Akarin Nimmannit MDManager of Routine to Research (R2R) Project

Assistant Dean for Quality Development Faculty of Medicine Siriraj Hospital

Mahidol University 

Definition of R2R Research

Research question: Originate from routine service/workSolve the service/work problem Improve the quality of service/work

Investigator/conductor The working staff (experiencing the problem)Might work with the invited expert

Result:Measure the significant patient health outcome or service

Surrogate outcome might not be relevant e.g. laboratory testing result

Implementation:Research result must return to improve the patient care

or service

Modified from the concept of Prof. Dr. Vicharn Panich, Chairman of Mahidol University Council

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Routine to Research (R2R) Unit

Launched in June 2004Health Services Research Management UnitMissions:Upstream to downstream

Routine work problem Research questionResearch proposal development Research proposal review (IRB-ethical clearance and

grant process)Research conduction monitoringManuscript/ implementation (service improvement)

Knowledge management (KM) for health services research

R2R Management Approach

KM basedR2R is not a “foreign body”, but a further

quality development progression. Integration of R2R research into common

hospital quality development (CQI-PDCA)R2R is an investment, not another burden.

R2R is voluntary work.Overcoming the “unpleasant” experiences

and attitudes towards researchR2R does not have to be very complex.R2R is not restricted only to the scholars.

Routine work

Clinic (Front office)

Support (Back office) Quality Criteria e.g. HA, JCIA &

TQAQuality Criteria e.g. HA, JCIA &

TQA

Knowledge Creation

Knowledge Translation

Medical Institute of the Kingdom toward International Excellence

Clinical Excellence

Innovation & Publication

Human Capital Excellence

Research Questions & Quality Development Topics are from..

1. Workflow: Value Stream Mapping• Care team: care process • Laboratory: Specimen collection, preparation, obtain,

handling, storage, process, report

2. Complaints & Occurrence Reports • What have happened• What/How factors associated with the incidence• What should be the solution/ What is the best way to

solve the problem

3. Indicators (process, output, outcome)• Target, Timing• Other institute/Best practice• Standard criteria (HA/JCIA/ISO)

4. Organizational goal (s)

Knowledge Management (KM) for R2R

Do believe R2R projects exists even before having the term “R2R”

Inspired to learn from real success story (sometime ‘not’ success story)

Good success story telling needs preparation (What & Whom to be shared)

More learn, less teach

Case: GYN Ultrasonography

Transabdominal ultrasound has been performed for decades

To obtain good vision, urinary bladder must have some volume of fluid

What is the appropriate volume?How much water should patient drink?How long the patient bladder will be filled?A Randomized Controlled Study

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Redo US every 10 mins until Gynecologists satisfy with the quality of image

93 GYN Pts with normal kidney function

93 GYN Pts with normal kidney function

Randomization

Drink Water 400 cc.n = 30

Gynecologist independently perform GYN US when 1. Patients feel incline to urinate or 2. 45 min after drinking water

Drink Water300 cc. n =31

Drink Water 500 cc.n = 32

Average waiting time and total bladder volume before

transabdominal ultrasound in each study group

(mean+SD)

Important finding: 300, 400 & 500 cc in 60 mins

Work instruction for advising the patient for GYN US

With appointment

No appointment

“an hour” before appointment time

1. Empty bladder 2. Drink - 300500

(10-16 oz) cc of fluid

3. Do not pass urine until examination

1. Do not pass urine2 . Drink 300-500 (10-16

oz) cc of fluid3 . Do not pass urine4 . Wait 45 minutes

Patient to the US station

Implementation Result

Indicators

US Success rate (%)

Before1

months3

months

Complete as Appointment

50 601. 8 9

Complete as instruction (No appointment )

70 811. 9 4

Satisfaction - 7 5 .2 9 1

Waste Elimination: Defect Rework, Overproduction, Waiting, Motion, Excessive Processing

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• 220 R2R projects• 130 Finished• >80% return to

improve services

Train and benefit a large majority of staffAllow employees flexibility to learn at their

own timeImprove a lot of the employee by way of

effective professional training and life long learning

Eliminate service defect, reduce waste and improve communication

Significant result Good composition of team

Hospital Management Asia: Human Resource Development

“We're Born to Learn, Not to Be Taught”John Abbott Author: Overschooled but Undereducated