Karien Uys, M.Soc.S, BNS, RN, CQI&PS

The Journey Continues

Best possible care: optimizing the likelihood of health outcomes desired by patients, families and clinician. Quality Care is:

Combined and unceasing efforts of everyone— healthcare professionals, patients and their families, researchers, payers, planners and educators to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development. Combined and unceasing efforts of to make the changes that will lead to: Better patient outcomes (health) Better system performance (care) Better professional development Quality Improvement is:

Quality Healthcare means providing our customers (patients, visitors and staff) with the right amount of care in a technically competent manner, with good communication, shared decision making, and cultural sensitivity. KFAFH Definition of Quality

Absence of preventable harm: avoidance of errors in clinical care resulting in injury to our patients. Patient Safety is:

Is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization's health and safety management. Characterized by communications founded on mutual trust, by shared perceptions of the importance of safety, and by confidence in the efficacy of preventive measures. Culture of Safety is:

At risk behavior like taking shortcuts or ignoring required safety steps. Reckless behavior:

Patients Safety Efficiency Effectiveness Appropriate Accessibility Patient Centered Quality of Care Care Providers KFAFH Individual Competence Organizational Competence Information Management Continuity of Care Evidence- based Medicine Education and Training Accreditation

How do we apply quality in KFAFH?

Prioritization: Prioritization: How do we choose what is the quality issues we need to focus on to improve patient safety?

Prioritization and Selection Considerations: What patients want you to fix? What staff want you to fix? What are the major gaps (variances) in your quality and patient safety monitoring data? What quality and patient safety incidents have you experienced (INCIDENT REPORTS) ? SWOT Analysis

What to do after the SWOT Analysis with all the findings?

Where to start? PRIORITIZE!!!!!

Prioritization Matrix

Example: buying a car CriteriaCost1=Expensive2=Moderate3=CheapStorage1=Small2=Moderate3=SpaciousComfort1=Uncomfortable2=Moderate3=Comfortable Fun 1=Boring 2=Just OK 3=Lots of FunLook1=Ugly 2=Just OK 3=BeautifulTotal Weight Sport car SUV 4x4 Family car Station wagon

Example: buying a car CriteriaCost1=Expensive2=Moderate3=CheapStorage1=Small2=Moderate3=SpaciousComfort1=Uncomfortable2=Moderate3=Comfortable Fun 1=Boring 2=Just OK 3=Lots of FunLook1=Ugly 2=Just OK 3=BeautifulTotal Weight Sport car SUV 4x Family car Station wagon

Example: buying a car CriteriaCost1=Expensive2=Moderate3=CheapStorage1=Small2=Moderate3=SpaciousComfort1=Uncomfortable2=Moderate3=Comfortable Fun 1=Boring 2=Just OK 3=Lots of FunLook1=Ugly 2=Just OK 3=BeautifulTotal Weight Sport car SUV 4x Family car Station wagon

Adding Weight CriteriaCost1=Expensive2=Moderate3=CheapStorage1=Small2=Moderate3=SpaciousComfort1=Uncomfortable2=Moderate3=Comfortable Fun 1=Boring 2=Just OK 3=Lots of FunLook1=Ugly 2=Just OK 3=BeautifulTotal Weight Sport car 1x1= 1 1x2= 2 1x3= 3 3x5= 15 3x10= SUV 4x4 1x1= 1 2x2= 4 3x3= 9 2x5= 10 2x10= Family car 2x1= 2 3x2= 6 2x3= 6 1x5= 5 1x10= Station wagon 3x1= 3 3x2= 6 3x3= 9 1x5= 5 1x10= 10 33

Adding Weight (Male perspective) CriteriaCost1=Expensive2=Moderate3=CheapStorage1=Small2=Moderate3=SpaciousComfort1=Uncomfortable2=Moderate3=Comfortable Fun 1=Boring 2=Just OK 3=Lots of FunLook1=Ugly 2=Just OK 3=BeautifulTotal Weight Sport car 1x1= 1 1x2= 2 1x3= 3 3x5= 15 3x10= SUV 4x4 1x1= 1 2x2= 4 3x3= 9 2x5= 10 2x10= Family car 2x1= 2 3x2= 6 2x3= 6 1x5= 5 1x10= Station wagon 3x1= 3 3x2= 6 3x3= 9 1x5= 5 1x10= 10 33

CriteriaCost1=Expensive2=Moderate3=CheapStorage1=Small2=Moderate3=SpaciousComfort1=Uncomfortable2=Moderate3=Comfortable Fun 1=Boring 2=Just OK 3=Lots of FunLook1=Ugly 2=Just OK 3=BeautifulTotal Weight Sport car 1x1= 1 1x3= 3 1x10= 10 3x2= 6 3x5= SUV 4x4 1x1= 1 2x3= 6 3x10= 30 2x2= 4 2x5= Family car 2x1= 2 3x3= 9 2x10= 20 1x2= 2 1x5= 5 38 Station wagon 3x1= 3 3x3= 9 3x10= 30 1x2= 2 1x5= 5 49 Adding Weight (Female perspective)

Prioritization Practice Session Divide class in groups Brainstorm Make a list And start Scoring!!!!!

Prioritization Matrix Practice

How does MSD apply quality?

MSD QI Measures WorkloadAccessibilityEffectivenessEfficiencyUtilizationSafetyClinicalStaffing

Process Improvemen t PDCA Cycle

F O C U S

F – Find the problem O – Organize the team C – Check the current process U – Understand gaps in current process S – Select the outcome

F - Find the problem

O – Organize the team

C – Check the current process

U - Understand the causes of process variation

Barrier: “Don’t like product” 5 Whys Analysis Pareto Chart of the barriers to Hand Hygiene

S – Select the outcome S S pecific M M easurabl e T T imescaled A A ttainable R R elevant Does your KPI show progress towards the desired results? Does the KPI contribute to measuring the overall success? Does your KPI clearly tell you what to achieve by the project? Does the KPI let you track and account for the project ? Is there an exact end point to work towards ? Increase the hand hygiene compliance in medical unit from 30.6 to ≥85% within 3 months

P – Plan D – Do What will we do? When will it be done? ? Who will be responsible How much will it cost? 16 to 30 Sep Oct Sep Sep 2017 weekly 15 Oct 2017 weekly 20 Oct 2017

Check

Act Control Subject Subject Goal Frequency of Measure Criteria for Decision Action/ Responsible Party Analysis Method Hand Hygiene Compliance Rate 85% Monthly for 6 Month then Quarterly onwards Lower than 80% Committee Leaders Report to Medical Unit head Nurse Managers and CQI&PS Direct observation Control Plan

MSD Policy: Eliminate harm change culture = Patient Safety All MSD Hospital personnel should be able to report patient safety issues and errors or near misses without fear of reprimand or punishment.

A focus must be placed on remedial actions to assist rather than punish staff members.

Hospital leadership must implement a process to prevent retribution against individuals who report issues related to the culture of safety.

Staff should not be blamed for errors that occur due to a breakdown in the system/process or communication.

Reckless behavior requires accountability. Hospital management must maintain accountability by establishing zero tolerance for reckless behavior.

Hospital management must encourage teamwork and create structure, processes, and programs that allow this positive culture to flourish.

Humans will err despite their best efforts, knowledge and motivation. Therefore goal of Patient Safety is not to eliminate human error, but to create safe systems to prevent them from reaching the patient. Context of error is more important than the participant. Ask "How did it happen" not "Who did it'? Assumes good intentions, ability, motivation and knowledge Systems or processes that depend on perfect human performance are fatally flawed. Most adverse events result from a cascade of failures in a flawed system

Questions? THANK YOU The Journey Continues