Introduction. Singapore and its Quality and Patient Safety Position. Singapore 2004: Top 5 Key Risk Factors. High Body Mass

Transcription

1 Introduction Singapore and its Quality and Patient Safety Position Singapore 2004: Top 5 Key Risk Factors High Body Mass (11.1%; 45,000) Physical Inactivity (3.8%; 15,000) Cigarette Smoking (7.4%; 28,000) High Blood Pressure (7.3%; 28,000) High Blood Cholesterol (6.6%; 25,000) 1

2 Singapore Resident Population Age Profile 2008 Actual vs 2050 Projection June 2008 Actual Year 2050 Projection Source: Singapore Statistics Department Monthly Digest of Statistics Singapore July 2009 Source: United Nations Population Division 2

3 Healthcare Spending is increasing o Singapore GDP from 4% to 8% o S$4 billion to S$8 billion a year over next five years o Healthcare will cost more o Our system is complex and the cost drivers are numerous. We could Innovate, Redesign, Reduce Waste 3

4 Redefining Singapore Healthcare Cost to Cost Effectiveness Aim is Health, not Healthcare Making It Happen Bottom-line to Value Episodic ( snapshot ) to Longitudinal, Whole System approach to measuring and managing quality Enablers: Manpower, IT, Research & Innovation Singapore Ministry of Health, December 2011 What do Patients really want? Cure Me Heal Me Don t hurt me Respect me as a person Don t make me waste my money 4

5 IOM Six Primary Aims Safe Equitable Efficient Patient s View Timely Effective Patient- Centered - Institute Of Medicine Report, IOM Six Primary Aims Safe Hippocrates -do no harm Effective Based on sound knowledge Patient-Centered Respectful, responsive to individual preferences, needs and values Timely Unnecessary waits should be reduced Efficient Many steps to get the job done; waste Equitable Should not vary in quality because of patient characteristics, such as ethnicity, or geographic location 5

6 The Patient s Journey 1 Patient asks for primary care Institute National of Healthcare Group, Quality SIN SIN Setting Aims 6

7 Learning Outcomes o Understand the system perspectives in relation to Healthcare Improvement Work o State the importance of developing an AIM statement at the beginning of Improvement Work o Identify the fundamental elements of an effective AIM statement The Deming System of Profound Knowledge All managers need to have a System of Profound Knowledge, consisting of four parts: Appreciation of a system: understanding the overall processes involving suppliers, producers, and customers (or recipients) of goods and services; Knowledge of variation: the range and causes of variation in quality, and use of statistical sampling in measurements; Theory of knowledge: the concepts explaining knowledge and the limits of what can be known; Knowledge of psychology: concepts of human nature. 7

8 Appreciation of a System Improvement requires us to understand where things fit Making sense of what is happening, where, who and how we get what we get 8

9 Systems: Leverage for Improvement Events (crisis, anecdotes, incidents, problems) Trends and Patterns (time-series charts) Leverage for Improvement System Structure (pattern of interrelationship among key components of the system: hierarchy, policy processes, and perceptions) The Patient s Perspective 1 Patient asks for primary care 2 Investigate primary care 3 Treatment Outpatient 7 Step-down Care Community 4 Diagnosis & decision about care 6 Rehabilitation 5 Treatment hospital 9

10 Who else needs to be involved? Call for Action! Adverse Event (AE) Prevalence Study (2002) o Adverse Drug Event (ADE) as one of the major contributors to the overall AE rate in 3 acute hospitals o Accounted for 19% of all AEs o Associated with 2% of hospitalisation episode 10

11 Driver Diagram Understanding the System for reducing Adverse Events OUTCOME MEASURE AE per 100 inpatient episodes To decrease Adverse Event (AE) Rate for Inpatients at Hospital A from 11% to less than 5% by 2013 Reduce Medication Errors by 50% What changes can we make? Primary Drivers What? Safety Culture Process Redesign Learning From Errors Secondary Drivers How? Awareness & Communication Patient Safety Training Patient Safety Briefing Open & Fair Incident Reporting Policy Patient Safety Leadership Walkabout Dedicated ICU Pharmacist Pharmacist managed Inpatient Anticoagulation Service Medication Reconciliation Integration of eimr & imar Smart Pumps Inpatient Pharmacy Automation System Standardised Medication Error & ADE Terminology System Analysis Tool for Medication Errors & ADEs Standardised Prescribing Abbreviations Pharmacy Intervention Database SBAR 11

12 Medication Safety Collaboratives Dedicated ICU Pharmacist Medication Reconciliation NHG Patient Safety Workshop Pharmacist Managed Inpatient Anticoagulation Service Inpatient Pharmacy Automation System NHG Patient Safety Leadership Walkabout Smart Pumps Systems Analysis Tool for Medication Errors and Adverse Drugs Events (ADE) Coaching Model for Improvement 12

13 Model of Improvement o What are we trying to accomplish? o How will we know that a change is an improvement? ACT PLAN o What change can we make that will result in improvement? STUDY DO Guide-Post for Setting Aims HOW GOOD BY WHEN FOR WHOM What are we trying to accomplish? Develop Aim Statement using SMART Technique - unambiguous, clear, specific, numerical, measurable, time-frame Relates to the System Focuses what needs to be accomplished Meets Management Expectation Guides the Team and Project 13

14 Example 1: Effective AIM statement All patients above age of 65 years old with more than 5 or more chronic medications, have a medication reconciliation donewithin48hoursofadmissionwithinayear. How Good By When For Whom all defined patients have med reconciliation within 48hrs within a year (project aim) elderly patients with poly pharmacy admitted Example: Medication Reconciliation 14

15 Example 2: Effective AIM statement 90% patients reach therapeutic range (INR 1.8-4) within 5daysofinitiationofWarfarinwithin6months How Good By When For Whom 90%ofpatientswithin5days 6 months(project aim) patients initiated on Warfarin Example: Pharmacist-Managed Inpatient Anticoagulation Inpatient anticoagulation service started 15

16 Example 3: Effective AIM statement Increase rate of voluntary electronic hospital occurrence reportingfromamonthlymeanof100to200permonthby the1 st quarterof2008 How Good By When For Whom 100 fold improvement 1 st Quarter 2008 Entire Hospital Our first step into major change What will you do, your first 100 days? 16

17 Exercise Read and Reflect o Work together in small groups o Choose a topic of common interest and relevance to the group o Develop a strong, clear aim statement to guide improvement work on this topic o Discuss how you would set the goal in this aim statement 17

18 Acknowledgements Materials for program sourced from: o The Improvement Guide: A Practical Approach to Enhancing Organizational Performance by Gerald J. Langley et al o The Healthcare Quality Book: Vision, Strategy & Tools by Scott B. Ransom et al o Toward Optimized Practice [ Online information; retrieved on 24/08/12] o o Enhancing Clinical Practice Improvement: A Tribute, 2008 (National Healthcare Group, Singapore) o Adding Years of Healthy Life, 2010 (National Healthcare Group, Singapore) o Ministry Of Health, Statement of Priorities, FY 2011 Singapore o Model for Improvement by Carol Haraden(Institute for Healthcare Improvement) o Visuals adapted from Flickr/LumaxArt Questions? 18