Small Country Big Change

Date: Created by: Suzanne Proudfoot

Conflicts of Interest

NilKo Awatea-CMDHB has paid for me to attendNo-one has paid me for my adviceNo other Business interests connected to my work

AcknowledgementsLeadership at Ko Awatea and Counties Manukau Health

Staff on the ‘Pilot site’ at CMH CCC

National Clinical Lead

Data analyst

HQSC sponsorship and partnership

The participating teams

ContextPopulation 4.4 million

Auckland population 1.4 million

20 District Health Boards

25 Intensive Care Units

- Geographically widely dispersed

- Vary in size and function

ResultsBetter patient experience

Decreased hospital stay

Reduction in patient harm

Rate reduction from 3.32/1,000 to 0.4/1,000 line days over 22 months

Results 10 Non consecutive months with Zero CLAB April 2012 to January 2014 (22 months)

Rate reduction from 3.3/1,000 to 0.28 in the first 12 months and 0.4/1,000 line days over the 22 month duration

Potential CLAB prevented in 22 months 105 Savings up to $2.1 million Lives saved 10 Spread to 61 units outside of the ICUs One ward at the pilot site >900 Days CLAB free

Collaborative Structure

Select Topic

Faculty / Expert

Meeting

Identify Change

Concepts

Ko Awatea and DHB Participants

Prework

LS 1 Nov 2011

P

S

A D

P

S

A D

LS 3March 2013

LS 2 June 2012

Holding the

Gains

Spread

Halfw

ay

Sept 2011 March 2013

ContextPopulation 4.4 million

Auckland population 1.4 million

20 District Health Boards

25 Intensive Care Units

Unlocking Relationships between CLAB Prevention and Collaboratives

The underpinning philosophy of the collaborative

It is more than equipment and procedures Isomorphic pressures Develop ‘organic’ networks Reframes a social problem Uses multiple interventions to Change practice Uses data as a disciplinary force

More than Just Equipment and Procedures

It is the philosophy of the collaborative- Different units have different starting points- Quality Improvement is non-linear and the guiding

principals change as you go along.- Allows for local adaptation

Keep going back to the framework!

Isomorphic pressures

Institutional level, specialty level, Regional and National Level– Normative– Mimetic – Coercive

Develops Organic networks Effective, horizontal pathways

- Supported by the Model- Connected by the Model

Forms a community

Reframes a Social Problem Owned by ICU

PersonalisedPrevents harm to innocent people

Uses multiple interventions to change practice

Empowers everybody– Resets norms and rituals– Puts the patient in the centre of care– Builds capacity and capability

Increases accountability at all levels– Without supervision– Rewards community membership– Enables wider society (calls to centre)

Uses Data as a Disciplinary Force

Using Measurement for Quality Improvement– Is there a problem?– How big is the problem?– Look how we solved the problem– Is the problem under control?

It is more than equipment and procedures Isomorphic pressures Develops ‘organic’ networks Reframes a social problem

The underpinning philosophy of the collaborative

Uses multiple interventions to Change practice

Uses data as a disciplinary force