Upload
others
View
4
Download
0
Embed Size (px)
Citation preview
Learning Session 1
MCA Ward Collaborative
Steve
9.15
Overview of the Ward Collaborative
Time Topic Who
9.00 Icebreaker Nicola/Maria
9.15 Agenda and Overview Steve
9.35 Welcome Becky Joyce & Helen Brown
9.45 Quality Improvement and Microsystem Basics
(Inc. October Sky Video)
Nicola & Jo
10.45 Break
11.00 Story from the Field – Respiratory CHANGE team Jennifer and team
12.00 Effective Meeting Skills Maria
12.15 Lunch
13.00 Getting Started - Understanding your system using
the 5Ps (Including Speed Painting Video)
Steve
13.15 5Ps team exercise (using EMS) Maria
14.30 Break
14.45 Process Mapping (including Paper Aeroplane) Steve & Jo
15.45 Involving Patients in improvement Laura
16.00 Planning Time – Next steps Claire
17.00 Close
MCA Ward Collaborative Aims
• To support wards to improve care for the patients they serve by March
2016.
• To build quality improvement capability with the staff on those wards
so that quality improvements can be maintained and improvement
becomes continuous during this period.
• To support and develop new MCA coaches working in the ward
environment by buddying them with experienced service improvement
coaches.
• To create an opportunity for wards to learn from each other, share
improvements and good ideas to accelerate the rate of improvement
for patients
Ward Collaborative Teams & Coaches
Team & Wards Faculty Coach MCA Coach
GSM
(B5 & B6 NGH) Steve Claire
Gastro
(RH3 & RH4 NGH) Nicola Davlyn
Spinal (Osborn 2) Maria Donna
Spinal (Osborn 3) Kevin Tim
Infectious Diseases
(E1 & E2 RHH) Nick Colin
Orthopaedics (F1 RHH) Jo Laura
Cardiology CCU Paul Aileen
Ward Collaborative Overview
Workbook p15
Learning Session Overview
Session 1 Session 2 Session 3 Session 4
Introduction to the
collaborative.
QI and
microsystem
fundamentals,
Effective meeting
skills,
understanding
your system using
the 5Ps
Process mapping,
Patient
involvement.
Story from the
field. (CHANGE
room).
Progress reports
from all teams,
Feedback and
sharing on the
5Ps,
Themes and Aim
statements,
Change Ideas and
PDSA,
Measurement
basics.,
Story from the
field. (Hadfield 6)
Planning Time
Progress Reports
from all teams,
Psychology for
improvement
Run charts and
Variation,
5s,
SDSA and
sustaining
improvement.
Planning Time
Progress Reports
from all teams as
posters and
presented case
studies.
Capacity and
demand basics.
Planning multiple
improvements
using driver
diagrams
Learning Session Overview
Session 1 Session 2 Session 3 Session 4
Introduction to the
collaborative.
QI and
microsystem
fundamentals,
Effective meeting
skills,
understanding
your system using
the 5Ps
Process mapping,
Patient
involvement.
Story from the
field. (CHANGE
room).
Progress reports
from all teams,
Feedback and
sharing on the
5Ps,
Themes and Aim
statements,
Change Ideas and
PDSA,
Measurement
basics.,
Story from the
field. (Hadfield 6)
Planning Time
Progress Reports
from all teams,
Psychology for
improvement
Run charts and
Variation,
5s,
SDSA and
sustaining
improvement.
Planning Time
Progress Reports
from all teams as
posters and
presented case
studies.
Capacity and
demand basics.
Planning multiple
improvements
using driver
diagrams
Learning Session Overview
Session 1 Session 2 Session 3 Session 4
Introduction to the
collaborative.
QI and
microsystem
fundamentals,
Effective meeting
skills,
understanding
your system using
the 5Ps
Process mapping,
Patient
involvement.
Story from the
field. (CHANGE
room).
Progress reports
from all teams,
Feedback and
sharing on the
5Ps,
Themes and Aim
statements,
Change Ideas and
PDSA,
Measurement
basics.,
Story from the
field. (Hadfield 6)
Planning Time
Progress Reports
from all teams,
Psychology for
improvement
Run charts and
Variation,
5s,
SDSA and
sustaining
improvement.
Planning Time
Progress Reports
from all teams as
posters and
presented case
studies.
Capacity and
demand basics.
Planning multiple
improvements
using driver
diagrams
Learning Session Overview
Session 1 Session 2 Session 3 Session 4
Introduction to the
collaborative.
QI and
microsystem
fundamentals,
Effective meeting
skills,
understanding
your system using
the 5Ps
Process mapping,
Patient
involvement.
Story from the
field. (CHANGE
room).
Progress reports
from all teams,
Feedback and
sharing on the
5Ps,
Themes and Aim
statements,
Change Ideas and
PDSA,
Measurement
basics.,
Story from the
field. (Hadfield 6)
Planning Time
Progress Reports
from all teams,
Psychology for
improvement
Run charts and
Variation,
5s,
SDSA and
sustaining
improvement.
Planning Time
Progress Reports
from all teams as
posters and
presented case
studies.
Capacity and
demand basics.
Planning multiple
improvements
using driver
diagrams
Becky Joyce
Helen Brown
Welcome
9.45 – 10:10
Nicola & Jo
What is Quality Improvement?
Key Elements Required for Improvement to
Happen
• Will to do what it takes to change to a new
system
• Ideas on which to base the design of the
new system
• Execution of the ideas
COMPLEXITY
Ford Mustang
1968 2015
Royal Hallamshire Hospital
1968 2014
Age-standardised five-year relative survival rate,
female breast cancer, England and Wales, 1971-2009
0
10
20
30
40
50
60
70
80
90
100
1971-1975
1976-1980
1981-1985
1986-1990
1991-1995
1996-1999
2001-2006*
2007-2009*
% s
urv
ival
Period of diagnosis
* England only
Chance of Successful Outcome
Time
Surgery Post-Op
Potential
Actual: Great
Actual: Poor
Health care: Good News / Bad
News
QUALITY IMPROVEMENT? What is
High Quality care is care that is:
• Safe – no needless deaths
• Effective – no needless pain or suffering
• Patient-Centered – no helplessness in those
served or serving
• Timely – no unwanted waiting
• Efficient – no waste
• Equitable – for all
Quality: The IOM’s Six Aims
Workbook p19
Improvement
The combination of a ‘change’ (improvement)
combined with a ‘method’ (an approach or
specific tools) to attain a superior outcome
Workbook p20
Model I: Bad Apples
The
Problem
Quality
Frequency
The Simple, Wrong Answer
Blame
Somebody
The Cycle of Fear
Increase
Fear
Micromanage Kill the
Messenger
Filter the
Information
Model 2: Positive deviance
Model 2: Continuous Improvement
“Every Defect is a Treasure”
Quality
F
req
ue
nc
y
Quality
Improvement - The
structure
Assessment - 5Ps
Diagnosis - Change Ideas
Treatment
- PDSA
SDSA
‘Standardise’
Plan
•Objective
•Questions and
predictions (Why)
•The plan – who what
where when
Do
•Do the Plan
•Document problems,
observations
•Begin analysis
of the data
Study
•Complete analysis of
data
•Compare data to
predictions
•Summarise the
learning
Act
•What changes
are to made now?
•What is the next
cycle
PDSA
PDSA - experimentation • Always start with a specific aim - What are we trying to accomplish?
• How will know if this is an improvement? – Data.
• Small tests of change over a short time
• Debrief frequently
• Communicate results
• Repeated Cycles
• When we meet our aim? –
SDSA = Standardise
SDSA
1
3
2
P
DS
A
P
DS
A
P
DS
A
P
DS
A
P
DS
A
P
DS
A
4
5
6
The Value of “Failed” Tests
“I did not fail one
thousand times; I found
one thousand ways how
not to make a light bulb.”
Thomas Edison
Workbook p34
Nicola & Jo
10.10
Microsystem Basics
Understanding Systems
• What is a “system”?
• How do we define a “system”?
Understanding Systems
• What is a system?
•System = a collection of processes working
together to produce a defined output
“Every system is perfectly designed to
get the results it gets.”
Paul B. Batalden, MD
Co-Founder The Institute for Healthcare Improvement
Founding Director, Center for Leadership and Improvement,
The Dartmouth Institute for Health Policy and Clinical Practice
Founding Director, Healthcare Improvement Leadership Development
The Dartmouth Institute for Health Policy and Clinical Practice
Co-Founder Institute for Healthcare Improvement
37 Workbook p30
Processes?
• How is a process different from a “system”?
• Can we brainstorm a series of processes which
make up the “systems” we might encounter in our
improvement work?
Elements of a Process
39
Suppliers Outcomes
Thing being passed along
Inputs Outputs
Sequence of steps
Microsystems
• 1992 – Quinn – ‘Intelligent Enterprise’
• Studied the ‘best of the best’
• They are organised around the frontline
interface with the customer
• ‘Smallest replicable unit’
Microsystems
• Nelson, Batalden, Godfrey 2000 – 2007
• Looked at the characteristics of high
performing clinical microsystems
• Formulated a curriculum to develop high
performing microsystems
Chest
Medicine
STH
“The principal task of the mesosystem is
to enable the work of the microsystems
for the population(s) of patients served.”
Paul Batalden
What is a Clinical Microsystem?
“The Place where Patients,
Families and Clinical Teams
meet.
It’s where everything happens
with, for and to the patient
and family.”
High Performing Clinical Microsystems
Information
&
Information
Technology
Staff • Staff focus
• Education &
Training
• Interdependence
of care team
Patients • Patient Focus
• Community &
Market Focus
Performance • Performance
results
• Process
improvement
Leadership • Leadership
• Organizational
support
45
Ownership not Buy In
‘If you want to make true and lasting
change, ask the people who do the
work how to go about it’
Daren Anderson, MD
VP/Chief Quality Officer
Community Health Center, Inc.
Team Coaching
Improvement
Science
Microsystem
Improving Microsystems – The Elements
QI
18
Workbook p22
Team Coaching
Improvement
Science
Microsystem
Improving Microsystems – The Elements
QI
18
Workbook p22
Team Coaching
Improvement
Science
Microsystem
Improving Microsystems – The Elements
QI
Workbook p22
Coaching
It is not telling people what to do.
It is giving them a chance to examine
what they are doing in the light of their
intentions.
Peter Senge,
MIT and Society for Organizational Learning
‘Improvement in health care is
20% technical and 80% human’
Marjorie Godfrey, MS, RN
The Dartmouth Institute For Health Policy and
Clinical Practice
People and Behaviours
Workbook p32
The Team Coaching Model
Transition Phase Reflection,
Celebration & Renew
`
Pre Phase Getting Ready
Action Phase Art & Science of
Coaching
Godfrey, MM (2012) In Press
Action Phase
Transition Phase
Pre- Phase
Pre- Phase
Action Phase
Transition Phase
Pre- Phase
Action Phase
Transition Phase
Pre- Phase
Action Phase
Transition Phase
Pre-
Phase
Action
Phase
Transition
Phase
The Team Coaching Model Over Time
Pre-
Phase
Action
Phase Transition
Phase
53 Godfrey, MM
Team Coaching
Improvement
Science
Microsystem
Improving Microsystems – The Elements
QI
Workbook p22
People vs. System
“80% of the problem is the system
not the people”
W. Edwards Deming
Professor of statistics at New York University (1946–1993)
Author, lecturer, and consultant
Photo © 2014 The W. Edwards Deming Institute Blog
Founding Director, Healthcare Improvement Leadership Development
The Dartmouth Institute for Health Policy and Clinical Practice
Co-Founder Institute for Healthcare Improvement
Workbook p33
Just like a patient…
To improve a microsystem’s “health” status
An interdisciplinary group:
• Assesses
• Diagnoses
• Treats
• Follows-up
based on improvement science and performance feedback.
Microsystem Improvement
Assessment
Diagnose
Treat -
‘PDSA’ &
‘SDSA’ What is the purpose of this
team?
What do staff think?
What do patients think?
What does the data tell us?
Define the high-level process
Microsystem Improvement
Assessment
Diagnose
Treat -
‘PDSA’ &
‘SDSA’
Define themes, Set aims
Deeply understand a process
Explore the reasons for what
we think are the issues
Microsystem Improvement
Assessment
Diagnose
Treat -
‘PDSA’ &
‘SDSA’ Plan – Do – Study – Act
Plan a small test of change
Agree balanced measures
Is the change an
improvement?
Quality Improvement -
The structure
Assessment - 5Ps
Diagnosis - Change Ideas
Treatment
- PDSA
SDSA
‘Standardise’
5P Assessment
Theme
Global Aim
Change Ideas
Specific Aim
Measures
Flowchart
Cause & Effect
The Microsystem
Improvement Ramp
Global Aim
1
2
3
SDS
A
P
DS
A
P
DS
A
P
DS
A
PDSA
1
3
2
Global Aim
1
2
3
5 P Assessment
Theme
Global Aim
Change Ideas
Specific Aim
Measures
SDSA
P
DS
A
P
DS
A
P
DS
A
PDSA
1
3
2
Dartmouth Microsystem Improvement Curriculum
Workbook p28
10.45 – 11.00
Break
11.00 – 12.00
Jennifer Hill, Debbie Doanne, Jo Myers, Lindsay
Swain
Chat show guests:
The Respiratory CHANGE team
Maria
12.00 – 12.15
Effective Meeting Skills
Effective meetings
• Conducted in a disciplined manner
• Active participation of all
• Clear action items
• Agenda for the next meeting
• Evaluation of the meeting
• Runs to time and time well spent
Workbook p40
Participant Participant
Participant
Four essential effective meeting roles
Leader
Facilitator
Recorder
Time -
keeper
Participant
Roles
Rotate
Workbook p40
Leader
Workbook p41
Timekeeper
Workbook p41
Recorder
Workbook p41
Facilitator
Workbook p41
7 Step meeting process
1. Clarify Aims – what needs to be done –
priorities
2. Assign Meeting Roles
3. Review agenda – how much time, and priority
4. Work through the agenda
5. Review actions captured
6. Set the agenda for next time
7. Evaluate the meeting
Workbook p42
Ground Rules
• Put time in early on to set these
• Agree how you will work with each other
• Put them up in the room you meet in
CHANGE room - Ground Rules
• You all have a valuable viewpoint – there is no hierarchy
• It’s about the system not individuals
• Please don’t interrupt or start a second conversation
• Don’t say it can’t be done!
• If you oppose you must propose
• Participate in the meeting not in the corridor later!
• Mobiles & Blackberry's off - or at least on silent
• Be present on time and stick to time
• Cut off lengthy discussions, assign items to the car park
• Have and follow an agenda
• Assign actions only to those present at the meeting
• Assign meeting roles
Workbook p44
EVALUATION 0 10
What went well? What could be improved?
Next Meeting….
Workbook p46
12.15 – 13.00
Lunch
Paul
13.00 – 13.15
Getting Started - Understanding your system
using the 5Ps
5P Assessment
Theme
Global Aim
Change Ideas
Specific Aim
Measures
Flowchart
Cause & Effect
The Microsystem
Improvement Ramp
Global Aim
1
2
3
SDS
A
P
DS
A
P
DS
A
P
DS
A
PDSA
1
3
2
Global Aim
1
2
3
5 P Assessment
Theme
Global Aim
Change Ideas
Specific Aim
Measures
SDSA
P
DS
A
P
DS
A
P
DS
A
PDSA
1
3
2
Dartmouth Microsystem Improvement Curriculum
Effective Meeting Skills
Workbook p28
“To do things differently, we must see
things differently. When we see things
we haven’t noticed before, we can ask
questions we didn't know to ask before.”
John Kelsch, Xerox
77
Assessment - • We need data to understand the system
Purpose
5 Ps
Workbook p50 -57
Purpose -
• Why does your microsystem exist?
• What is the purpose of your efforts and work?
‘To enable people with CF to live as normal a
life as possible’
To provide high quality care in an
environment that promotes patient
and employee satisfaction.
Patients
• What is the patient age
distribution?
• Where do you patients come
from?
• Where do they go after
interacting with your
microsystem?
• How satisfied are they?
• Do you notice patterns based
on seasons in your patient
volumes and acuity?
• What are the top diagnoses?
Patients - Who is Evie?
A fictional typical falls
patient who is •83 years old• Lives on her own• Widowed 5 years ago
• Broke her wrist in a fall 6 years ago
• This year has started to have dizzy episodes and
has fallen 5 times• Her GP has referred her to the Falls clinic
Professionals
• Who does what and when
in your microsystem?
• Is the right person doing
the right activity at the right
time?
• What do staff think could
be improved?
• What is the level of staff
satisfaction?
What would you want to change in Renal OPD?
0% 20% 40% 60% 80% 100%
Clinical Outcome
Customer Care
Hospital environment - Cleanliness
Hospital environment - Layout
Hospital environment - Furniture
Clinc appointment scheduling
Information available in outpatients
Waiting time for patients
Seeing the appropriate staff member
Time of day clinic held
Room use/allocation
Staff working patterns
Available equipment
% of replies
1 - No change required 2 3 4 5 - Large change required
Processes
• Review the current system using process
mapping
• Identify the ‘Value’ & the ‘Waste’
Patterns
• What patterns exit in your microsystem?
• What is the variation across the day, week,
• How often do you meet to discuss patient care,
safety and quality?
• What are your results and health outcomes?
Clinic VC147B Tuesday 1/11/11
8.3
0
8.4
5
9.0
0
9.1
5
9.3
0
9.4
5
10
.00
10
.15
10
.30
10
.45
11
.00
11
.15
11
.30
11
.45
12
.00
12
.15
12
.30
12
.45
13
.00
13
.15
13
.30
13
.45
14
.00
Patient 1
Patient 2
Patient 3
Patient 4
Patient 5
Patient 6
Patient 7
Patient 8
Patient 9
Patient 10
Patient 11
Patient 12
Patient 13
Patient 14
Patient 15
Patient 16
Patient 17
Patient 18
Patient 19
Patient 20
Patient 21
Patient 22
Patient 23
Patient 24
Patient 25
Patient 26
Patient 27
Patient 28
Patient 29
Patient 30
Patient 31
Patient 32
Patient 33
Patient 34
Patient 35
Patient 36
Patient 37
Patient 38
Patient 39
Patient 40
84
Example 5Ps - Pulmonary Vascular
Disease Unit - RHH
The 5Ps
Workbook p106
5P Assessment
Theme
Global Aim
Change Ideas
Specific Aim
Measures
Flowchart
Cause & Effect
The Microsystem
Improvement Ramp
Global Aim
1
2
3
SDS
A
P
DS
A
P
DS
A
P
DS
A
PDSA
1
3
2
Global Aim
1
2
3
5 P Assessment
Theme
Global Aim
Change Ideas
Specific Aim
Measures
SDSA
P
DS
A
P
DS
A
P
DS
A
PDSA
1
3
2
Dartmouth Microsystem Improvement Curriculum
Effective Meeting Skills
Maria
13.15 – 14.30
5Ps team exercise (using EMS)
The 5Ps
Workbook p106
5Ps team exercise – Instructions (50 min)
• In your teams have a go at creating a mock 5P
poster for your ward(s) using:
- mock data pack (on your tables)
- information in your work books on p.50-57
- ideas from the Respiratory team
- your expert knowledge re your specialty!
• Complete the 5Ps collection planning document
as much as you can
• Practice Effective Meeting Skills! (p.40)
5Ps team exercise – Instructions (20 min)
• Review the posters and planning documents
with your colleagues (10 min x 2)
- one person from the team stays at their table
- the rest of the team moves to another table
14.30 – 14.45
Break
Steve & Jo
14.45 – 15.45
Process Mapping
Paper Airplane Factory
• 4 people per factory
• Customers’ orders for 18 airplanes
• Build as many as you can in 5 minutes
• Must be delivered in the same sequence as
ordered
500 grains/30 secs
270 grains/30 secs
170 grains/30 secs
270 grains /30 secs
Bottlenecks
500/30 secs
270/30 secs
170/30 secs
270/30 secs
InputOutput
Using Process
Maps to generate
change ideas
Replace hospital
kitchen assessment
with home visit
Home visit first step
after referral
Home visit screened
out unnecessary
hospital visits Clinic redesign –
patient stays in one
room – combines all
motion into 1 step
Standard paperwork
reduced duplication
and rework on hand
off
Laura
15.45 – 16.00
Involving Patients in improvement
Claire
16.00 – 16.50
Planning Time – Next steps
3 THINGS – 30 MINUTES – GET CREATIVE
1
• Work out the logistics of your meetings Workbook pg. 3
2
• Work out how you will get to know your MCA coaches Workbook pg. 109
(Pre-phase)
3
• Work out how you will communicate with the rest of your ward team
Think about the media you are going to choose …
…what works for one might not work for another
Steve
16.50 – 17.00
Close
What's Next !
1. Establish your weekly meetings
2. Start working with your coaches
3. Start collecting your 5Ps
Next Session
Action Meeting!
20th May 2015
A Floor Seminar Room
Hadfield Block, NGH
3 People per team maximum
Prepare an update on your progress
Ward Collaborative Overview