Project Design: IHI’s Will, Ideas, Execution Jane Taylor, Ed.D. Improvement Advisor for SCCM

2 What is 5 Alive? 5 Alive: reduce under-5 mortality by two thirds from 1990 baseline from 110 deaths per 1000 live births to less than 40 per 1000 live births by Country-wide project in Ghana – 4 waves between July 2008 and Dec. 2015

3 What might we learn from this? IHI/API’s Tom Nolan’s framework: – Will – Ideas – Execution

4 Will Theory How leaders make the status quo uncomfortable and use a pull strategy toward the change Organizations and systems need it to get results Sepsis ICU may not be “best” place to treat patients with sepsis How to make the medical and surgical units attractive as a place to treat patients? How to make the protocol’s a great idea? How to create dissatisfaction with current morbidity and mortality?

5 Ideas New systems require better ideas about what is done, how it is done, who does it and what useful relationships will look like in order to make the new system work Ideas will come from inside and outside the system Demands robust approaches to scanning environment, evidence and current knowledge base to find changes to prototype, test

6 Execution What are the processes that have to cooperate to make the new system work? How do they work, and how can they work together in better ways? What work flows need improvement, redesign? New aim must be articulated, shared.

7 Vital questions to evaluate function of will, ideas and execution Is project aligned strategically? Is it connected with leadership and management priorities ? Is there solid leadership capacity throughout? Can leaders easily access data to understand how spread is going How accountable are leaders for results and gaps? How can we maintain an open dialog for adaptations, new ideas and other suggestions (IHI Lessons Learned from Fives Alive p. 14)

8 Vital Qs for Ideas Is there a useful vehicle (like a network, learning community, improvement collaborative) for spread of ideas? Are ideas fully vetted and evaluated before “abandoning” them? Are we focusing on the “how” of the “what?” Are we tapping into those who may be “marginalized in the care team?” for ideas too? (IHI Lessons Learned from Fives Alive p. 14)

9 Vital Qs for Execution Do we have ambitious, measureable goals? – Can they be achieved through redesign – Do we recognize the human factors limitations of working harder, being more vigilant? Are we attending to how we create more learning that results in behavior change? How we create collaborative learning among spread units? Do spread units have QI teams testing changes? Assessing progress? Do they have local data? (IHI Lessons Learned from Fives Alive p. 14)