Welcome & introductions
© 2013 AQuA
House keeping
Agenda
TIME
08.30
09:00
09:45
10.45
11.00
12.30
13.00
14.30
14.45
16.00
16.30
AGENDA ITEM
CONTENT
Registration & coffee
Welcome & Housekeeping
Programme Introduction
Faculty, overview,
completion of pre
assessments
BREAK
Quality Improvement Tools
Aim setting, driver
diagrams, project
charters
LUNCH
Sustainability & Spread
NHS Sustainability
Model, spread
concepts
Break
Sustainability & Spread cont
Summary of the day Homework & Evaluation
CLOSE
SPEAKER
Andrea
McGuinness
Andrea
McGuinness
Jodie Whittle
Bernie O’Hare
Helen Baxter
Session aims
1.
2.
3.
4.
5.
6.
7.
8.
9.
All attendees & core faculty to meet
Confirmation of programme delivery
Clarification of programme aims & objectives
Review core Quality Improvement
Opportunity to review & discuss skills assessments
& how this will be reviewed during programme
Agreed expectations & commitments (compact)
Safety culture questionnaire referenced
Safety Culture tool discussed
Safety Culture tool contextualized into programme
objectives & project objectives
Programme
Objectives
• To support your team to develop a shared purpose and vision for safety
• To support your team to deliver a successful safety improvement project
• To create an opportunity for teams to learn together in a safe and
stimulating environment
• To provide an expert faculty that offers education, information, innovation
and opportunity for teams to challenge and be challenged around safety
improvement
• To utilise best practice, critical thinking and current knowledge to support
teams and individuals to stretch and develop their safety and quality
improvement capabilities
• To identify prior knowledge and skills for teams and individuals, to improve
this and the ability to apply it within their roles.
© 2013 AQuA
Overview
© 2013 AQuA
Kirkpatrick New World
Project assessment
Toolkit & workbooks
When you see this sign a tool or template is
available to help you
© 2013 AQuA
Faculty
• AQuA
–Jodie
–Bernie
–Clare
–Andrea
• External experts/guest
speakers
© 2013 AQuA
Support
• Phone calls
• Visits
• WebEx
Our rules
Getting to know you
• Take a pen & piece of paper
• 5 mins to draw a pig
• If you have done this before you have 2
options…
– Cheat
– Don’t cheat!
Feedback
Compacts
Using compacts
• Reciprocal agreement
• More than a wish list but less than a contract!
• It is both an agreed document and a way of
working together for mutual advantage
• It achieves better outcomes for people and
communities
• It establishes clear rules of engagement
• It provides standards for fair and meaningful
consultation
Benefits of a compact
• It advances equality and gives our work a
stronger voice
• It aids embedding and developing good practice
• It is an agreement that guides and improves
relationships
• It is a framework for better partnership working
• It is a commitment to work more closely together
so that groups are properly involved
•
•
•
•
•
•
•
•
•
•
•
AQuA
Compact
Respect for all opinions & perspectives
No secrets for safety
Core team continuity
Programme delivery as planned
Toolkits & templates made available
Support application of learning to safety project
Show, teach try approach
Additional support alongside workshops
Slides on Portal
Support to drive safety improvement projects
Utilise your evaluation & feedback to improve our
programme
Attendees
•
•
•
•
•
Respect all opinions & perspectives
Attend at all sessions
Participate in discussions & activities
Apply learning to safety project
Attend/join on prearranged calls or WebEx
sessions
• Evaluate & feedback to AQuA (2 sides
today!)
• No secrets for safety
Write your own compacts
• In teams agree your own team compacts
• Identify how you will share this within your
organisation
Compact agreement
Feedback
Patient Safety Culture
Assessment Tool
•
•
•
•
•
Why
What
When
Where
How
Patient Safety Culture Survey
•Raise staff awareness about patient safety.
•Diagnose and assess the current status of patient safety
culture.
•Identify strengths and areas for patient safety culture
improvement.
•Examine trends in patient safety culture change over time.
•Evaluate the cultural impact of patient safety initiatives and
interventions.
•Conduct internal and external comparisons.
Feedback
Break
Quality Improvement
Methodology Basics
Model for Improvement
AIM: What are we trying to accomplish?
MEASURES: How will we know if a
change is an improvement?
CHANGE: What changes can we make
that will result in improvement?
Act
Study
A P
S D
Plan
Do
28
Solution V’s Problem
© 2014 AQuA
But before we start…………… do you
really understand the problem??
Solution vs
Problem
© 2014 AQuA
How do you know what needs
improving?
Quantitative data
Qualitative data
We benchmark poorly
Patients who complain
We’re failing our target
Patients we interview
Our Outcomes are poor
Staff feedback
© 2014 AQuA
© 2014 AQuA
Why, why, why?!
‘Results indicate that when preschoolers ask
"why" questions, they're not merely trying to
prolong conversation, they're trying to get to
the bottom of things.’
http://www.sciencedaily.com/releases/2009
/11/091113083254.htm
Frazier et al. Preschoolers' Search for
Explanatory Information Within Adult-Child
Conversation. Child Development, 2009;
80 (6): 1592 DOI
© 2014 AQuA
Maps
Proces
s Map
Value
Stream
Map
© 2014 AQuA
Diagrams
Spaghett
i
Fishbone
© 2014 AQuA
Measles /
Dot
Diagram
Analysing qualitative data
Thematic
analysis: Look for
the common
themes
Construct a story
around typical
findings
The power of a
good quote
Qualitative Data
Pareto Chart
250
100
90
200
80
70
50
100
40
30
50
20
10
0
0
Lack of Time
Lack of
Consistency
Poor
Information
Delayed
Treatment
Incompetence
Poor Care
%
60
Number
150
Structuring Projects
Project Charters
• A Project Charter is a tool
• A clear statement of what you intend to
achieve,
• How you are going to measure success
• What you are going to work on to achieve
success.
• A Charter is a concise outline of a project
What should a Charter include?
It should answer three questions:
1. What are we trying to accomplish?
2. How do we know that a change is an
improvement?
3. What changes can we make that will lead
to improvement?
Aims
Setting an Aim
• What are you trying to accomplish?
• How good? By when? For whom(or what
system)
Safe
Timely
Effective
Efficient
Equitable
Patient Centred
Crossing the Quality Chasm: A New
Health System for the 21st Century,
48
2001 Institute of Medicine
Aim Statement
Good
Bad
Ugly
We aim to reduce harm and improve patient safety for all of our
internal and external customers.
By June of 2012 we will reduce the incidence of pressure ulcers in the
critical care unit by 50%.
Our outpatient testing and therapy patient satisfaction scores are in the
bottom 10% of the national comparative database we use. As directed
by senior management, we need to get the score above the 50th
percentile by the end of the 1st Quarter of 2012.
We will reduce all types of hospital acquired infections.
According to the consultant we hired to evaluate our home health
services, we need to improve the effectiveness and reliability of home
visit assessments and reduce rehospitalisation rates. The board agrees,
so we will work on these issues this year.
Our most recent data reveal that on the average we only reconcile the
medications of 35% of our discharged inpatients. We intend to increase
this average to 50% by 1/4/12 and to 75% by 31/8/12.
49
Aim Statement
Brief rationale.
(What’s the problem? Why is it important? What are we going to do about it?)
What exactly are you trying to achieve?
For whom are you going to improve it for?
By how much will you improve it?
By when are you aiming to achieve it?
Final Aim Statement
Adapted from
50
Group
Work
51
Driver Diagrams
Driver Diagrams – why use them?
• Breaks down any broad aim, graphically, into
increasing levels of detailed actions that must or
could be done to achieve the stated aim
• Helps to focus on the cause and effect
relationships that exist in complex situations.
• Well defined drivers that can form the focus of
improvement efforts.
NHS Tayside
53
Driver Diagram
Secondary Driver
Primary Driver
Aim
Primary
Outcome
(Measure)
A.
B.
C.
D.
Secondary Driver
Primary Driver
Primary Driver
Primary drivers are
system components
which will contribute to
moving the primary
outcome.
A.
B.
C.
D.
Secondary Driver
A.
B.
C.
D.
Secondary drivers are
elements of the associated
primary drivers. They can
be used to create projects
or change packages that
will affect the primary
driver.
55
Developing Drivers
• Dedicate time for team and subject matter experts –
ask them to come prepared!
• Revisit your aim statement.
• Brainstorm potential Primary Drivers & check
– ’If I made an improvement in this driver what would it
achieve?’
– ’If I could influence (or improve) against all of these
drivers is there anything else that could go wrong and
prevent me achieving my aim?’
• For each Primary, brainstorm Secondary Drivers &
check
NHS Tayside
56
• Add relationship arrows
Driver Diagram - STAR Unit
Primary Drivers
Care Planning
Aim
A reduction in
incidents of
violence&
aggression by
20% in the
STAR Unit
during
2012/13
Environment
Therapeutic
Interventions
Workforce
© 2010 AQuA
Primary drivers are the systems
changes which will contribute to
achieving the Aim outcome measure.
Secondary Drivers
A. Raise awareness
B. Introduce a SU advanced
statement re management of
V&A.
A. Post all records (agreed actions)
of the community meetings in a
central area.
B. Post a weekly activity programme
at a central point on the ward.
A. Develop a formal process
regarding the planning of social &
therapeutic activities.
B. Introduce a community meeting.
C. Redesign role of staff member –
activity co-ordinator.
A. Review and compare data – make
data easily available to staff..
B. Identify specific times/places/
personnel involved in V&A.
C. Provide poster for staff comments
re new PDSAs.
D. Provide staff with written updates
re V&A to inform staff on return
from days off.
E. Recruit permanent staff to vacant
posts.
Secondary drivers are interventions
associated with primary drivers. They
can be used to create projects or
change packages that will affect the
primary driver.
57
Aim / Outcome
Primary Drivers
Know what
patients want /
need for lunch
90% of
patients in
Bay 1 receive
their lunch of
choice
everyday by
12.30 by July
2013
Lunch &
equipment
arrives on time
Ward Staff are
available to give
out lunch
Patients are
available to
receive lunch
Secondary Drivers
Menu cards
distributed
Choices recorded &
communicated
Diet requirements
understood
Numbers established &
communicated
Time for delivery agreed
Access to ward available
Allocate lunch duty
Complete other tasks prior
to lunch arrival
Staff appropriately
trained
Schedule inpatient appts
appropriately
Appropriately positioned
Maintained at appropriate
temperature
58
Feedback
Break
Helen Baxter
Sustainability & spread
Next steps
Today
1. Complete and return evaluations (2
sides!) please
2. Assess project against scale provided
3. Agree next contacts as a team
4. Decide support from AQuA & contact
Clare to arrange this
Next session
Day 2 Tomorrow
• Same venue
• Same start time!