new typeof network
y Instead of Hospital Administrators,in this project, Students were theChange Agents in spreading thisquality improvement tool
y Students used new socialnetworking features as a primarymeans of building their projectnetwork
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Pro ject Proposal
I. Vision/Mission
II. Setting Aims
III. Proposal Outline
I. Background
II. The Intervention
III. Strategy for Implementation
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Outline
I. Introduction to Quality Improvement
II. Innovation to Design
III. The PilotIV. Implementation
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Outline
III. The Pilot
1) Using PDSA Cycles
2) Communication
3) Data Collection
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The Pilot
� Start as a pilot
y Small scale with a few individualstesting your improvement method
y Use Plan-Do-Study-Act (PDSA)cycles during this pilot phase
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The Pilot: Using PDSA Cycles
� Run a test trial on asmall scale
� Follow a simple
´PDSAµ cycle forpilot
y Plan
y Do
yStudy
y Act
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Example:
Using PDSA CyclesSafe Surgery Student Sprint
One student.One hospital. Threeoperating rooms.
� Plan:
y Introductory seminar and
teaching with hospitaladministration and residents.� Do:
y One week trial using 3 ORs� Study:
y Feedback session given toresidents and surgical staff..
� Act:y Continued piloting the
checklist in 3 operatingtheaters with improvementsin place.
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The Pilot: Communication
� Background education
y Share the facts
y Answer questions ahead of time
� Energize your team
y Get them excited about change!
� Communication
y Ensure that all of those participating in pilot are awareof their roles and project aims
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The Pilot: Data Collection
� Plot data over time
� Seek usefulness
�
Use sampling� Integrate measurement into daily routine
� Use qualitative and quantitative data
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Example
Data CollectionSafe Surgery Student Sprint
Wales, UK Jan ² June 2009
� Students were datacollectors in ORy
25 students observed 83operations
y Reported observationsinto an online data form
� Evaluated 5 items of
standard procedure� Data used to encourage
implementation
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Outline
V. Implementation
1. Pilot to Implementation
2. Keys to Successful Adoption
3. Project expansion
4. Leadership Changes
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Implementation
� After the pilot, evaluate for ways you can makethe project successful on a larger scale
� Create a step-by-step process outline for easyengagement
� Be ready for resistance
y Be prepared to address counter arguments
� Champions can lead the way
� Continue to Collect Data
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Keys For Successful
Adoption
� Relative Advantagey Degree to which an innovation is perceived as being better than
the idea it supersedes
� Compatibility
y Degree to which an innovation is perceived to be consistent withthe existing values, past experiences and needs of potentialadopters
� Complexityy Degree to which an innovation is perceived as difficult to use
� Trialabilityy Opportunity to experiment with the innovation on a limited
basis
� Observabilityy Degree to which the results of an innovation are visible to others
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Example:
Spreading your pro ject´Check a Box. Save a Live.µ
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Leadership ChangePassing the Torch
� Remember handoffs are a leading cause of error!
� Ensure members of the original team will be ableto continue carrying out efforts
� Document logistical challenges andrecommendations for the next leader
� Keep lines of communication open
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Summary Objectives
� List overarching global aims of improvement
� Form a multi-disciplinary team
�
Begin to innovate, design, and implement astudent-run quality improvement project
� Use Plan-Do-Study-Act cycles for improvementinitiatives
� e Bold. Be a Change Agent!