Aim of Organ Donation Breakthrough Collaborative “Committed to saving or enhancing thousands of lives a year by spreading known best practices to the nation’s largest hospitals, to achieve organ donation rates of 75% or higher in these hospitals.” -- Health and Human Services Secretary Tommy G. Thompson, National Leaders & Collaborative Teams

Record-Shattering Results Previous Record Month for Donation: 556 Donors October, 2003: 584 Donors January, 2004: 594 Donors May, 2004: 609 Donors June, 2004: 590 Donors

% of Hospitals Meeting Monthly Goal

Summary of Results Major, Sustained Increases in Process Measures Breakthrough Increases in Outcome Measures are Emerging Over 20 Hospitals Have Achieved Sustained Outcomes of 75% or Better Almost All Teams Know How to Test & Improve

High Leverage Changes: What Successful Teams Have Done These Have a Direct Relationship To Outcomes/Results Most Are A Synergistic Combination Of Change Concepts Within Or Across Strategies WHAT I WANT TO BRING TO YOUR ATTENTION ARE HIGH LEVERAGE CHANGES--- ---CHANGES THAT HAVE A DIRECT RELATIONSHIP TO OUTCOMES AND RESULTS AND OFTEN CUT ACROSS THE FOUR STRATEGIES--- YOU WILL SHORTLY HEAR FROM TEAMS WHO ARE IN ACTION AROUND THESE CHANGES, AND HAVE THE RESULTS TO PROVE IT THEY, THE FACULTY, AND COLLABORATIVE LEADERSHIP, BELIEVE ALL TEAMS SHOULD BE FOCUSING ON SUCH HIGH LEVERAGE CHANGES TO PROPEL YOU FORWARD. MY REQUEST TO YOU IS THAT YOU REVIEW THESE HIGH LEVERAGE CHANGES, AND OVER THE NEXT 36 HOURS IDENTIFY ACTIONABLE ITEMS FOR YOUR TEAM AND PLAN ACTION IN AS MANY AS POSSIBLE AFTER LS3.

First Things First What Successful Teams Have Tackled First They Assure That Change is Deep Enough into the System to be Sustained WHAT I WANT TO BRING TO YOUR ATTENTION ARE HIGH LEVERAGE CHANGES--- ---CHANGES THAT HAVE A DIRECT RELATIONSHIP TO OUTCOMES AND RESULTS AND OFTEN CUT ACROSS THE FOUR STRATEGIES--- YOU WILL SHORTLY HEAR FROM TEAMS WHO ARE IN ACTION AROUND THESE CHANGES, AND HAVE THE RESULTS TO PROVE IT THEY, THE FACULTY, AND COLLABORATIVE LEADERSHIP, BELIEVE ALL TEAMS SHOULD BE FOCUSING ON SUCH HIGH LEVERAGE CHANGES TO PROPEL YOU FORWARD. MY REQUEST TO YOU IS THAT YOU REVIEW THESE HIGH LEVERAGE CHANGES, AND OVER THE NEXT 36 HOURS IDENTIFY ACTIONABLE ITEMS FOR YOUR TEAM AND PLAN ACTION IN AS MANY AS POSSIBLE AFTER LS3.

System Redesign The High Leverage Changes Are the Framework for the Redesigned System First Things First are building blocks that need to be in place to create that system – these are the basics, the key change concepts and action items that teams need to do first.

A Call to Action on High Leverage Changes Advocate Organ Donation As the Mission Involve Senior Leadership to Get Results Deploy A Self-Organizing OPO/Hospital Team Practice Early Referral, Rapid Response Learn Effective Requesting Implement Donation After Cardiac Death THEY FALL INTO SIX AREAS OF ACTION BUT THIS IS NOT MEANT TO BE THE DEFINITIVE LIST OF WHAT WORKS AND WHAT’S MAKING IT WORK.

First Things First Physician & clinical champions are known. Process in place for conducting real time death record reviews. OPO “Presence": in house coordinator Focused change agenda based on analysis of current hospital data "Team Huddles" are the norm Clinical Triggers in use After Action Reviews are the norm "Effective Requesting" in place, in action

Timetable for Spread Now: Launch Spread Strategy at LS3 Thru September, 2004: Sustain Pace With Current Collaborative Teams Summer/Fall: Develop Knowledge Management System Summer: Pre-work for 2nd Collaborative Teams July, 2004: Convene Spread Leaders September, 2004: LS4 + LS1 of 2nd Collaborative Thru May, 2005: Continue Basic Support to Teams May, 2005: Conduct “National Learning Congress”

Learning Session 4-1 San Diego, California September 13-14, 2004 Satellite Broadcast:: 8:00 am to 12:30 pm on September 13 550 Current Collaborative Participants ~700 New Participants for Collaborative 2 Satellite Downlink Sites Across the Nation Recipient Whose Life Was Saved by Collaborative 1 Celebratory, High-Energy, Launching the Next Bigger Phase Getting New Teams in Action, Fostering Existing Teams as Mentors

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it is the only thing that ever has.” Margaret Mead, Cultural Anthropologist