A Framework for Better Care

Transcription

1 A Framework for Better Care Creating Value- Using the Right Tool for the Job in a Resilient Healthcare System Andrew Johnson Robyn Clay-Williams Paul Lane

2 Our bit Queensland it s huuuge Quebec is Tiny

3

4

5

6 Our Journey

7

8

9

10 The Ten C s Cohesion CARE CLEAR OWNERSHIP CONSTRAINTS COMMUNICATION CAPTURE COMPETENCE COMPLIANCE CHALLENGE CULTURE COGNITION

11 COMPLEXITY RESILIENT HEALTH CARE Person centered "Engineering In" success Situation Dependant QUALITY IMPROVEMENT QUALITY ASSURANCE SAFETY II COMPLEX ADAPTIVE SYSTEMS FRAM HIGH RELIABILITY PDSA BENCHMARKING AUDIT REDESIGN LEAN / SIX SIGMA Person Agnostic "Engineering out" Failure Process Dependent 8 March 2017 Sheraton Hotel New Orleans VARIABILITY

12 COMPLEXITY Of Processes Better Care Choosing the right tool for the job RELIABLE Making the right thing easier to do ROBUST Making care better in the real world RESILIENT Dealing with the unexpected ITERATIVE Person centered Context specific "Engineering In" success Situation Dependent Risk Homeostasis Embracing Adaptation Emergence Complex Interdependencies System performance Ambiguity Humans as resources Deals with the complex Principles Complex Adaptive Systems Theory FRAM Simulation Theory of Constraints Ten Cs SEQUENTIAL Person Agnostic Context agnostic "Engineering out" Failure Process Dependent Static Risk Risk management Reducing Unwarranted Variation EBM Independent variables Localised optima Certainty Humans as points of failure Deals with the complicated Standardisation RCA FMEA Checklists Never / Always Six Sigma Automation Audit VLAD Standards PDSA Benchmarking Redesign Risk management Lean Morbidity and Mortality Accreditation Common Underpinnings Leadership and Management Use of Data Human Factors SAFETY CULTURE Implementation Science ETTO Townsville 23/04/17 VARIABILITY of Inputs / Outputs

13

14 COMPLEXITY UNPREDICTABILITY Townsville - Complex and Unpredictable

15 COMPLEXITY UNPREDICTABILITY Townsville - Working the angles

16 COMPLEXITY UNPREDICTABILITY Framework for Better Care Townsville - Just Better Care

17 COMPLEXITY RELIABLE Making the right thing easier to do UNPREDICTABILITY Framework for Better Care Townsville - find it the easy way

18 COMPLEXITY ROBUST Making care better in everyday work RELIABLE Making the right thing easier to do UNPREDICTABILITY Framework for Better Care Townsville - live in the real world

19 RESILIENT Dealing with the unexpected ROBUST Making care better in everyday work COMPLEXITY RELIABLE Making the right thing easier to do UNPREDICTABILITY Framework for Better Care Townsville - expect the unexpected

20 RESILIENT Dealing with the unexpected COMPLEXITY PRINCIPLES ROBUST Making care better in everyday work STANDARDS RELIABLE Making the right thing easier to do STANDARDISATION UNPREDICTABILITY Framework for Better Care Townsville - Principled

21 Principles Tools: Patient Partnership FRAM Simulation Ten Cs Negotiation Resilience Assessment Grid Consensus Statements RESILIENT Dealing with the unexpected Standards Tools: Lean Six Sigma Change Management PDSA Clinical Audit / M&M Benchmarking Redesign Clinical Guidelines ROBUST Making care better in everyday work Standardisation Tools: Checklists Automation Accreditation RCA / FMEA Protocols Clinical Pathways RELIABLE Making the right thing easier to do COMPLEXITY UNPREDICTABILITY Framework for Better Care Townsville - Filling the Gaps

22 Productive "Engineering In" success Capability Focus Person dependent Context specific Embracing Adaptation and emergence Complex Interdependencies Humans as resources Iterative Deals with the complex Principles Tools: Patient Partnership FRAM Simulation Ten Cs Negotiation Resilience Assessment Grid Consensus Statements UNPREDICTABILITY RESILIENT Dealing with the unexpected Standards Tools: Lean Six Sigma Change Management PDSA Clinical Audit / M&M Benchmarking Redesign Clinical Guidelines ROBUST Making care better in everyday work Standardisation Tools: Checklists Automation Accreditation RCA / FMEA Protocols Clinical Pathways RELIABLE Making the right thing easier to do Framework for Better Care Townsville - in the FRAMe COMPLEXITY Protective "Engineering out" Failure Compliance Focus Person Agnostic Context agnostic Process Dependent Independent variables KPI Focused Humans as points of failure Sequential Deals with the complicated

23 Productive Principles Tools: Patient Partnership FRAM Simulation Ten Cs Negotiation Resilience Assessment Grid Consensus Statements UNPREDICTABILITY RESILIENT Dealing with the unexpected Standards Tools: Lean Six Sigma Change Management PDSA Clinical Audit / M&M Benchmarking Redesign Clinical Guidelines ROBUST Making care better in everyday work Standardisation Tools: Checklists Automation Accreditation RCA / FMEA Protocols Clinical Pathways RELIABLE Making the right thing easier to do Framework for Better Care COMPLEXITY Protective Johnson A, Clay-Williams R, Lane P 2017

24 It Looks Pretty But how do you use it?

25 Can You Help Please Difficult resuscitation in Emergency Department Multiple Specialties Involved Unclear roles and responsibilities Dispute Allegations Felt that it didn t go well

26 Productive Principles Tools: Patient Partnership FRAM Simulation Ten Cs Negotiation Resilience Assessment Grid Consensus Statements UNPREDICTABILITY RESILIENT Dealing with the unexpected Standards Tools: Lean Six Sigma Change Management PDSA Clinical Audit / M&M Benchmarking Redesign Clinical Guidelines ROBUST Making care better in everyday work Standardisation Tools: Checklists Automation Accreditation RCA / FMEA Protocols Clinical Pathways RELIABLE Making the right thing easier to do COMPLEXITY Protective Framework for Better Care Johnson A, Clay-Williams R, Lane P 2017

27 Standardisation of difficult airway trolley Establish multidisciplinary meetings Collaboration on protocol for resuscitation of complex patients Develop multidisciplinary simulation program What Did We Do?

28 Productive Principles Tools: Patient Partnership FRAM Simulation Ten Cs Negotiation Resilience Assessment Grid Consensus Statements UNPREDICTABILITY RESILIENT Dealing with the unexpected Standards Tools: Lean Six Sigma Change Management PDSA Clinical Audit / M&M Benchmarking Redesign Clinical Guidelines ROBUST Making care better in everyday work Standardisation Tools: Checklists Automation Accreditation RCA / FMEA Protocols Clinical Pathways RELIABLE Making the right thing easier to do Framework for Better Care COMPLEXITY Protective Johnson A, Clay-Williams R, Lane P 2017

29 So, What do you reckon?

30

31 On Safety We need a definition (or a description) that we can understand and use from Australia, all the way to the Aase end of the world

32 On Safety A state of well-being generated as a result of productive and protective efforts to maximize benefits and minimize risks of healthcare. We achieve safety by working collectively with our patients, their families and the community.

33

34 High Reliability Organisations We defined a series of incremental changes that hospitals should undertake to progress toward high reliability. These changes involve the leadership's commitment to achieving zero patient harm, a fully functional culture of safety throughout the organization, and the widespread deployment of highly effective process improvement tools. Chassin 2013

35 High Reliability Organisations Five Principles State of collective mindfulness - preoccupied with failure Resist the temptation to simplify their observations Sensitivity to operations and obligation to speak up Commitment to resilience Deference to expertise

36 Robust Process Improvement Methodologies Lean Six Sigma Change Management

37 What s in a word? Resilience HRO Version HRO - Resilience refers to an organization's capability to recognize errors quickly and contain them, thereby preventing the harm that results when small errors propagate, are compounded, and mushroom into major problems. Chassin and Loeb 2013

38 Resilience - Resilient Health Care Version Resilience is an expression of how people, alone or together, cope with everyday situations - large and small by adjusting their performance to the conditions. An organisation s performance is resilient if it can function as required under expected and unexpected conditions alike (changes / disturbances / opportunities). Erik Hollnagel 2015

39 Resilience Aussie Definition

40 Resilience Aussie Definition Getting the right outcome for our patients despite s#1t happening along the way

41 Key Differences High Reliability Organisations Engineering out failure Resilience as error detection and correction Risk elimination - Zero harm Tools established and proven outside Healthcare Hierarchical System Resilient Health Care Engineering in success Resilience as coping with the unexpected Risk expected as part of normal operations Tools evolving - opportunity for healthcare to lead Complex Adaptive System Townsville - be the difference

42 So Dad What your telling me is that reliability is the glass half empty approach to patient safety And Resilient Health Care is the glass half full? Caitlin Johnson (aged 13) 2013 only very slightly paraphrased

43 Common Underpinnings Leadership and Management Use of Data Human Factors Safety Culture Implementation Science Patient care

44