Teaching and Measuring Systems Thinking in a Quality and Safety Curriculum
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1 Teaching and Measuring Systems Thinking in a Quality and Safety Curriculum Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland Ohio
2 Acknowledgements Team: Co-PI: Shirley M. Moore, RN, PhD Mary A. Dolansky, RN, PhD Mamta Singh, MD, MS, VA Quality Scholar Aleece Caron, PhD Patrick Palmieri, PhD, Psychometrician Farrokh Alemi, PhD, Systems Engineer Funding: Robert Wood Johnson Foundation 9/1/08-2/28/10
3 OBJECTIVES Definition Significance Ways to teach Measurement Examples of research
4 Systems Thinking & QSEN
5 Definition of Systems Thinking An individual s or team s ability to consider a group of interdependent people, items, processes and products and services that have a common purpose or aim Nolan & Provost, 1990
6 Definition An approach to problem solving that Views problems as parts of an overall system rather than a specific part Requires cyclical rather than linear cause effect thinking
7 Domains Sequence of events Causal sequence Multiple causations possible Variation of different types (random-special) Interrelations of factors Patterns of relationships Feedback loops Mechanisms that explain the cause and effect
8 Importance Quality Improvement Nurses are part of systems of care Outcomes in care (NDNQI) Identify gaps between local and best practices Approaches for changing processes of care QSEN, 2007
9 Importance Safety Delineate categories of errors Use root cause analysis and FMEA Participate in error reporting Appreciate the cognitive and physical limitations of human performance QSEN, 2007
10 Importance BUSINESS Systems Thinking is one of the 5 core knowledge areas needed for learning organizations (Senge, 1990)
11 Importance Systemsbased Practice Medical Knowledge Practice-based Learning & Improvement Developing competence as a physician Interpersonal & Communication Skills Patient Care Professionalism Medicine Competencies
12 Importance The Future of Nursing Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States
13 Importance The Future of Nursing Systems thinking is required to redesign healthcare to improve the quality and safety of care.
14 Ways to teach
15 Continuum of Systems Thinking Personal Effort Systems Oriented I will turn my patient I will post a note above the bed to remind others I will ask other nurses about products to prevent ulcers I will look at our ulcer rate on our unit I will compare our unit ulcer rate with benchmarks
16 Ways to teach Flow charting the system
17 Process diagrams
18 Delivery of Care Ways to teach Patient/family factors Health care worker factors Time pressures Competing demands Previous care experiences Payer expectations Institutional support Comfort with patient Comfort with family
19 Ways to Teach SAFETY
20 SAFETY Ways to Teach Root Cause Analysis
21 Ways to Teach
22
23 Measurement Systems Thinking Scale (STS).
24 Response Format Instructions: Please read each of the statements and place an x in the answer box that indicates frequency of agreement with the statement: When I want to make an improvement 1. I believe the harder I work the more improvement I can make Never Seldom About Half the Time X Often Most of the Time X
25 Examples of Items (8 of 30) I believe the harder I work the more improvement I can make I think recurring patterns are more important than any one specific event I believe understanding how the chain of events occur is crucial I think that lasting change relies on personal effort and motivation
26 Systems Thinking Scale Psychometrics (N=342) 3 subscales Interdependencies Personal Effort Reliance on Authority
27 Systems Thinking Scale System Interdependencies 20 items Psychometrics (N=342) Internal Reliability Alpha=.83 Test-retest Correlation=.74
28 Discriminate Validity 3 dose levels of systems thinking education No dose graduate level nursing students Low dose Medical students RCA case High dose 12 week CQI course
29 Concurrent Criterion-Related Validity SA question on a root cause analysis QIKAT Quality Improvement Knowledge & Attitude Test
30 Sample No Dose Systems Thinking Scale (STS) Pre 61.0 (7.1) STS & Comparative Test N=32 Low Dose N=78 Post 57.3 (5.5) Pre 56.1 (7.4) Post 54.9 (8.6) *p=.01 *p=.001 SA question on systems thinking & STS Correlation=.28 High Dose Pre 60.1 (8.3) QiKAT & STS N= 12 Post 62.0 (7.4) *p=.01 Correlation=.46
31 Conclusion A reliable and valid measure of systems thinking increases our ability to assess he effect of our educational efforts. Enhance our efforts to increase systems thinking in our graduates.
32
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