GHA Hospital Engagement Network HAC Learning Collaborative

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GHA Hospital Engagement Network HAC Learning Collaborative. Webinar ~ September 19, 2012 Kelley Dotson, GHA Freya Gilbert, Hughston Hospital Meryl Montgomery, MCCG. Follow-Up from 8/28 Evaluations. Technical Issues with Webinar Screen and volume Transcript with handouts - PowerPoint PPT Presentation

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  • GHA Hospital Engagement Network HAC Learning CollaborativeWebinar ~ September 19, 2012

    Kelley Dotson, GHAFreya Gilbert, Hughston HospitalMeryl Montgomery, MCCG

    Learn. Act. Improve. Spread.Keep the Drum Beat Going.

    Follow-Up from 8/28 EvaluationsTechnical Issues with WebinarScreen and volumeTranscript with handoutsView the presentersWebinar Material AvailabilityAgenda emailed with linksMaterials posted to GHA websiteParticipation in Sharing and LearningAllow participant to submit questions/requests prior to webinarOpen forum during webinar to allow sharingSmall group meetings with similar hospitalsSubscribe to the list serve at HealthcareCommunities.org (exchange info-EBP, Examples)Application of Reliability ConceptsHospitals examples through presentationsOpen forum for exchange of information

    Learn. Act. Improve. Spread.Keep the Drum Beat Going.

    Review concepts of the Reliability Theory used at specific hospitalsDiscuss improvement work for reliable design conceptsShare struggles and ideas related to using concepts of the Reliability Theory

    Learning Objectives

  • Reliability Theory Concepts in PracticeMed Rec - Hughston HospitalFreya Gilbert, RNAdministrative Director of Quality & Clinical PracticeHughston Hospital

    Learn. Act. Improve. Spread.Keep the Drum Beat Going.

    Analyzing Testing & ImplementingQuestion the Connection

    Key QuestionYour EvaluationIs the connection between goals and processes clear? (Failure to connect process measures to outcome goals makes no sense!)Medication Reconciliation-We learned to have an overall measurable goal and then to develop short term goals and objectives. Finding some objectives that we could reach quickly. Accomplishing quick wins starts the momentum and facilitates engagement from the front line staff.Is the design strategy primarily vigilance and hard work?

    Has some degree of segmentation been used to test?

    Is standard work with testing been part of the design?

    Is a design methodology being used?

    Are small tests of change being used in a rapid cycle?

    Is data collection rapid enough?

    Learn. Act. Improve. Spread.Keep the Drum Beat Going.

    Analyzing Testing & ImplementingQuestion the Design Strategy

    Key QuestionYour EvaluationIs the connection between goals and process clear?Is the design strategy primarily vigilance and hard work? (Am I guilty of using hard work and vigilance as my only strategy)Hard work is involved with any project but a focused on drilling down to processes to simplify. Process flow chart completed on steps for admitting patient at each point. Looked at differences and planned on ways to standardize process. Stratagy was to motivate front line staff by involving them in each step of the improvement process. Ask about their needs and thoughts for improvement.Has some degree of segmentation been used to test?Is standard work with testing been part of the design? Is a design methodology being used?Are small tests of change being used in a rapid cycle?Is data collection rapid enough?

    Learn. Act. Improve. Spread.Keep the Drum Beat Going.

    How to Measure Human FactorHow to Measure the Human Factor Human Factor Tests of Study the Design Process Identify Human Factor Tests of Change & Resulting Defects Develop Process to Resolve Defects

    Performance Rate = LESS than 95%Performance Rate = 95% or GREATERProcesses are varied, optional, & dependent upon human factorCommon equipmentStandard order sheets Personal check listsWritten policies/procedures Multiple choice protocolsProcesses are standard, routine, & instigate human factorDecision aidsPromptersStandard defaults Hard stopsRedundant processes

    Compliance feedback shared without solutions = Work harder next time Good Intent to Comply + Vigilance & Hard Work Process Failure Invited Performance NOT SustainedHabits, patterns, & schedules used in the process design to enhance compliance

    Human Factors (at least 25%) + Reliability Science Process Failure Prevented, Identified, Mitigated Performance SustainedEducation and training to provide information to increase awareness with NO standard process specified Education and training provides information to increase knowledge with processes specified, articulated, & tested

    How to Measure the Human Factor Human Factor Tests of Study the Design Process Identify Human Factor Tests of Change & Resulting Defects Develop Process to Resolve Defects

    Learn. Act. Improve. Spread.Keep the Drum Beat Going.

    Analyzing Testing & ImplementingQuestion SEGMENTATION

    Key QuestionYour EvaluationIs the connection between goals and process clear?Is the design strategy primarily vigilance and hard work? (Am I guilty of using hard work and vigilance as my only strategy)Has some degree of segmentation been used to test?Yes. We looked at each step of our medication reconciliation process by admission type & location. Focus was placed on obtaining the initial medication history.Is standard work with testing been part of the design? Is a design methodology being used?Are small tests of change being used in a rapid cycle?Is data collection rapid enough?

    Learn. Act. Improve. Spread.Keep the Drum Beat Going.

    Segmentation-Enables control of some variables-Defines boundaries success of sequential expectations-Tests validity rather than addressing the barriers-Forces understanding of the differences among segment-Fosters deeper understanding of design complexity-Allows the formation of predictable timelinesFinding the FIRST SegmentMUST represent a reasonable volumeShould have clearly defined boundariesInvolve willing participants to avoid barrier of agreeingAllows neutralization of key variables or barriersEstablishes a design themeIdentifying OTHER SegmentsTotal segment topics not to exceed 4-5Segment follows design theme (type of admission, physician, etc.)Segments differ by a distinct design featureAdjustment of the initial segment division as the design developsSegments cover the population involved in the topic

    Learn. Act. Improve. Spread.Keep the Drum Beat Going.

    Testing & ImplementingQuestion STANDARDIZATION vs STANDARD WORK

    Key QuestionYour EvaluationIs the connection between goals and process clear?Is the design strategy primarily vigilance and hard work? (Am I guilty of using hard work and vigilance as my only strategy)Has some degree of segmentation been used to test?Is standard work with testing been part of the design? Yes. We analyzed a specific step in a process to determine working, identified possible failures and an improvement goal, and then standardized process for all admitting units, and continue to test.Is a design methodology being used?Are small tests of change being used in a rapid cycle?Is data collection rapid enough?

    Learn. Act. Improve. Spread.Keep the Drum Beat Going.

    Standardization - Standard Work*KEY LEARNING POINT*

    A standardized process design using knowledge of human factors & acceptable science is superior to varied processes

    Allows training of new employees & enables testing of current employeesProvide the appropriate infrastructure (the how, what, where, who & when)The what we are standardizing is based on scientific evidenceInitial standardized protocol requires little time when testing a very small scaleChanges to the protocol in the initial stages should be required and encouraged The how is based on systems knowledge and does not require scientific evidenceDefects are studied and used to redesign the process

    Successful description of a process by 5 front line process users likely to achieve 95% performance & to sustain the performance over time

    Learn. Act. Improve. Spread.Keep the Drum Beat Going.

    Analyzing Testing & ImplementingQuestion the DESIGN METHODOLOGY

    Key QuestionYour EvaluationIs the connection between goals and process clear?Is the design strategy primarily vigilance and hard work? (Am I guilty of using hard work and vigilance as my only strategy)Has some degree of segmentation been used to test?Is standard work with testing been part of the design? Is a design methodology being used?Lean Six Sigma, Plan Do Check Act Tools used were audit form, walk through of process on each unit, flow chart each unit, FMEA, analysis of results, run chartsAre small tests of change being used in a rapid cycle?Is data collection rapid enough?

    Learn. Act. Improve. Spread.Keep the Drum Beat Going.

    Three Step Design for ReliabilityPoints 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

    StepsTechniquesPrevent initial failure by standardizing the process to achieve 80%Identify the process to standardizeSegment the population to test the design for anomalies2. Identify failures in step 1 and apply an action to achieve 80% for these failuresUtilize a robust concept to make visible failures from step 1 after step 1 has achieved 80% reliability Once the failure is identified, apply an action to mitigate the failure3. In either step 1 and/or step 2 detect the failures and use the knowledge from analysis of the failures to redesignIdentify common failuresDevelop a method to measure & study failuresUtilize knowledge of common failures to redesign either step 1 or step 2

    Learn. Act. Improve. Spread.Keep the Drum Beat Going.

    Analyzing Testing & ImplementingQuestion the SMALL, RAPID CYCLE TESTS

    Key QuestionYour EvaluationIs the connection between goals and process clear?Is the design strategy primarily vigilance and hard work? Has some degree of segmentation been used to test?Is standard work with testing been pa