1. Quality Improvement in Critical Care The value of teamwork

2. Improving Patient Safety in Critical Care The value of teamwork

4. 1.Financial management (including “control”) Strategic management Leadership Communication skills Human resources Creating and teaching an ICU manager

5. “Doctor, tell me how well we are doing with regards to the AHRQ document and the practices that improve patient safety?”

6. INPUTOUTPUT Processes Accountability

7. AHRQ Report on Patient Safety  -blockers in high risk operative patients DVT prophylaxis Feeding (enteral; parenteral), Skin management, Antibiotic impregnated CV catheters, Consentable procedures      

8. INPUTOUTPUT Processes Information

9. Management Basics 1.What are we doing now? Utilization reviewUtilization review 2.How well are we doing? BenchmarkingBenchmarking

10. 1.Using primary data acquisition to evaluate outcomes Clinical trials Surveillance studies 2.Using primary data acquisition for other questions Registries and data banks 3.Summarizing existing information Literature reviews Meta-analysis Group Judgment Consensus conference Mathematical modeling "How to" Benchmark

11. INPUTOUTPUT Processes Information Intervention Change

12. Management Basics 1.What are we doing now? Utilization reviewUtilization review EvaluationEvaluation 2.How well are we doing? BenchmarkingBenchmarking 3.How to improve? Change, U.M. and TranslatingChange, U.M. and Translating 4.Did we achieve desired change?

13. Overall, What Changes Clinical Practice ? Most interventions effective under some circumstances - none effective under all.Most interventions effective under some circumstances - none effective under all. –Interventions based on assessment of barriers are more likely to be effective “Diagnostic analysis”“Diagnostic analysis” Multi-faceted interventions more effectiveMulti-faceted interventions more effective –Educational outreach and reminder systems appear promising

14. Networking to Integrate…. Hospitals Core Support Team ç Research Expertise ç Summary Reports ç Educational Sessions ç Practical Advice ç Questions ç Feedback on Studies ç Insight ç Data

15. Barriers to Good Decision Making Performance of an individual or team is a function of, and determined by, P = M x C P = M x C B Where: P = performance M = motivation C = competence B = barriers C = competence B = barriers

16. QI