100,000 patients 23,000 fewer strokes

Transcription

1

2 In patients who have had a stroke or TIA, aspirin reduces risk by 23% 100,000 patients 23,000 fewer strokes 58% of eligible patients receive aspirin = 13,340 fewer strokes

3 Two options Fidelity Increase asprin to 100% of eligible patients = a further 9,660 strokes prevented Efficacy Requires a proportional improvement over aspirin of 74% Clopidogrel = 10% higher efficacy than aspirin

4 Evidence based discovery Evidence based delivery 17 years to get 14% of evidence into practice Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yrbk of Med Informatics 2000; 65-70

5 Implementing at scale. can it be done? Will Ideas Execution

6 By what method?... only the method counts W Edwards Deming

7 Our change theory A clear and stretch goal A method Predictive, iterative testing

8 The Model for Improvement This model is not magic, but it is probably the most useful single framework I have encountered in twenty years of my own work on quality improvement Dr Donald M. Berwick Former Administrator of the Centres for Medicare & Medicaid Services Professor of Paediatrics and Health Care Policy at the Harvard Medical School

9 The Improvement Guide, API

10 100 metre dash video

11 Q1: What are we trying to accomplish? How much, by when? Unachievable by hard work alone Once it s agreed, it s non-negotiable

12 The Model for Improvement

13 The Improvement Guide, API

14 Why its important to measure the right things, right

15

16 The right measures are the ones derived from purpose Simon Guilfoyle, 2013

17 What if you use the wrong measures? Simon Guilfoyle, 2013

18 What if you measure the right things, but in the wrong way? Simon Guilfoyle, 2013

19 And if we didn t measure anything? Simon Guilfoyle, 2013

20 A better approach? Averages before and after the change Number of days lost to absence Absence Cycle Time Count (min.) Does this show an improvement? 0 Avg Before Change Avg After Change

21 Cycle Time (min.) Absence Count Change Made date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

22 Cycle Time (min.) Absence Count Change Made Unit 2 date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

23 Cycle Time (min.) Absence Count Change Made date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

24 The Improvement Guide, API

25 A change is not always an improvement.. A new haircut is not always a good thing.

26 If I d asked people what they wanted, they would have told me: faster horses Henry Ford

27 The Improvement Guide, API

28 Do Study Act Plan Do Study Act What s next? What will happen if we try something different? Did it work? Let s try it

29 Sequence for Improvement Make part of routine operations Sustain & spread a change to other locations Test under a variety of conditions Implement a change Theory & prediction Test a change Develop a change Based on slide IHI 2009

30 Why test changes.? Increase the belief Find out if it works! Learn how to adapt the change to different settings Evaluate the sideeffects Minimise resistance

31

32 Mr. Potato Head

33 Please choose 4 individuals: 1. Note taker To fill out Timekeeper Needs a watch with a second hand (or equivalent) 3. Quality Assurance Individual Evaluates the quality of Mr. Potato Head 4. To build Mr. Potato Head

34 Baseline before we start We need a volunteer to build Mr. Potato Head A time keeper A note taker A quality consultant 34

35 Making a Prediction What is your theory? What do you think will happen? What is your prediction about time? Think ahead to future tests.and how they might be shaped by the current small test. 35

36 Quality: Accuracy Scoring 36 Score Requirement 1 Not all parts of the Mr. Potato Head are on 2 All parts of the Mr. Potato Head are on, but not in the correct positions 3 All parts of the Mr. Potato Head are on and in the correct positions

37 Rules Fill out the PDSA prior to every Mr. Potato Head asssembly and use the PDSA form. Answer ALL the questions prior to beginning the test. Formally debrief after EVERY Mr. Potato Head assembly. DOCUMENT your Aims, Results, Theories, Predictions. Perform a few Mr. Potato Head Assemblies. Start each PDSA with all pieces inside Mr. Potato Head and the back cover must be on. Listen for periodic announcements or questions from me.

38 Have Fun! 38

39 Learning points 39

40 Getting the most out of the exercise This exercise is designed to explore how to perform a test of change. During the simulations, observe - the conversations that occur - the generation of ideas - any disagreements - the team dynamics - the interactions between individuals. Think about what is happening and how it might apply in a clinical setting. 40

41 @jasonleitch