1. So far but how good? 29 September 2009 Presenter: Mike Davidge
LS3: So far but how good?

2. Content Some good news [5] What & why [5]
What happens when its not [5]
So how good are we [8]
What to do [2]
Content area preview [5]
LS3: So far but how good?

3. Measured all patients and made changes Baseline with 10 patients
A good news story
% patients with peri-operative normothermia
Brecon theatre
Changes made:
Changed to Bair hugger gowns
Comprehensive warm up
Changed thermometers
100%
80%
% patients
Measured all patients and made changes
60%
Baseline with 10 patients
40%
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LS3: So far but how good?

4. What is a reliable process?
“Reliability is the ability of a person or system to perform and maintain its functions in routine circumstances, as well as hostile or unexpected circumstances” Wikipedia
“Reliability is the extent of failure-free operation over time.” David Garvin – Harvard Business School
“When I’m here it works, when I’m not it doesn’t” Healthcare professional
LS3: So far but how good?

5. Why Reliable Design? Most processes deliver haphazard results
Almost all studies that investigate the reliability of the application of clinical evidence conclude that it is 80% or worse
Unreliable processes lead to variable outcomes
2 Studies in the US indicated up to 50% of patients received sub-optimal care
LS3: So far but how good?

6. The cumulative effect of unreliable processes
23 step process
What if all steps in process were 95% reliable?
Out of 100 patients:
95 safely negotiate first step
90 safely negotiate first 2 steps (95%x95%)
How many come through all 23 steps? 31
LS3: So far but how good?

7. What happens when we’re unreliable
Turn to neighbour
Tell them about an occasion when a process where you work broke down or went wrong
Did it have a detrimental effect on patient care?
Vote: Hands up if you could think of an example
Keep them up if it affected patient care
LS3: So far but how good?

8. How Hazardous Is Healthcare?
LS3: So far but how good?

9. Very few whole Trust measures
So how good are we?
411
Data series
Very few whole Trust measures No
Yes
47%
53%
% with at least 6 data points No
Yes
% with last 6 data points at 95% or above
38%
15%
LS3: So far but how good?

10. The First Law of Improvement
“Every System Is Perfectly Designed to Achieve Exactly the Results It Gets”
(Both reliable and unreliable processes don’t happen by accident, they are carefully planned)
LS3: So far but how good?

11. Content Area breakouts: Leadership perspective
Clearly describe your organisational outcome goals
VAP, CLI, Mortality etc
Understand the relationship between processes and outcomes
Set process expectations for the teams
eg all elements of the ventilator bundle will be done 95% of the time on eligible patients
Demand data to show how reliable the process has become
Set reasonable timescales
Put your money where your mouth is
If outcomes have not improved and process reliability is high provide resources to determine the “correctness of performance” of the processes
LS3: So far but how good? 11

12. Content Area breakouts
Focus on reliability
Before lunch
How to design a reliable process
2 case studies
After lunch (clinical content areas only)
Make a plan to design your next reliable process
Prepare feedback for tomorrow’s planning session
LS3: So far but how good?