1. "Engagement and Commitment" of the C-Suite and Physicians The 4 E’s and Daily Goals April 21, 2008

2. Senior leaders Team leaders Staff EngageHow does this make the world a better place? EducateWhat do we need to do? ExecuteWhat keeps me from doing it How can we do it with my resources and culture? EvaluateHow do we know we improved safety? Pronovost: Health Services Research 2006 Leading Change

3. Daily Goals: Engaging Clinicians Learn how to implement daily goals in your ICU

4. Background Communication defects common People and organizations who create explicit goals achieve more than those who do not Rounds generally patient rather than provider centered

5. Examples Work and Personal Wean Diurese Continue supportive care Meeting with no agenda I’ll do it later I will be home sometime this evening

6. % of respondents reporting above adequate teamwork

7. Percent Understanding Patient Care Goals

8. Impact on ICU Length of Stay 654 New Admissions: 7 Million Additional Revenue Daily Goals

9. How to use daily goals? Be explicit Important questions –What needs to be done for discharge –Safety risk –Scheduled labs Completed on rounds Stays with bedside nurse Modify to fit your setting and your project

10. Moving Forward Never doubt that a small, thoughtful group of committed of citizens can change the world…. Indeed it’s the only thing that ever has Margaret Mead