The Scottish Patient Safety Programme

Transcription

1 The Scottish Patient Safety Programme Prototype, Implement, Spread Carol Haraden, PhD, and Gordon Thomson, MSc, MRPHarmS Remember a time when a change spread quickly and quite easily? Why did this happen?

2 Remember a time when a change worked in one area but did not spread? What were the reasons? Prototyping, Implementation, and Spread Prototyping: Working with a small number of staff or a team to determine how to execute the change(s) and if the change(s) create improvement Implementing: After the successful prototype, implement on the entire prototype ward, theatre, ITU using all Spread: After the successful implementation in the entire prototype ward, theatre, ITU, spread changes to other wards, theatres etc. using all

3 Clarify How We Spread: Within Hospitals and Service Lines First: a successful prototype Second: Full implementation in prototype area using all (1 nurse to 3 nurses to 5 nurses to all nurses) Third: spread to target areas Fourth: spread to all target areas Prototyping 1 test PDSA 1 test PDSA 1 test Works well with 1 Don t move on until it works well with one - right? Works with 1 but will it work with 3? 1 test PDSA 1 test Works well with 3 Don t move on until it works well with 3 - right?

4 1 test PDSA 1 test PDSA 1 test Works well with 5 MOVE ON TO IMPLEMENTATION! Implementing: One-Three-Five-All WHAT? all nurses on a ward all surgeons in a theatre or service all pharmacists 1 day - 3 days - 5 days - all days 1 shift - 3 shifts - 5 shifts - all shifts

5 Spreading: One-Three-Five All WHAT? all ward surgeons in a theatre or service all pharmacists 1 day - 3 days - 5 days - all days 1 shift - 3 shifts - 5 shifts - all shifts Attributes of an Idea That Facilitates Spread Relative advantage Compatibility with current values Simplicity Testability Observability Rogers

6 Adopter Categories Innovators Early Adopters Early Majority Late Majority Laggards 2.5% 13.5% 34% 34% 16% from Rogers, 1995 Identifying and Integrating Early Adopters Search for successful sites ( Found Pilots ) Focus on the influencers as messengers Invest resources initially with the early adopters Make the work of early adopters observable

7 IHI Framework for Spread Leadership -Topic is a key strategic initiative -Goals and incentives aligned -Executive sponsor assigned -Day-to-day managers identified Measurement and Feedback Better Ideas -Develop the case -Describe the ideas Set-up -Target population -Adopter audiences -Successful sites -Key partners -Initial spread plan Social System -Key messengers -Communities -Technical support -Transition issues Knowledge Management Framework for Spread Better Ideas - Validated by science or experience - Packaged in a way that can be used Set Up - Target population - Adopter audiences - Successful sites - Key Partners - Initial spread plan

8 Social System - Key messengers - Communities - Technical support - Transition issues Leadership - Communicate the theme, remove roadblocks - Align incentives with safety goals - Use outside forces to drive the changes Spread of SPSP Changes Aim: Spread of surgical briefings and pause; SSI prevention Building the case: Document cases interrupted by incorrect, missing or malfunctioning equipment, wrong or missing information, unprepared patient Waste of precious time for everyone Cancelled cases Patient and caregiver unhappiness Better outcomes

9 BBIS (Best Board in Scotland) Target population: 6 Hospitals 1,700 + physicians on medical staffs 1,578 available beds 10,000 Employees 54,608 Acute & long-term admissions Adopter Audience Started with the surgical team that was motivated to change Made the changes visible to all Posted data Plan the Spread of One of Your Changes Better Ideas Set Up Social System Leadership

10 References Attewell, P. Technology Diffusion and Organizational Learning, Organizational Science, February, 1992 Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, N.J.: Prentice Hall, Inc Brown J., Duguid P. The Social Life of Information. Boston: Harvard Business School Press, Cool et al. Diffusion of Information Within Organizations: Electronic Switching in the Bell System, , Organization Science, Vol.8, No. 5, September - October Dixon, N. Common Knowledge. Boston: Harvard Business School Press, Fraser S. Spreading good practice; how to prepare the ground, Health Management, June Gladwell, M. The Tipping Point. Boston: Little, Brown and Company, Kreitner, R. and Kinicki, A. Organizational Behavior (2 nd ed.) Homewood, Il:Irwin,1978. References Langley J, Nolan K, Nolan T, Norman, C, Provost L. The Improvement Guide. San Francisco: Jossey-Bass Lomas J, Enkin M, Anderson G. Opinion Leaders vs Audit and Feedback to Implement Practice Guidelines. JAMA, Vol. 265(17); May 1, 1991, pg Myers, D.G. Social Psychology (3rd ed.) New York: McGraw-Hill, Prochaska J., Norcross J., Diclemente C. In Search of How People Change, American Psychologist, September, Rogers, E. Diffusion of Innovations. New York: The Free Press, Shaw, P. Changing Conversations in Organizations: A Complexity Approach to Change. London, U.S. Canada: Routledge 2002

11 References Barabasi AL. Linked: How Everything is Connected to Everything Else and What It Means. New York, NY: Plume Books; Berwick, DM. Lessons from developing nations on improving health care. BMJ May 8; 328(7448): Brock WA, Nolan K, Nolan TW. Pragmatic science: accelerating the improvement of critical care. New Horiz 1998;6: Dixon NM. Common Knowledge: How Companies Thrive by Sharing What They Know. Cambridge, MA: Harvard Business School Press; 2000 Fraser HF, Jazayeri D, Kempton K, Mosely M, Choi S, Pachao F, Bayona J. A system for modeling medication requirements for the management of drug resistant tuberculosis in developing countries. Medinfo. 2004;2004(CD):1603. Granovetter M. Strength of weak ties. Am J Social. 1973; 78: Langley G, Nolan K, Nolan T, Norman C, Provost L. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco: Jossey-Bass Publishers; Rogers EM. Diffusion of Innovations. 4 th ed. New York, NY: Free Press; World Health Organization. Innovative care for chronic conditions: building blocks for action. Geneva: WHO; World Health Organization (HTM/EIP) and Institute for Healthcare Improvement. An Approach to Rapid Scale-up Using HIV/ADS Treatment and Care As An Example. Geneva: WHO; 2004.