1. Transforming Wales, Transforming the World: The 1,000 Lives Campaign and the International Patient Safety Movement 1,000 Lives Campaign -- Learning Session Zero Cardiff, Wales March 18, 2008 Joseph McCannon Vice President Institute for Healthcare Improvement

2. Ground to Cover… An overview of national efforts to improve health care safety and quality A case study from the United States Some key lessons and insights as you embark on your ambitious program Questions and discussion

3. An International Movement of Movements

4. An International Movement of Movements (cont) Wales Canada Denmark Scotland Japan Brazil Russia South Africa Ghana Laboratories for large-scale change

5. So… …what’s going on here?

6. The Five Eras of Health Care Improvement 1. Migration from apprenticeship to science 2.Combination of bioscience and health care science 3.Maturation of health services research 4.Development of agenda for patient safety and quality improvement 5.Improvement at the center of strategic action

7. IHI’s “Rings” of Activity Innovation Prototype Dissemination

8. Campaign Origins Origins of IHI’s 100,000 Lives Campaign: ─Frustration with persistent variability in the quality of care, along with the national scope and rate of change; ─Belief that our sense of urgency was shared by leaders and providers throughout the system; ─Charismatic leadership ─Belief in the value of a shared, explicit set of aims.

9. 100,000 Lives Campaign Objectives (December 2004 – June 2006) Save 100,000 Lives Enroll more than 2,000 hospitals in the initiative Build a reusable national infrastructure for change Raise the profile of the problem - and our proactive response

10. Six Changes That Save Lives Deployment of Rapid Response Teams…at the first sign of patient decline Delivery of Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack Prevention of Adverse Drug Events (ADEs)…by implementing medication reconciliation Prevention of Central Line Infections…by implementing a series of interdependent, scientifically grounded steps called the “Central Line Bundle” Prevention of Surgical Site Infections…by reliably delivering the correct perioperative antibiotics at the proper time and taking several other associated actions Prevention of Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically grounded steps called the “Ventilator Bundle”

11. 100,000 Lives Campaign Objectives (December 2004 – June 2006) Save 100,000 Lives Enroll more than 2,000 hospitals in the initiative Build a reusable national infrastructure for change Raise the profile of the problem - and our proactive response

13. 100,000 Lives Campaign Objectives (December 2004 – June 2006) Save 100,000 Lives Enroll more than 2,000 hospitals in the initiative Build a reusable national infrastructure for change Raise the profile of the problem - and our proactive response

15. 100,000 Lives Campaign Objectives (December 2004 – June 2006) Save 100,000 Lives Enroll more than 2,000 hospitals in the initiative Build a reusable national infrastructure for change Raise the profile of the problem - and our proactive response

16. The 100,000 Lives Campaign Scorecard An estimated 122,000 lives saved by participating hospitals (through work on the Campaign but also through other improvements and work on complementary initiatives) Over 3,100 Hospitals Enrolled ─Over 78% of all discharges ─Over 78% of all acute care beds ─Over 85% of participating hospitals sending IHI mortality data Participation in Campaign Interventions: –Rapid Response Teams: 60% –AMI Care Reliability: 77% –Medication Reconciliation: 73% –Surgical Site Infection Bundles: 72% –Ventilator Bundles: 67% –Central Venous Line Bundles: 65% –All six: 42%

17. Additional Campaign Status Over 55 field offices (“nodes”) Vibrant national partner support Thousands on national calls and unprecedented web activity New tool development and harvesting Unprecedented media coverage (Newsweek, US News and World Report, Wall Street Journal, New York Times, JAMA) Related campaigns forming nationally and globally Changes in standard of care in participating facilities (e.g. over 25 hospitals going a year without a VAP)

19. The Six Interventions from the Prior Campaign Plus… …new interventions targeted at harm: Prevent Pressure Ulcers... by reliably using science-based guidelines for their prevention Reduce Methicillin-Resistant Staphylococcus Aureus (MRSA) Infection…by reliably implementing scientifically proven infection control practices Prevent Harm from High-Alert Medications... starting with a focus on anticoagulants, sedatives, narcotics, and insulin Reduce Surgical Complications... by reliably implementing all of the changes in care recommended by the Surgical Care Improvement Project (SCIP) Deliver Reliable, Evidence-Based Care for Congestive Heart Failure…to reduce readmissions. Get Boards on Board….Defining and spreading the best-known leveraged processes for hospital Boards of Directors, so that they can become far more effective in accelerating organizational progress toward safe care

20. Some Early Returns Enrollment eclipsing 3,700 hospitals (70-75% of all US hospital beds) Nodes in all 50 states and 155 mentor hospitals Outstanding national call attendance (250-500 lines per call) More than 50,000 downloads of intervention materials (very strong interest in MRSA, Pressure Ulcer and “Boards on Board” interventions) Increased action in rural, pediatric and public affinity groups Promising intervention-level results 4,000 lines engaged on National Action Day Over 30 million new media impressions Vibrant Fall Harvest in all 50 states and DC

21. Early Returns (continued) 150 New Jersey Hospitals reduced pressure ulcers by 70% Many Campaign hospitals report going over a year without a ventilator-associated pneumonia, central-line infection Exceptional results on virtually every intervention in every state and every type of facility

22. The Big Questions… Will we help drive a massive national reduction in harm? (Results) Will we help hospitals in a meaningful way? (Value)

23. What are the Key Elements of Success in a Hospital? Leadership Honest review of data Prioritization Proper resourcing Clinician engagement Capacity with improvement and project management

24. Framework for Change Within the Organization Will Ideas Execution (“profound knowledge” + infrastructural commitment)

25. What are the Key Elements of Success in a State or Nation? Leadership attention and fidelity to crisp aims Optimism Joy and “heart” Frontline ownership Simplicity and practical direction Sophisticated coordination among all stakeholders Vibrant sharing and networking (all teach – all learn)

26. Forces of Note in Transforming Health Care (Complex Dynamics) Consumers Caregivers Policy/politics Payers/Purchasers Media Research Community Information Technology Push for Transparency

27. What are the Key Elements of Success in a State or Nation? Leadership attention and fidelity to crisp aims Optimism Joy and “heart” Frontline ownership Simplicity and practical direction Sophisticated coordination among all stakeholders Vibrant sharing and networking

28. Important Lessons on Large-Scale Change Large scale is a challenge and a blessing. Devolve control and trust local adaptation (ecosystem). Make peace with instability – practice creativity and opportunism Balance partnership and independence (clear operating values). Obsession with logistics is a healthy obsession.

29. A Sequence of Change 1.An innovative discovery 2.A demonstration in 50 hospitals 3.Outstanding results in 4 states 4.Interest from purchasers and payers 5.A state law in 14 states 6.A national mandate 7.A part of graduate-level training 8.An expectation and a standard 9.Confidence in ability to make change 10. More ambitious aims

30. An International Movement of Movements

31. Laboratories for change Studying differences in: Scale Pace Measurement Resources National interest or “felt need” Local skill Tolerance of media and policymakers

32. Remember… The network you’re building

34. Remember… The network you’re building The story you’re in the midst of telling

35. Remember… The network you’re building The story you’re in the midst of telling The patients and family that deserve the best care possible (your aim)

36. Why Optimism? We need a detailed, hopeful vision. Incredible care-givers and innovators across the nation. Our families are aging, getting sick, managing chronic disease (this is very personal…) Because this is not boiling the ocean…it is hard work but it is possible. “I dwell in Possibility…” – Emily Dickinson