GHA Hospital Engagement Network HAC-Learning Collaborative Webinar ~ June 20, 2012 Kelley Dotson, GHA Nancy Fendler, GMCF Anne Hernandez, GMCF Kathy McGowan,

GHA Hospital Engagement Network HAC-Learning Collaborative

Webinar ~ June 20, 2012Webinar ~ June 20, 2012

Kelley Dotson, GHAKelley Dotson, GHANancy Fendler, GMCFNancy Fendler, GMCF

Anne Hernandez, GMCFAnne Hernandez, GMCFKathy McGowan, GHAKathy McGowan, GHA

Learn. Act. Improve. Learn. Act. Improve. Spread.Spread.

Keep the Drum Beat Keep the Drum Beat Going.Going.

• Discuss evidence based practice elements of a prevention program for VTE

• Define process assessment and evaluation using specific tools & examples

• Review participation information & guidelines

Learning Objectives



Overview

Education

•Process Assessment

•Process Evaluation

Discussion



Key changes are then implemented in a cyclical fashion

Performance Improvement Team Should Ask Three Questions:

Act• What changes are to be made?• Next cycle?• Adopt, adapt, or abandon??

Plan• Objective• Questions and predictions (why)• Plan to carry out the cycle (who, what, where, when)

Study• Complete the analysis of the data

•Compare data to predictions

•Summarize what was learned

Do• Carry out the plan• Document problems and unexpected observations• Begin analysis of the data

The PDSA Cycle for Learning & Improvement:



Rapid Cycle Change (Repeated Use of the Cycle)

Hunches Theories

Ideas

Changes That Result in

Improvement

A P

S D

APS

D

A P

S DD S

P ADATA

TIME

DIFFICULTY(Proactive Improvement that slowly changes the intrinsic noise over time)



Skills Which Support Improvement:

• Challenge the boundaries (creative thinking)

• Visualize the ideal

• Remove the “current way of doing things” as an option (think outside the box)

• Always go back to the overall practice goals to guide the PDSA cycles



To Accelerate Improvement:

• Develop focused, relative objectives

• Strive for usefulness in the data collection and analysis

• To obtain “buy in” begin with evidence-based goals

• Test first on a small scale and spread the good or well-adapted plans for change



Do. Small Tests of Change

• ALL improvement requires change, but not all changes lead to improvement

• The ability to develop, test, and implement changes is essential for continuous improvement

• A change concept is a general notion or approach to change that has been found to be useful in developing specific ideas for changes that lead to improvement. Creatively combining change concepts with knowledge about specific subjects can help generate ideas for tests of change.

• After generating ideas, run Plan-Do-Study-Act (PDSA) cycles to– Test a change or group of changes on a small scale



Why DO small tests of change?

• To increase your belief that the change will result in improvement.

• To decide which of several proposed changes will lead to the desired improvement.

• To evaluate how much improvement can be expected from the change.

• To decide whether the proposed change will work in the actual environment of interest.

• To decide which combinations of changes will have the desired effects on the important measures of quality.

• To evaluate costs, social impact, and side effects from a proposed change.

• To minimize resistance upon implementation.



D SP A

Cycle 5: Spread to other patients, physicians, units…

Cycle 4: Implementation of system change(s)

Cycle 3: Wider scale tests of change

Cycle 2: Follow up Tests with larger study group

Cycle 1: Very Small Scale Test

A PS D

D SP A

APS

DA PS D

DATA

Changes that result in

improvement

Hunches, theories, ideas

The PDSA Cycle for Learning and Improvement:



DATACycle 5: Make adjustments and implement protocol system wide

Cycle 4: Test protocol on additional units with a larger patient population

Cycle 3: Test protocol with one physician on one unit with one population

Cycle 2: Establish draft protocol for ordering prophylaxis according to best practice

Cycle 1: Develop system for regularly obtaining information regarding appropriate ordering and administration of prophylaxis for surgery patients(SCIP: VTE 1 & VTE 2)

D SP A

A PS D

D SP A

APS

DA PS D

VTE Prophylaxis integrated into

routine care for all

Develop successful

approaches to improve delivery

of VTE Prophylaxis

AimDecrease the number of VTE occurrence during hospitalization



What you’ve ALREADY done

Selected specific HAC to address

Formed Team

Set Aim

Established Measures

Selected Change

Tested Change

NOW WHAT?????



PLAN State the Objective of the planPlan the Change (what, who, when, where?)Predictions (what is expected to happen?)Data Collection (who, what, when, where?)

DO Describe what actually happened when you ran the test of change

STUDY ASSESS the measured results and EVALUATE how they compare to the predicted results

ACT Describe what changes to the plan will be made for the next cycle from what you learned

Small Test of Change Worksheet



How Do We Know That A Change is an Improvement?

• Are specific measures tested during the PDSA cycles demonstrating desired results?

• Does the change facilitate the overall goal(s) of the practice?

• Can this change be attained (and maintained) without undue interference with other important practice goals?



What to do with the Tests of Change?

Assess

Evaluate



STUDY. What did the tests tell us???

ASSESS AND EVALUATE

LEARN from Each Test….Was there improvement???

– NO. Make adjustments and repeat the test on a small scale

– YES. Expand the tests and gradually incorporate larger and larger samples until you are confident that the changes should be adopted more widely

NOW…change is ready for implementation on a broader scale (an entire pilot population or on an

entire unit)



ACT. Implement & Spread

• Implementation is a permanent change to the way work is done – Involves building the change into the organization – Infrastructure are not heavily engaged in the testing phase

• Documentation & written policies?• Hiring, training, and compensation?

*Implementation also requires the use of the PDSA cycle*

Learn optimal sequencing of tasks Work with people to help adoption and adaptation



Spread is the process of taking a successful implementation process from a pilot unit or pilot population and replicating that change or package of changes in other parts of the organization

*Spread efforts benefit from the use of the PDSA cycle*Plan how to adapt changes to other areaDetermine if the change resulted in the improvement

HOW??????

ACT. Implement & Spread 2



Sustained Change OVER TIME = IMPROVEMENT

• Improvement takes place over time• Determining if improvement has really happened and

if it is lasting requires observing patterns over time

Run charts• Graphs of data over time • Tool for assessing the effectiveness of change



RUN CHARTS

Run charts have a variety of benefits: •Help improvement teams formulate aims by depicting how well (or poorly) a process is performing•Help in determining when changes are truly improvements by displaying a pattern of data that can observe as changes are made •Give direction to improvement with information about the value of particular changes



IHI RESOURCES

RUN CHART TOOL•http://www.ihi.org/knowledge/Pages/Tools/RunChart.aspx

TRACKER TOOL•http://app.ihi.org/Workspace/tracker/



Assessing Assessing

Monitoring Improvement…RUN CHARTS



RUN CHARTS 2



RUN CHARTS 3



RUN CHARTS 4



Useful Strategies to Hold the Gains:

• Establish and document new processes• Make formal changes to job descriptions• Use regular measurements and audits• Factor new goals/processes into staff

training and new hire orientation• Assign ownership of new processes• Address the “social aspects” of change



Address the “Social Aspects” of Change:

• Provide and disseminate widely information on why the change is being adopted

• Give specific information on how the change will affect people

• Seek and use input from others, (especially those directly affected by the change), and encourage their support

• Publicize the PDSA results and what was learned from them

• Understand and address the causes of resistance to change



IMPROVEMENT Summary

• Step 1: Plan • Plan the test or observation, including a plan for collecting data.• State the objective of the test. • Make predictions about what will happen and why. • Develop a plan to test the change. (Who? What? When? Where?

What data to collected?)

• Step 2: Do • Try out the test on a small scale.• Carry out the test. • Document problems and unexpected observations. • Begin analysis of the data.



Step 3: Study•Take time to analyze the data and study the results. •Compare the data to your predictions. •Summarize and reflect on what was learned.

Step 4: Act •Refine the change, based on what was learned from tests.•Determine what modifications should be made. •Prepare a plan for the next test.

Summary



Hospital Engagement Network (HEN)*Review*

• Hospital Acquired Conditions– Pressure Ulcer Prevention– Fall Reduction– VTE Prevention– Adverse Drug Events (ADE)

• Each Hospital will work towards improvement in all areas

• Initially, each hospital will identify TWO conditions of focus for reporting

• Hospitals will report data using defined measures upon request



*Review* June is CATCH-UP Month

• HAC Specific Learning Collaborative– Kelley to email summary sheet for progress

• Individualized for each hospital with completed items

• Defined guidelines for information needed

– Each hospital representative will be contacted • GHA/GMCF and hospital representative will walk

through the progress sheet and discuss any concerns

• Review will assist communication and understanding

– Access Telnet and Materialshttps://quality.gha.org/Home/HospitalEngagementNetworkHEN/LearningCollaboratives/

HospitalAcquiredConditionsEventsHAC/Meetings.aspx

– Complete Sign-in Sheets and Evaluations• March 21 April 18• May 16 June 20



Questions or Concerns

• Kelley Dotson, RN, MSN, CPHQ– [email protected]– 770-249-4511

Documents

GHA Hospital Engagement Network HAC-Learning Collaborative Webinar ~ June 20, 2012 Kelley Dotson, GHA Nancy Fendler, GMCF Anne Hernandez, GMCF Kathy McGowan,