1. HOW-TO GUIDE: STARTING A STUDENT RUN QUALITY IMPROVEMENT PROJECT TMIT Student Projects QuickStart Package ™

2. Objectives  List overarching global aims of improvement  Form a multi-disciplinary team  Begin to innovate, design, and implement a student-run quality improvement project  Use Plan-Do-Study-Act cycles for improvement initiatives

3. Outline I. Introduction to Quality Improvement II. From Innovation to Design III. The Pilot IV. Implementation

4. Outline I. Introduction to Quality Improvement 1) Aims for improvement 2) Multi-professional teamwork 3) Students role

5. So You Want To Create Change? “While all changes do not lead to improvement, all improvement requires change.” - Institute for Healthcare Improvement

6. From Theory to Practice: “Check a Box. Save a Life.” The First Global Student Sprint to Improve Healthcare  We will use this example to illustrate how students can design, pilot, and implement a project  The Innovation- Students taking the lead with efforts in spreading the WHO Surgical Safety Checklist

7. Aims for Improvement We need healthcare that is:  Safe Avoid injuries to patients from the care that is intended to help them.  Effective Match care to science; avoid overuse of ineffective care and underuse of effective care.  Patient-Centered Honor the individual and respect choice.  Timely Reduce waiting for both patients and those who give care.  Efficient Reduce waste.  Equitable Close racial and ethnic gaps in health status.

8. Safer Patient Care Business School Public Policy Nursing Medical Pharmacy Public Health Health Admin Multi-Professional Teamwork

9. Students Role  There are hundreds of processes that can be improved in a system.  What you can do? Gain Knowledge ○ Raise awareness and share knowledge of the System Be Active ○ Pilot and implement a safe practice Use Evidence ○ Research latest evidence-based improvement strategies ○ Collect data before and after improvement strategy

10. Pharmacy: Track antibiotic use and costs for surgical patients. Engineering: Examine patient flow and fit checklist into OR processes. Health Admin: Determine the cost savings in your hospitals from the checklist. Public Health: Track patient outcomes and measure impact. MD//DO/RN: Engage your classmates to learn it, use it, and seek advice from others. Safe Surgery Student Sprint Example: Multi-Disciplinary Student Involvement

11. Outline I. Introduction to Quality Improvement II. From Innovation to Design III. The Pilot IV. Implementation

12. Outline II.From Innovation to Design 1. Forming Your Team 2. Setting Aims 3. Creating a Strategy 4. Change Concepts 5. Project Proposal

13. Innovating, not reinventing  If you are talking to the right people, chances are you will stumble across someone who has had similar thoughts about changing the current system  Connect early and discuss methods that are already in place or being researched  Your greatest barrier can be your attempt to do this on your own  Get a team on board and work together!

14. Forming Your Team  Collaborative Partners Multi-disciplinary team Each member with different expertise  Recruit key opinion leaders and advisors Find a mentor who is connected to your project through a department affiliation or quality improvement committee

15. Example: Recruiting Key Opinion Leaders Safe Surgery Student Sprint  A student used an evidence-based improvement strategy such as the WHO Surgical Checklist  Introduced checklist to key opinion leaders of hospitals, including: Superintendant of Hospital Chair of Surgery Chief of Quality Assurance

16. Forming Your Team Leadership  Responsibility Charting Distinguish individual roles with listed activities Using this tasking method gives the whole team a global view of the project’s evolution  Logistics Create short deadlines Have frequent update meetings  Team work! Team work! Team work!

17. Example: Responsibility Charting Safe Surgery Student Sprint Steps/ActionsTasksDeadlineStatusOwnerNotes Creating a Vision/Strategy Project Proposal Action Plan 3/12/2009 3/15/2009 Complete Pending Sarah John Submitting to advisor Will email Pilot StudiesCase studies4/5/2009PendingSarah John Michael Draft #2 DeliverablesStudent PowerPoint 5/1/2009PendingMichaelDraft #1 completed PublicationsPoster session5/1/2009PendingJohnWill email committee

18. Setting Aims 1. State your aim clearly 2. Identify the population and system to be improved 3. Set numerical goals To better measure outcomes 4. Set Stretch Goals Give yourself a timeline ○ Ex: Reduce infections by 50% in 6 months 5. Avoid Aim Drift Focus on your goal and try not to steer away

19. Creating an Improvement Strategy 1. Critical thinking about the current system 2. Benchmarking 3. Using technology 4. Creative thinking 5. Using change concepts

20. Change Concepts An approach to change that has been useful in developing ideas for improvement efforts:  Eliminate Waste  Improve Work Flow  Manage Time  Focus on Variation  Change the Work Environment  Error Proofing

21. Example: Using a Change Concept Changing the work environment  Building a new type of network Instead of Hospital Administrators, in this project, Students were the Change Agents in spreading this quality improvement tool Students used new social networking features as a primary means of building their project network

22. Project Proposal I. Vision/Mission II. Setting Aims III. Proposal Outline I. Background II. The Intervention III. Strategy for Implementation

23. Outline I. Introduction to Quality Improvement II. Innovation to Design III. The Pilot IV. Implementation

24. Outline III. The Pilot 1) Using PDSA Cycles 2) Communication 3) Data Collection

25. The Pilot  Start as a pilot Small scale with a few individuals testing your improvement method Use Plan-Do-Study-Act (PDSA) cycles during this pilot phase

26. The Pilot: Using PDSA Cycles  Run a test trial on a small scale  Follow a simple “PDSA” cycle for pilot Plan Do Study Act

27. Example: Using PDSA Cycles Safe Surgery Student Sprint One student. One hospital. Three operating rooms.  Plan: Introductory seminar and teaching with hospital administration and residents.  Do: One week trial using 3 ORs  Study: Feedback session given to residents and surgical staff..  Act: Continued piloting the checklist in 3 operating theaters with improvements in place.

28. The Pilot: Communication  Background education Share the facts Answer questions ahead of time  Energize your team Get them excited about change!  Communication Ensure that all of those participating in pilot are aware of their roles and project aims

29. The Pilot: Data Collection  Plot data over time  Seek usefulness  Use sampling  Integrate measurement into daily routine  Use qualitative and quantitative data

30. Example Data Collection Safe Surgery Student Sprint Wales, UK Jan – June 2009  Students were data collectors in OR 25 students observed 83 operations Reported observations into an online data form  Evaluated 5 items of standard procedure  Data used to encourage implementation

31. Outline I. Introduction to Quality Improvement II. Innovation to Design III. The Pilot IV. Implementation

32. Outline V. Implementation 1. Pilot to Implementation 2. Keys to Successful Adoption 3. Project expansion 4. Leadership Changes

33. Implementation  After the pilot, evaluate for ways you can make the project successful on a larger scale  Create a step-by-step process outline for easy engagement  Be ready for resistance Be prepared to address counter arguments  Champions can lead the way  Continue to Collect Data

34. Keys For Successful Adoption  Relative Advantage Degree to which an innovation is perceived as being better than the idea it supersedes  Compatibility Degree to which an innovation is perceived to be consistent with the existing values, past experiences and needs of potential adopters  Complexity Degree to which an innovation is perceived as difficult to use  Trialability Opportunity to experiment with the innovation on a limited basis  Observability Degree to which the results of an innovation are visible to others

35. Example: Spreading your project “Check a Box. Save a Live.”

36. Leadership Change Passing the Torch  Remember handoffs are a leading cause of error!  Ensure members of the original team will be able to continue carrying out efforts  Document logistical challenges and recommendations for the next leader  Keep lines of communication open

37. Summary Objectives  List overarching global aims of improvement  Form a multi-disciplinary team  Begin to innovate, design, and implement a student-run quality improvement project  Use Plan-Do-Study-Act cycles for improvement initiatives  Be Bold. Be a Change Agent!