1. Characteristics of Successful QI Teams
Mirek Skrypak
Associate Director for Quality and Development
@MirekSkr @HQIP

2. Safe Timely Efficient Equitable Effective Patient-centered
Teams working on quality improvement address the following:
Safe
Timely
Efficient
Equitable
Effective
Patient-centered
Safe: avoiding injuries to patients from the care that is intended to help them.
Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care.
Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy.
Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status
Effective: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.
Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.
@MirekSkr @HQIP

3. @MirekSkr @HQIP

4. X Y Simplicity Patient sees doctor
Healthy and productive member of the community
@MirekSkr @HQIP

5. Complexity
@MirekSkr @HQIP

6. The NHS 133 People to take care The Patient of the patient
@MirekSkr @HQIP

7. Complex systems
@MirekSkr @HQIP

8. Do we know how good we are?
Some key questions to ask as a team…
Do we know how good we are?
Do we know where we stand relative to the best?
Over time, where are the gaps in our practice that indicate a need for change (i.e. improvement)?
In our efforts to improve, what’s working ?  
Do we know/understand where variation exists in our organisation?
@MirekSkr @HQIP

9. Don’t get lost in improvement approaches
There are many improvement approaches - each with their own evangelists.
Richard Bomer’s work…….
Whilst not solely using audit the DH and subsequently NHS E have invested heavily in audit and supported it consistently over the last nearly 20 years
@MirekSkr @HQIP

10. Break out Exercise Get into groups of 5,6,7,8:
Assign a time keeper/ball drop counter
Assign a number to each of the other people at your table, starting with the number 1 and continuing until you run out of people
@MirekSkr @HQIP 10

11. Break out Exercise
Your current process involves tossing the tennis ball (provided) from person to person, following the sequence provided on the next slide
Practice your process one time
Time keeper please:
Time how long the team takes to complete the process (in seconds)
The number of times they drop the tennis ball
@MirekSkr @HQIP 11

12. Exercise Sequence 8 people 7 people 6 people 5 people 1 1 4 1 4 8 1 43 4 7 8 2 6
6 people
5 people 1 2 3 4 6 7 5 1 2 3 4 5 6 1 2 3 4 5
@MirekSkr @HQIP 12

13. Time? Drops?
@MirekSkr @HQIP

14. Break out Exercise
Team Aim: We aim to reduce the time taken for every person to touch the ball in sequence.
We also aim to reduce our ball drops
Rules:
The initial sequence as provided must be adhered to
You may only test one change idea at a time
Record the time and ball drops after each change
@MirekSkr @HQIP 14

15. Exercise Sequence 8 people 7 people 6 people 5 people 1 1 4 1 4 8 1 43 4 7 8 2 6
6 people
5 people 1 2 3 4 6 7 5 1 2 3 4 5 6 1 2 3 4 5
@MirekSkr @HQIP 15

16. How did you get on ? Fastest Time ? Breakthrough Changes?
@MirekSkr @HQIP

17. PDSA Learning Cycle @MirekSkr @HQIP
“A goal without a plan is just a wish” “It’s not the plan that’s important, it’s the planning.”
Antoine de Saint-Exupery Dr. Graeme Edwards
Langley et. al
@MirekSkr @HQIP 17

18. @MirekSkr @HQIP

19. @MirekSkr @HQIP

20. @MirekSkr @HQIP

21. Why are we measuring?
@MirekSkr @HQIP

22. @MirekSkr @HQIP

23. A personal view from John Welch clinical lead (sepsis) regional QI collaborative
Clinicians and patients to set the agenda
Clarity, simplicity; ambition with realism
Exemplars, information, feedback (“how we’re doing”) that feels current and relevant at the local level
Do-ers as well as “leaders” - and credible leaders who get their hands dirty
Robust critique - allowing doubters to voice their concerns and to shape what’s done; and change if new evidence or new information emerges
Recognition that sometimes a place or team or time just isn’t right
@MirekSkr @HQIP

24. Model at least these 5 behaviours by… Santana et al 2011 J Hosp Med, Behaviors of Successful Interdisciplinary Hospital Quality Improvement Teams
motivating involved hospital staff toward a shared goal
creating opportunities for learning and problem-solving
addressing the impact of changes to care processes on staff
protecting the integrity of the new care processes
representing each involved clinical discipline effectively.
These behaviors may enhance a QI team’s ability to motivate the various disciplines involved, understand the care process they must change, be responsive to front-line concerns while maintaining control over the improvement process, and share information across all levels of the hospital hierarchy.
Teams in successful hospitals did not avoid interdisciplinary conflict, but rather allowed each discipline to contribute to the team from its own perspective.
Successful QI teams addressed the concerns of each involved discipline, modified protocols guided by clinical outcomes, and became conduits of information on changes to care processes to both executive managers and front-line staff.
@MirekSkr @HQIP

25. Specification and planning Infrastructure design
The Four Habits of High-Value Health Care Organizations
NEJM 2011 Bhomer
Specification and planning
Infrastructure design
Measurement and oversight
Self-study
“Learn from the patient of today, to improve the care for the patient of tomorrow”
Learn from mistakes
Be creative
Capitalise on User Experience and Feedback (including your own team members)
@MirekSkr @HQIP

26. The Value of “Failed” Tests
“I did not fail one thousand times; I found one thousand ways how not to make a light bulb.”
Thomas Edison
When asked by a critical journalist how it felt to have failed 1000 times, Edison is said to have replied… 26
@MirekSkr @HQIP 26

27. Learning from mistakes to increase P.A.C.E of QI
Probe
‘Doctor, what other options are you considering if we can’t get the tube in’
Alert
‘Doctor, O2 is at 40% and still dropping, the tube not going in, what about a tracheostomy kit?’
Challenge
‘Doctor, we need to conduct a tracheostomy now or we will loose the patient’
Emergency
‘I’m alerting the resuscitation team to do the tracheostomy’
@MirekSkr @HQIP

28. "Creativity is seeing what everyone else has seen, and thinking what no one else has thought" ~ Einstein
@MirekSkr @HQIP

29. Design versus user experience and what could happen when you respond to user
@MirekSkr @HQIP

30. @MirekSkr @HQIP

31. 1)Control the controllables
Words of wisdom….
1)Control the controllables
2)Football is like a bank, the more you put in the more you will get out
3)You are only as good as your last game
@MirekSkr @HQIP

32. THANK YOU Mirek Skrypak Associate Director for Quality and Development
@MirekSkr