Welcome!

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:


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:


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?


New David

OUTCOME

AIM: A new David!

AIM: A new David!

MAJOR INFLUENCES

DietDiet

ExerciseExercise


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!


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


Getting from Influences to Interventions


AIM: A new David!

AIM: A new David!

DietDiet

ExerciseExercise

ACTION

Limit daily intake

Limit daily intake

Substitute low calorie foods


Avoid alcoholAvoid alcohol

Bike to workBike to work

Hacky Sack in office



Adding In Measurement


AIM: A new David!

AIM: A new David!

DietDiet

ExerciseExercise

ACTION

Limit daily intake

Limit daily intake



Avoid alcoholAvoid alcohol

Bike to workBike to work



• 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


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


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?


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.


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!


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


PDSA TESTING: QUESTIONS AND COMPONENTS






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.


PDSA Testing: Questions and ComponentsPDSA TESTING: QUESTIONS AND COMPONENTS


Find out if David can ride a bike.


David rides around the building.


Theory: If David can make it around the building, he knows how to ride a bike. Prediction: He’ll succeed with flying colors.


He’ll head out in one direction and return around the building. Or... he won’t.


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



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



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


Action Planning Worksheet: Linking Aim Statement, Influences, and Interventions


PDSA TESTING: QUESTIONS AND COMPONENTS or “Plan”






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


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


Tasks


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


Processes

Culture


Information Infrastructure

42

Transparency Accountability

PERSONAL MASTERYTEAM APPROACH

People are the basic unit


Tasks


Processes

Culture

Learning Organization

1. Systems Thinking2. Vision 3. Information Infrastructure4. Team Approach5. Personal Mastery

Tasks


Processes

Culture

Tasks


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!

Welcome!

Documents

Transcript of Welcome!