1. SUSTAINING YOUR GAINS Kim Stelmacovich, M.H.Sc. Project Manager, CPSI

2. Learners will be able to: – Evaluate interim project outcomes using SPC run chart rules – Distinguish between changes to care and improvements to care – Distinguish between short term improvement and sustained improvement – Help your team prepare for Action Period #2 using tools from the Sustainability Workbook Learning Objectives

3. Group One: Repeat Participants Group Two: New Participants FFLS Participants

4. “ When new ways of working and improved outcomes become the norm… not only have the process and outcome changed but the thinking and attitudes behind them are fundamentally altered and the system surrounding them are transformed as well.” NHS Institute of Innovation and Improvement (2005) What is Sustainability?

5. The Value of Time Series Data and SPC Run Chart Rules

6. Change or Improvement?

9. The Value of Time Series Data Help you make decisions- Change or Improvement? Help focus on what is important Move you away from anecdotes and one person’s view Build confidence Will help you “sell” your ideas to colleagues Set the stage for improvement/identify problem areas Provide a common frame of reference for staff and leadership

10. SPC Run Chart Rules

11. Sustainability Workbook Tool

12. Rule One: A Shift Six or more consecutive points either all above or all below the median Rule Two: A Trend Five or more consecutive points all going up or all going down Rule Three: An Astronomical Data Point An obviously different value; anyone studying the chart would agree that it is unusual SPC Run Chart Rules

13. A Shift Bed Turns on Target Unit

14. A Shift con’t

15. A Trend

16. An Astronomical Data Point

17. What Does Sustained Improvement Look Like?

18. Source: Saskatchewan Health Quality Council ALOS on Target Unit Sustained Improvement

19. Sustainability = 10 – 15 consecutive data points Rule of Thumb

20. By March 2012, Participating teams will have: Reviewed their Falls Prevention and Injury Reduction Improvement Plans for sustaining practice change; Integrated sustainability strategies into their Falls Improvement Plans; Collected and submitted data monthly on measures to SHN for Falls Intervention and used this data to monitor and facilitate sustained improvement; Demonstrated a 20% improvement in their baseline measures and sustained for 3 consecutive months. FFLS Improvement Aim

21. … Demonstrated a 20% improvement in their baseline measures and sustained for 3 consecutive months FFLS Improvement Aim cont ** Need 7-12 more data points to verify sustainability **

22. Beyond Measurement: Putting it all Together

23. The Sustainability Process Improve Care Are Improvements Sustained? Hard Wire Gains

24. Improve Care

25. Are Improvements Sustained?

26. Hard Wire Gains People Processes Organization NHS Institute, 2011

27. How to Hardwire: Plan to Sustain! Quotes from the Flo Collaborative (2008): “ We will review the data collected on a monthly basis as we move forward with our spread to all units… If we are within our expected targets, we will begin to monitor every 2 months. In addition we are monitoring the qualitative feedback from staff who are involved in the process to ensure it is meeting their needs as well”.

28. How to Hardwire: Plan to Sustain! “ The [auditing] system allows for assigned staff and management to audit the accuracy and completeness of the boards on a weekly basis… All staff can see the results of these audits. The Unit Administrator reviews the results and celebrates successes and addresses gaps through staff meetings in a timely manner. The Unit Administrator also provides weekly updates to the Program Director and the committee of the Medical Advisory Council. The Program Director reinforces successes and opportunities for improvement on her walkabouts on the unit.”

29. How to Hardwire: Audit Your Practice! OutcomeAudit Infection RateHand Hygiene Patient Satisfaction with mealsTime required to distribute meals on unit Falls IncidenceNumber of falls risk screening tools completed on admission to unit Staff SatisfactionNumber of interruptions to nurse during medication rounds

30. How to Hardwire: Organizational Strategies Communication Systems Training/education/re-education Facilities/Equipment Job Descriptions Policies and Procedures Project Plans/Budgets/Timelines NHS Institute, 2011

31. How to Hardwire: Communication Communication Systems Training/education/re-education Facilities/Equipment Job Descriptions Policies and Procedures Project Plans/Budgets/Timelines NHS Institute, 2011

32. Source: Saskatchewan Health Quality Council To prevent “slippage”, it’s important that we communicate the following to all individuals supporting improvements to care: Why are we doing this? What will it mean to me? What will you do to support me? What do you want from me in return? How to Hardwire: Communication

33. How to Hardwire: Job Descriptions Communication Systems Training/education/re-education Facilities/Equipment Job Descriptions Policies and Procedures Project Plans/Budgets/Timelines NHS Institute, 2011

34. How to Hardwire: Job Descriptions “ … The Unit Administrator reviews the results and celebrates successes and addresses gaps through staff meetings in a timely manner. The Unit Administrator also provides weekly updates to the Program Director and the committee of the Medical Advisory Council. The Program Director reinforces successes and opportunities for improvement on her walkabouts on the unit.”

35. The Sustainability Process Improve Care Are Improvements Sustained? Hard Wire Gains

36. "One worthwhile task carried to a successful conclusion is worth half-a-hundred half-finished tasks". Malcolm S. Forbes

37. Questions?