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September 2017 Henry Rice, MD

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Presentation on theme: "September 2017 Henry Rice, MD"— Presentation transcript:

1 Duke University Global Health Patient Safety and Quality Training Fellowship
September 2017 Henry Rice, MD Chief, Division of Pediatric General Surgery Professor of Surgery, Pediatrics, and Global Health

2 Content Part I Fellowship Goals and Objectives
Part II Work to date in Guatemala Part II Program Development Part III Represented Duke Faculty Mentors Part IV Training Overview Fall 2017 Part V Guatemalan Fellows

3 Training Fellowship Aims and Objectives
The goal of the Duke University Global Health Patient Safety and Quality Training Fellowship is to train health care scholars from low- and middle-income countries to lead quality and patient safety efforts in their home institution. Figure 1. Safety and Quality Fellowship Core Curriculum Overview

4 Work done to date in Guatemala
Safety Culture Assessment in a Pediatric Nephrology Unit in Guatemala SCORE Baseline assessment of a unit’s safety culture Targeted QI initiative development integrated into fellowship training Clinical Outcome Analysis Reassessment every months Pilot assessment in LMIC

5 Training Fellowship Development
Developmental Aims Sep 2017 Oct 2017 Nov-Dec 2017 Jan-Summer 2018 Fall 2018 Core Competencies Framework Safety Culture and Quality Improvement Project Proposals Project Execution Ongoing Implementation and Oversight Reassessment of Safety Culture Guatemala Fellows Duke Team Didactic and experiential training at Duke University Hospital. Identification of targeted safety culture and QI projects. Finish online Safety and Quality Training. Assistance with department action plans including tools to enhance the culture of safety. Translate evidence-based patient safety/clinical quality practices into appropriate initiatives at their home institution. Formal debriefing with unit staff hosted by Guatemala and Duke Safety Leaders. Progressing establishment of patient safety/quality improvement projects. Provide ongoing guidance and support of fellows regarding patient safety and clinical quality priorities. Employment of re-assessment of safety culture survey lead by Duke and Guatemala Safety Leaders. Concurrent safety culture, QI, and clinical outcome analysis.

6 Quality and Patient Safety Mentors Guatemalan Fellows Fall 2017
Faculty Representing Duke Surgery, Anesthesiology, Patient Safety, Pediatrics, and Internal Medicine Henry Rice, MD, Chief of Pediatric Surgery DUHS, Co-Director of Global Health Safety and Quality Fellowship Joel Boggan, MD, MPH, Associate Program Director for QI and PS Medicine Residency Program Karen Frush, MD, Chief PSO DUHS & VP, Quality LifePoint Hospitals Judy Milne, MSN, RN, CPHQ, CPPS, Patient Safety Officer, DUHS Alexander Allori, MD, MPH, Director of Quality and Safety for Duke Pediatric Surgery Brad Taicher, DO, MBA, Director of QI in Anesthesiology at DUHS Kyle Rehder, MD, Director Pediatric Critical Care Fellowship, Trainer in TeamSTEPPS Kara Lyven, Senior Associate Patient Safety Officer Duke Patient Safety Heather McLean, MD. Vice Chair of Quality at Duke Children’s Hospital Marie McCulloh, MSN, RN, CPPS, Associate Patient Safety Officer, Duke Quality Network Aaron Rose, MBA, Administrative Director of Quality and Safety, Duke Children’s Hospital Vani Sistla, MPH, Children’s Surgery Program Manager, SSI Project Bryan Sexton, PhD, Director of the Patient Safety Center for DUHS

7 Safety and Quality Fellowship Training Overview Guatemalan Fellows Fall 2017
Global Burden of Unsafe Medical Care Henry Rice, MD (Co-Director) Multidisciplinary Engagement in Patient Safety Joel Boggan, MD, MPH Unit Teamwork and Communication Kyle Rehder, MD Introduction to Patient Safety and Quality Background and Importance Safety and Quality on the Global Health Agenda Global Metrics and Quality Improvement Importance of multidisciplinary unit briefings Engaging nursing and ancillary staff from beginning Start small on one unit Encourage staff to speak up about concerns Influence of Leadership/Executive Walkrounds Removing the stigma with “debriefings” Be mindful of resilience Empower key stakeholders across disciplines Learning Boards Safety Culture Introduction and Importance Judy Milne, MSN, RN, CPPS and Kara Lyven, PSO Introduction to Quality Improvement Heather McLean, MD Important Lessons in Quality Improvement Alexander Allori, MD, MPH and Vani Sistla, MPH SCORE survey review and debriefing of Guatemala Pediatric Nephrology unit Action plan development The relationship between clinical outcomes and safety culture Identifying Quality Gaps “Good Catch” Awards Introduction to translating theory to practice in home institution Quality 101 Six domains of Quality Performance Improvement tools/methodology (i.e. PDSA, Key Driver Diagrams, etc.) Case study in pediatric CLABSI Quality improvement methodologies Engaging a small core QI team Rapid Improvement Process Engaging Leadership and key stakeholders How to identify opportunities for development Local QI Implementation Case Study in SSI

8 Safety and Quality Fellowship Training Overview Guatemalan Fellows Fall 2017
Introduction to Learning from Defects Kara Lyven, PSO TeamSTEPPS Master Training Course (2 days) Duke Patient Safety Leaders Patient Safety and Quality in Low Resource Hospital Settings Karen Frush, MD, CPPS, and Marie McCulloh Learning from Defects 101 (LFD) LFD Methodology Practicing LFD with case studies Swiss Cheese Model Team Structure and Communication Principles to leading teams Situation Monitoring Change Management Coaching workshop Implementation workshop Translate evidence-based patient safety/clinical quality practices into appropriate initiatives for unit at home institution Value based performance goals Utilization of clinical safety checklists Example of Duke Life Point Community Hospital Program Failure Mode & Effects Analysis Judy Milne MSN, RN, CPPS and Kara Lyven, PSO Patient Safety Leadership Course (3 days) Bryan Sexton, PhD Practical Applications of Quality Improvement Aaron Rose, MBA and Vani Sistla, MPH Basics of FMEA FMEA Matrix Utilization Barriers of FMEA FMEA Workshop (Kidney Transplant Workflow) Hands-on tips for risk management Proactive Risk Reduction Science behind Safety Culture Resilience Evidence-based executive rounding Tools and framework for safety and quality improvement Pacing change in a sustainable way Just Culture/Fair Accountability Translate evidence-based patient safety/clinical quality practices into appropriate initiatives for unit at home institution Value based performance goals Utilization of clinical safety checklists Example of Duke Life Point Community Hospital Program

9 Guatemalan Fellows - Fall 2017
“Working with Duke has showed us that we have to start small in making changes,” says Dr. Ramirez. “We can then continue to build on that, and by improving our communication and using tools that we have been given, we can improve the environment for both our staff and our patients.” Carla Ramirez, MD, Pediatric Surgeon (left) and Sindy Mendez, MD, Pediatric Nephrologist (right) Roosevelt Hospital, Guatemala City, Guatemala

10 Guatemalan Fellow Testimonial - Fall 2017

11 Dr. Rice and Judy Milne

12 Dr. Rice and Judy Milne

13 Dr. Allori, Dr. Rice, and Vani Sistla (Duke Surgery)

14 Dr. Rice

15 Dr. McLean

16 Aaron Rose and Vani Sistla – Duke Surgery

17 Dr. Karen Frush and Marie McCollugh

18 Bria Johnston and Judy Milne

19 Kara Lyven

20 Judy Milne teaching FMEA

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