1. Quality is Personal So is Harm Manoj Jain, MD, MPH www.MJain.net

2. Goal Share my journey Quality Improvement is a universal principle Quality Improvement is personal

4. Journey

5. First Do No Harm Primum non nocere Hippocratic Oath – Hippocrates 460BC to 370 BC Hippocratic Corpus is in Epidemics: "The physician must...have two special objects in view with regard to disease, namely, to do good (and) to do no harm"Hippocratic Corpus

7. Ahimsa – Do not Harm Jainism - Mahavira Philosophy of Nonviolence - Ahimsa Mahavira- 599 BC – 527 BC

12. Various Strategies to Reduce Harm: Malpractice Suits Only 2 percent of negligent injuries resulted in claims Only 17 percent of claims appeared to involve a negligent injury. Win – Lose situation

13. Various Strategies to Reduce Harm: Regulations alone –A Compromise Lose- Lose Pay for Performance alone –A compromise lose – lose

14. Quality Improvement is the Nonviolence Strategy for Change Win –Win situation All parties grow to recognize a greater Truth

15. Common Elements in Quality Improvement and Nonviolence Status quo is not acceptable Collective action is required Transparency is critical

16. We must make Quality Improvement personal

17. PDSA: The Wheel of Improvement

18. Wheels in Motion: Continuous Quality Improvement

21. 4 Elements of Change Multidisciplinary Teams – Staff ownership Flow Meetings –Administrative support Bundles –Evidence based medicine Culture of Change –Horizontal decision-making

22. Adverse Events Per ICU Day* Multidisciplinary Rounds Hand Hygiene Protocol Vent Bundles ICU Medical Director Central Line Bundles UTI Bundles * A list of event triggers that have been shown to be indicators of potential quality of care issues (See trigger tool)

23. Nosocomial Infection Rates FY 2001-FY 2004 YTD

24. Average Cost Per ICU Episode 15.6% Decrease 8.6% Decrease

25. Essential Elements in Quality Improvement and Nonviolence Transparency –Public Reporting of quality data

30. Challenge to all: Marriage of Personal and Professional Take one personal deficiency (ask you spouse) and apply PDSA or Lean Take one personal/cultural/religious attribute and apply it in your professional life

31. BUILD A TEAM

33. Thank You! www.mjain.net