Create a Change

8/6/2019 Create a Change

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HOW-TO GUIDE:STARTING A STUDENT RUN QUALITYIMPROVEMENT PROJECT

TMIT Student Projects QuickStart Package �



Objectives

� List overarching global aims of improvement

� Form a multi-disciplinary team

�Begin to innovate, design, and implement astudent-run quality improvement project

� Use Plan-Do-Study-Act cycles for improvementinitiatives



Outline

I. Introduction to Quality Improvement

II. From Innovation to Design

III. The PilotIV. Implementation



Outline


1) Aims for improvement

2) Multi-professional teamwork

3) Students role



So You Want To Create Change?

´While all changes do not lead to improvement, all

improvement requires change.µ

- Institute for Healthcare Improvement



From Theory to Practice:´Check a Box. Save a Life.µ The First Global Student Sprint

to Improve Healthcare

� We will use this exampleto illustrate how students

can design, pilot, andimplement a project

� The Innovation-

y Students taking the lead

with efforts in spreadingtheWHO Surgical SafetyChecklist



Aims for Improvement

We need healthcare that is:

� Safey Avoid injuries to patients from the care that is intended to help them.

� Effectivey Match care to science; avoid overuse of ineffective care and underuse of effective

care.

� Patient-Centeredy Honor the individual and respect choice.

� Timelyy Reduce waiting for both patients and those who give care.

� Efficienty Reduce waste.

� Equitabley Close racial and ethnic gaps in health status.



Safer Patient Care

BusinessSchool

PublicPolicy

Nursing

Medical

Pharmacy

Public HealthHealth Admin

Multi-Professional Teamwork



Students Role

� There are hundreds of processes that can beimproved in a system.

� What you can do?

y Gain Knowledge Raise awareness and share knowledge of the System

y Be Active

Pilot and implement a safe practice

y Use Evidence Research latest evidence-based improvement strategies

Collect data before and after improvement strategy



Pharmacy: Track antibiotic use and costs for surgical patients.

Engineering: Examine patient flow and fit checklistintoOR processes.

Health Admin: Determine the cost savings in yourhospitals from the checklist.

Public Health: Track patient outcomesand measure impact.

MD//DO/RN: Engage your classmatesto learn it, use it, and

seek advice from others.

Safe Surgery Student Sprint

Example:

Multi-Disciplinary Student Involvement



Outline






Outline


1. Forming Your Team

2. Setting Aims

3. Creating a Strategy

4. Change Concepts

5. Project Proposal



Innovating, not reinventing

� If you are talking to the right people, chances are you willstumble across someone who has had similar thoughtsabout changing the current system

� Connect early and discuss methods that are already inplace or being researched

� Your greatest barrier can be your attempt to do this onyour own

� Get a team on board and work together!



Forming Your Team

� Collaborative Partners

y Multi-disciplinary team

y Each member with different expertise

� Recruit key opinion leaders and advisors

y Find a mentor who is connected to your projectthrough a department affiliation or quality

improvement committee



Example:

Recruiting Key Opinion Leaders Safe Surgery Student Sprint

� A student used anevidence-basedimprovement strategy

such as theWHO

Surgical Checklist

� Introduced checklist tokey opinion leaders of hospitals, including:

y Superintendant of Hospitaly Chair of Surgery

y Chief of Quality Assurance



Forming Your TeamLeadership

� Responsibility Charting

y Distinguish individual roles with listed activities

y Using this tasking method gives the whole team a

global view of the project·s evolution

� Logistics

y Create short deadlines

y Have frequent update meetings� T eam work!T eam work!T eam work!



Example:

Responsibility Charting

Safe Surgery Student Sprint

Steps/Actions Tasks Deadline Status Owner Notes

Creating aVision/Strategy

Project Proposal

Action Plan

3/12/2009

3/15/2009

Complete

Pending

Sarah

John

Submitting toadvisor

Will email

Pilot Studies Case studies 4/5/2009 Pending Sarah JohnMichael

Draft #2

Deliverables StudentPowerPoint

5/1/2009 Pending Michael Draft #1completed

Publications Poster session 5/1/2009 Pending John Will emailcommittee



Setting Aims

1. State your aim clearly

2. Identify the population and system to be improved

3. Set numerical goals

y To better measure outcomes

4. Set Stretch Goals

y Give yourself a timeline

Ex: R

educe infections by 50% in 6 months5. Avoid Aim Drift

y Focus on your goal and try not to steer away



Creating an Improvement

Strategy

1. Critical thinking about the current system

2. Benchmarking

3. Using technology

4. Creative thinking

5. Using change concepts



Change Concepts

An approach to change that has been useful indeveloping ideas for improvement efforts:

EliminateWaste

ImproveWork Flow

Manage Time

Focus on Variation

Change theWork Environment

Error Proofing



Example:

Using a Change ConceptChanging the work environment

� Building a new typeof network

y Instead of Hospital Administrators,in this project, Students were theChange Agents in spreading thisquality improvement tool

y Students used new socialnetworking features as a primarymeans of building their projectnetwork



Pro ject Proposal

I. Vision/Mission

II. Setting Aims

III. Proposal Outline

I. Background

II. The Intervention

III. Strategy for Implementation



Outline


II. Innovation to Design




Outline

III. The Pilot

1) Using PDSA Cycles

2) Communication

3) Data Collection



The Pilot

� Start as a pilot

y Small scale with a few individualstesting your improvement method

y Use Plan-Do-Study-Act (PDSA)cycles during this pilot phase



The Pilot: Using PDSA Cycles

� Run a test trial on asmall scale

� Follow a simple

´PDSAµ cycle forpilot

y Plan

y Do

yStudy

y Act



Example:

Using PDSA CyclesSafe Surgery Student Sprint

One student.One hospital. Threeoperating rooms.

� Plan:

y Introductory seminar and

teaching with hospitaladministration and residents.� Do:

y One week trial using 3 ORs� Study:

y Feedback session given toresidents and surgical staff..

� Act:y Continued piloting the

checklist in 3 operatingtheaters with improvementsin place.



The Pilot: Communication

� Background education

y Share the facts

y Answer questions ahead of time

� Energize your team

y Get them excited about change!

� Communication

y Ensure that all of those participating in pilot are awareof their roles and project aims



The Pilot: Data Collection

� Plot data over time

� Seek usefulness

�

Use sampling� Integrate measurement into daily routine

� Use qualitative and quantitative data



Example

Data CollectionSafe Surgery Student Sprint

Wales, UK Jan ² June 2009

� Students were datacollectors in ORy

25 students observed 83operations

y Reported observationsinto an online data form

� Evaluated 5 items of

standard procedure� Data used to encourage

implementation



Outline

V. Implementation

1. Pilot to Implementation

2. Keys to Successful Adoption

3. Project expansion

4. Leadership Changes



Implementation

� After the pilot, evaluate for ways you can makethe project successful on a larger scale

� Create a step-by-step process outline for easyengagement

� Be ready for resistance

y Be prepared to address counter arguments

� Champions can lead the way

� Continue to Collect Data



Keys For Successful

Adoption

� Relative Advantagey Degree to which an innovation is perceived as being better than

the idea it supersedes

� Compatibility

y Degree to which an innovation is perceived to be consistent withthe existing values, past experiences and needs of potentialadopters

� Complexityy Degree to which an innovation is perceived as difficult to use

� Trialabilityy Opportunity to experiment with the innovation on a limited

basis

� Observabilityy Degree to which the results of an innovation are visible to others



Example:

Spreading your pro ject´Check a Box. Save a Live.µ



Leadership ChangePassing the Torch

� Remember handoffs are a leading cause of error!

� Ensure members of the original team will be ableto continue carrying out efforts

� Document logistical challenges andrecommendations for the next leader

� Keep lines of communication open



Summary Objectives

� List overarching global aims of improvement

� Form a multi-disciplinary team

�

Begin to innovate, design, and implement astudent-run quality improvement project

� Use Plan-Do-Study-Act cycles for improvementinitiatives

� e Bold. Be a Change Agent!

Create a Change

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