Transcript Slide 1

Improvement Map: From Here to
Excellence
Reliable Routes to Exceptional
Hospital Care
May 20, 2009
Kathy Duncan, IHI Faculty
Institute for Healthcare
Improvement
• IHI is an independent not-for-profit
organization helping to lead the improvement
of health care throughout the world.
• Founded in 1991 and based in Cambridge,
Massachusetts, IHI works to accelerate
improvement by building the will for change,
cultivating promising concepts for improving
patient care, and helping health care systems
put those ideas into action.
The Campaign: A Recap
100,000 Lives Campaign Objectives
(December 2004 – June 2006)
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Save 100,000 Lives
Enroll more than 2,000 hospitals in the
initiative
Build a reusable national infrastructure
for change
Raise the profile of the problem - and our
proactive response
Six Changes That
Save Lives
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Deployment of Rapid Response Teams…at the first sign
of patient decline
Delivery of Reliable, Evidence-Based Care for Acute
Myocardial Infarction…to prevent deaths from heart attack
Prevention of Adverse Drug Events (ADEs)…by
implementing medication reconciliation
Prevention of Central Line Infections…by implementing a
series of interdependent, scientifically grounded steps
called the “Central Line Bundle”
Prevention of Surgical Site Infections…by reliably
delivering the correct perioperative antibiotics at the proper
time and taking several other associated actions
Prevention of Ventilator-Associated Pneumonia…by
implementing a series of interdependent, scientifically
grounded steps called the “Ventilator Bundle”
The 5 Million Lives Campaign
• Campaign Objectives:
─ Avoid five million incidents of harm over the next 24
months;
─ Enroll more than 4,000 hospitals and their
communities in this work;
─ Strengthen the Campaign’s national infrastructure for
change and transform it into a national asset;
─ Raise the profile of the problem - and hospitals’
proactive response - with a larger, public audience.
The Platform
The six interventions from the 100,000 Lives Campaign:
• Deploy Rapid Response Teams…at the first sign of patient decline
• Deliver Reliable, Evidence-Based Care for Acute Myocardial
Infarction…to prevent deaths from heart attack
• Prevent Adverse Drug Events (ADEs)…by implementing
medication reconciliation
• Prevent Central Line Infections…by implementing a series of
interdependent, scientifically grounded steps
• Prevent Surgical Site Infections…by reliably delivering the correct
perioperative antibiotics at the proper time
• Prevent Ventilator-Associated Pneumonia…by implementing a
series of interdependent, scientifically grounded steps
The Platform
New interventions targeted at harm:
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Prevent Pressure Ulcers... by reliably using science-based guidelines for
their prevention
Reduce Methicillin-Resistant Staphylococcus Aureus (MRSA)
Infection…by reliably implementing scientifically proven infection control
practices
Prevent Harm from High-Alert Medications... starting with a focus on
anticoagulants, sedatives, narcotics, and insulin
Reduce Surgical Complications... by reliably implementing all of the
changes in care recommended by the Surgical Care Improvement Project
(SCIP)
Deliver Reliable, Evidence-Based Care for Congestive Heart
Failure…to reduce readmissions.
Get Boards on Board….Defining and spreading the best-known leveraged
processes for hospital Boards of Directors, so that they can become far
more effective in accelerating organizational progress toward safe care
An International Network of Networks?
Some Returns…
• Enrollment 4,05100 hospitals (approximately 75%-80%
of all US hospital beds)
• Eight states at 100%; 18 states at 90% or better
• At least 2,000 hospitals at work on every intervention
and 53% committed to Board engagement
• Nodes in all 50 states (69 in total) and 200 mentor
hospitals
• Outstanding national call attendance (250-500 lines/call),
and more than 50,000 downloads of intervention kits
• Increased action in rural, pediatric, public affinity groups
• Over 50 million new media impressions
• Large national learning events (e.g., Fall Harvest,
National Network Day)
Rural Hospital Participation
• Approximately 1,700+ rural facilities are in the
Campaign, representing 43% of over 4,000 hospitals
enrolled
• Of the 200+ Mentor Hospitals
─ Nearly 60 hospitals are rural
─ 40+ Hospitals with ≤ 150 beds
─ Nine Critical Access Mentors
Where Do We Go From Here?
What hospitals value (and need)
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What we have learned about managing large-scale
improvement
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Our knowledge of what is possible
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Our urgent need
=
Where Do We Go From Here?
Aims, prioritization and practical support
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Ambitious, value-focused networks
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Our knowledge of what is possible
+
Our urgent need
=
Getting Started on the
Improvement Map
Three new interventions:
1.Prevent Catheter-Associated Urinary Tract
Infections
2.Link Quality and Financial Management:
Strategies for Engaging the Chief
Financial Officer and Provide Value for
Patients
3.WHO Surgical Safety Checklist
3 New Interventions
• Cather Associated UTI
• Linking Quality and Financial Management
• WHO Surgical Safety Checklist
Why CA-UTI?
• Most common hospital acquired infection
─More than 1 million cases annually
• 12-25% of all hospitalized patients receive
a urinary catheter
─Half of these did not have a valid indication
• Estimated cost per case of CA-UTI range
from $500-$3000
• Cost to healthcare system up to $450
million annually according to CMS
Preventing CA-UTI
1. Avoid unnecessary catheters
2. Insert using aseptic technique
3. Maintain catheters based on
recommended guidelines (daily care)
4. Review catheter necessity daily and
remove promptly
Potential for Success
• Numerous published studies reporting
reductions of 48- 81%
─Use of reminders
─Nurse-driven protocols
─Reduction in duration of catheter days
“The duration of catheterization is the most
important risk factor for development of
infection.”
SHEA-IDSA Compendium, October 2008
Link Quality and Financial Management:
Getting Started
1. Create a waste reduction portfolio.
2. Assign a finance team member to
improvement projects.
3. Know how to convert light green dollars
to dark green dollars.
4. Count the savings.
5. Work with the entire Leadership Team to
execute flawlessly.
Surgical Safety Is A
Serious Public Health Issue
• About 234 million operations are done
globally each year
• A rate of 0.4-0.8% deaths and 3-16%
complications means that at least 1 million
deaths and 7 million disabling
complications occur each year worldwide
Four Areas Of Focus
• Infection Prevention – “Clean Surgery”
• Anesthesia Safety – “Safe Anesthesia”
• Safe Surgical Teams – “The Operator and
Environment”
• Measurement – “Did we change things?”
National Implementation Test:
The Sprint
One test.
One OR.
By April 1.
So what happened?
─The results are in, and we have made great strides
in reducing the 17 year gap between research and
implementation of a new practice in patient
safety. Thank you to the 25 Nodes committed to
supporting the Checklist!
─Over 1,000 hospitals have told us that have
tested/plan to test the WHO Surgical Safety
Checklist, as of the April 1st deadline.
25 Nodes agreed to encourage the Surgical Safety
Checklist - Statewide
─If you would like to commit to the Sprint or have any
questions, please email [email protected].
IHI Will Continue Providing…..
─Surgical Safety Checklist Mentor Hospitals to
consult with for tips on testing and implementing the
Checklist: If you want to apply to become a Surgical
Safety Checklist Mentor Hospital, email
[email protected].
─Guidelines for making modifications to the WHO
Surgical Safety Checklist:
─Recordings of the WHO Surgical Safety
Checklist Q Sessions, including the call on March
19, posted to the WHO Surgical Safety Checklist
area of the IHI.org website (along with a range of
other free tools and resources):
Available Resources
• Getting-started kits (how-to guides, tips
and tricks, bibliographies, measure
definitions, alignment grids)
• National conference calls (recorded)
• Local learning opportunities (through
“nodes”)
• Thousands of other hospitals in the U.S.
and abroad
• More than 200 mentor hospitals
The Improvement Map
• A distillation of countless requirements
and measurements
• Sets of high-leverage processes
(organized by care setting) for achieving
“big dot” aims
• A sequential guide to performance
excellence
Look This Way
Initiatives
Patient Care
Processes
Processes to Improve
AMI Care
PURPOSE
End of Life Care
Mortality,
Harm,
Satisfaction,
Cost per
Case,
Equity
High Hazard medications
Support
Processes
Reliable Lab Processes
Boards on Board
Leadership and
Management
Time in Patient Care
CHAOS
CHAOS
Customers Will…
• Browse the Improvement Map
• Create their own maps by sorting and selecting
the processes in the Improvement Map based
on their own aims and circumstances
• Get detailed information about specific
processes on their own map, and be linked to
more information and resources
“What Would You Like To Do?”
Browse the
Improvement Map
by……
Sort by Aims:
Sort by Domain:
Enter search criteria
Drop Down Box: Mortality, Harm, Patient
Satisfaction………
Drop Down Box: Patient Care Processes,
Support Processes, Leadership and
Management Processes
IHI Improvement Map
Patient Care
Processes
Reduce Mortality
Reduce Harm
Improve Patient
Experience
Reduce Cost
per Case
Support
Processes
Leadership
Processes
Improvement Map Features and
Supports:
• Ideas about how to use the Improvement
Map
• General information on leading
improvement: how to set an improvement
agenda, how to assess capability, and
how to execute
• Connections to others working on the
Improvement Map (network/nodes)
• Links to programs that offer more support
and guidance
Entry Points
• How-to guides, tools and introductory calls at no
cost
• Virtual membership with unlimited access to
Expeditions and conference call series, affinity
groups, courses and video-based resources at a
lower price point
• Smaller, ambitious community of facilities pursuing
organization-wide change
• (Leadership Community and Collaboratives)
Kathy D. Duncan
[email protected]
870 739 3193