Quality is Personal So is Harm Manoj Jain, MD, MPH

Goal Share my journey Quality Improvement is a universal principle Quality Improvement is personal

Journey

First Do No Harm Primum non nocere Hippocratic Oath – Hippocrates 460BC to 370 BC Hippocratic Corpus is in Epidemics: "The physician must...have two special objects in view with regard to disease, namely, to do good (and) to do no harm"Hippocratic Corpus

Ahimsa – Do not Harm Jainism - Mahavira Philosophy of Nonviolence - Ahimsa Mahavira- 599 BC – 527 BC

Various Strategies to Reduce Harm: Malpractice Suits Only 2 percent of negligent injuries resulted in claims Only 17 percent of claims appeared to involve a negligent injury. Win – Lose situation

Various Strategies to Reduce Harm: Regulations alone –A Compromise Lose- Lose Pay for Performance alone –A compromise lose – lose

Quality Improvement is the Nonviolence Strategy for Change Win –Win situation All parties grow to recognize a greater Truth

Common Elements in Quality Improvement and Nonviolence Status quo is not acceptable Collective action is required Transparency is critical

We must make Quality Improvement personal

PDSA: The Wheel of Improvement

Wheels in Motion: Continuous Quality Improvement

4 Elements of Change Multidisciplinary Teams – Staff ownership Flow Meetings –Administrative support Bundles –Evidence based medicine Culture of Change –Horizontal decision-making

Adverse Events Per ICU Day* Multidisciplinary Rounds Hand Hygiene Protocol Vent Bundles ICU Medical Director Central Line Bundles UTI Bundles * A list of event triggers that have been shown to be indicators of potential quality of care issues (See trigger tool)

Nosocomial Infection Rates FY 2001-FY 2004 YTD

Average Cost Per ICU Episode 15.6% Decrease 8.6% Decrease

Essential Elements in Quality Improvement and Nonviolence Transparency –Public Reporting of quality data

Challenge to all: Marriage of Personal and Professional Take one personal deficiency (ask you spouse) and apply PDSA or Lean Take one personal/cultural/religious attribute and apply it in your professional life

BUILD A TEAM

Thank You!