Ron Collins, MD FRCP(C)Project Medical Director, Enhanced Recovery, IH

Co-Chair, Provincial Enhanced Recovery Collaborative, BCClinical Consultant, BCPSQC

Anesthesiologist, KGH

Innovation and Organizations

Disclaimer:

Speaker’s fees from Deltex Medical for GDFT

Objectives:Rock the Boat!

Reframe the problem?

Bad news, Good news…

Healthcare: A Perilous Journey

“Between the health care we have and thecare we could have lies not just a gap, but a chasm.” Institute of Medicine, 2001

“The immediate challenge to improving the quality of surgical care is not discovering new knowledge, but rather how to integrate what we already know into practice.” Urbach DR, Baxter NN BMJ, 2005

Evidence-based medicine.

Policy and procedure.

Standards and Guidelines.

Audits.

Limited success!

Hand Washing

Implementation…

The German ”Prevalence”Study in ICU

M M Levy, ASPEN 2007

92%

It is not like we think it is….

The German ”Prevalence”Study

M M Levy, ASPEN 2007

92%

4%

NSQIP

NSQIP

• Frequency of events reported

• Non-punitive response to errors

• Perception that management promote patient safety

• Organizational learning/continuous improvement

• Feedback and communication about safety incidents

• Handovers and transitions

• Teamwork within units

• Teamwork between units

A Culture of Patient Safety

A Culture of Caregiver Safety

CUSP, TPOT, Lean, WalkRounds

Success with MRSA

Success with MRSA

Social Networking

Social Networking

16

Length of stay reduced from 12.8 to 4.0 days.RIW reduced from 3.41 to 1.76

Benefit/cost ratio: 2.18ROI: 118%

CIHI estimated cost reduction of 48.4%.

1 5 91

31

72

12

52

93

33

74

14

54

95

35

76

16

56

97

37

78

18

58

99

39

71

01

10

51

09

11

31

17

12

11

25

12

91

33

13

71

41

14

51

49

15

31

57

16

11

65

16

91

73

17

71

81

18

51

89

19

31

97

20

12

05

20

92

13

21

7

0

10

20

30

40

50

60

70

80

UCL

LCL

Kelowna General Hospital Colorectal Patient Length of Stay Starting 3/09/2010

Patient Number

Le

ng

th o

f S

tay

(D

ay

s) UCL:

32.3 UCL: 10.3

Pre-ER-ACS Mean 12.8

ERACS Mean 4.1

ERACS Introduc-tion

Enhanced Recovery Processes of Care Reduce Complications

Successful Healthcare Organizations…

Promote a Culture of Caregiver Safety

Intentionally Connect with Caregivers

Actively Facilitate Diffusion of Innovation

Constantly Emphasize Alignment of ‘Purpose’