Building a framework for quality improvement in AHS: A case study of the Edmonton Zone

Transcription

1 Building a framework for quality improvement in AHS: A case study of the Edmonton Zone Dawn Hartfield BScMed, MPH, MD, FRCPC Associate Professor, Department of Pediatrics Faculty of Medicine and Dentistry, University of Alberta Medical Director Quality, Integrated Quality Management Edmonton Zone, Alberta Health Services

2 Learning Goals and Objectives Describe key elements necessary to QI programs Understand how these key elements were incorporated into the new EZ framework for QI Review results of the implementation process 2

3 Total lives lost per year How Hazardous Is Healthcare? 100,000 DANGEROUS (>1/1000) HealthCare REGULATED Driving ULTRA-SAFE (<1/100K) 10,000 1, Mountain Climbing Bungee Jumping Chemical Manufacturing Chartered Flights Scheduled Airlines European Railroads Nuclear Power ,000 10, ,000 1,000,000 10,000,000 Courtesy of Drs. Matlow & Tallett Number of encounters for each fatality 3

4 Institute of Medicine Report published ,000-89,000 patients die yearly from adverse events Equivalent to 1 jumbo jet going down every 2 days 25-50% are preventable Courtesy of Drs. Matlow & Tallett 4

5 Canadian Adverse Events Study Study used trigger tool methodology AE rate of 7.5 per 100 hospital admissions 37% were preventable Additional 6 acute care days per AE Death occurred in 20.8% with AEs Risk factor: older AGE Baker GR et al CMAJ 2004; 170 (11):

6 Economics of Patient Safety in Acute Care Utilized data from CAES Annual discharge rate Median cost per acute care day $950 Economic Burden: $1,071,983,610 37% are preventable: $396,633,936 Etchells E, et al. Canadian Patient Safety Institute, May

7 PDSA: Please Do Something, Anything! 7

8 Goal of Quality Management Framework Provide vision, leadership and direction for quality planning, quality monitoring and quality improvement within the Edmonton Zone. Enhance an integrated approach to quality within the Edmonton zone Develop a structure that links frontline to senior administration Deliver better quality, better outcomes, and better value to our population 8

9 Quality Management Framework Project Project Sponsors: David Mador Deb Gordon Project Team: Dawn Hartfield Donna Daniec Susan Silverthorne Julia Roy Kerstin Maciocha Maria Golberg Michael Auld Mareika Purdon 9

10 QMF Phases Phase 1: Requirements and Analysis Completed December 2013 Phase 2: Design Development of framework and supporting tools required for implementation Completed April 2014 Phase 3: Pilot Pilot implementation at Stollery Children s Hospital June 2014 Phase 4: Implementation Zone wide implementation underway Goal for completion: November 2014 (before flu season!) 10

11 QMF: Phase 1 Project Deliverables: Stakeholder Requirements Determined Literature Review Environmental Scan New proposed Committee Structure 11

12 QMF: Phase 1 Stakeholder Assessment Stakeholders VPs, QAC Chairs, senior leaders thirteen program areas 31/47 interviewed between July 10-Sept 23, /31 physician leaders Interviews completed by team of 3 people Standardized questions Qualitative analysis with key themes identified 12

13 QMF: Phase 1 Stakeholder Requirements Patient Centered Leadership: walk the talk Just Culture Accountability Physician & Staff Engagement Capacity Building Capability Development Recognizing Achievement Infrastructure Process Support Quality and patient safety is what unites everyone in the system; patients, physicians, staff, everyone we should be able to get everyone fired up around this. 13

14 QMF Phase 1: Literature Review Literature Review Patient Engagement Leadership Governance Measurement & Reporting Partner Engagement Capacity Development & Data Capability Development Other Aspects of Healthcare Process Support 14

15 QMF Phase 1: Literature Review Literature Review Patient Engagement Leadership Measurement & Reporting Partner Engagement Capacity Development & Data Capability Development Governance Process Support Stakeholder Interviews Patient & Family Centered Leadership: walk the talk Just Culture Accountability Physician & Staff Engagement Capacity Building Capability Development Infrastructure Process Support Recognizing Achievement 15

16 QMF Phase 1: Environmental Scan Five organizations were interviewed: Kaiser Permanente (United States) Mayo Clinic (United States) Interior Health (British Columbia) Providence Health (British Columbia) North York (Ontario) Standardized questions: Structure Resources Quality culture Educational requirements 16

17 QMF Phase 1: Environmental Scan All have an over-arching Committee Most have Program Based Committees All large QI Projects have a formal approval process All have a Project prioritization process Culture is very important Supported by leadership & communication Data and patients stories Education of frontline is important Supported by trained experts 17

18 Edmonton Zone Quality Improvement Structure 18

19 Role of Unit Quality Councils Quality Planning Coordinate QI activities on the unit Engage staff and families in QI Quality Monitoring Utilize data to prioritize QI activities Work closely with QA/Patient Safety Set performance targets and initiate QI activities to achieve and sustain goals Quality Improvement Conduct QI work using standard methodology 19

20 Role of Program Quality Councils Quality Planning Coordinate QI activities of the Program Engage staff and families in QI Quality Monitoring Utilize data to prioritize QI activities Work closely with QA/Patient Safety Set performance targets and initiate QI activities to achieve and sustain goals Quality Improvement Foster Development of Unit Council Members 20

21 Role of Zone Quality Council Quality Planning Coordinate QI activities for the Zone Quality Monitoring Utilize data to prioritize QI activities Work closely with provincial bodies Set performance targets for the Zone Quality Improvement Foster Development of Unit Council Members 21

22 Rationale for this Structure Develop clear line of site Unit to Program/Site to Zone Establish relationships and effectively utilize resources Develop capacity and capability Means to empower frontline care providers Build relationships by working in multidisciplinary team Improve just culture Improve job satisfaction Ultimately: Improve patient outcomes 22

23 QMF Phase 2: Design Established Terms of Reference Quality Planning, Quality Monitoring, Quality Improvement Process to prioritize QI Projects Roadmap Frontline Decision Making Tool Evaluation tool: Modified QI-PAT Recommended Curriculum Implementation Process Communication and Change Management Strategy 23

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26 Modified QIPAT-7 Leenstra et al. Validation of a Method for Assessing Resident Physician Improvement Proposals. JGIM 2007;22:

27 QMF Phase 2: Curriculum 27

28 QMF Phase 2: Implementation Process 28

29 QMF Phase 3: Pilot Implementation Pre-existing Site Quality council; NICU only Unit Quality Council Established 7 Unit Quality councils Goal: first meetings attained by 6/7 Awaiting first set of quarterly reports Where you start will probably not be where you finish! 29

30 QMF Phase 4: Implementation 13/22 of Program/Site Step 1 meetings complete by 24/09/ /13 have existing Program/Site Quality Councils 9 of these may have Unit Quality Councils 7/9 have existing Unit Quality Councils 9/13 minor improvements required 3/13 moderate improvements required 1/13 just starting up Strongest groups are part of provincial programs 30

31 QMF Phase 4: Zone Quality Council Provide leadership for QI at Zone level Advisory to Senior Leadership Team Support needs of Program/Site Councils Representation Key areas Frontline providers with QI expertise Patient volunteer Quarterly meetings of Program/Site QC 31

32 Sustaining Change: Education Education of Committee Members and Leaders Access to QI Curriculum and resources Unit Councils organize their strategy to ensure members develop knowledge and skill in QI Prosci is a highly recommended change management tool Alberta Improvement Way Educational needs assessment survey 32

33 Sustaining Change: Results Annual completion of IHI Assessments: Building Capacity Self-Assessment Who Needs what? (the dosing formula) Improvement Capability Self-Assessment Tool Process Measures Number of meetings held in first year Development of performance targets Completion of quarterly reports Outcome Measures expect to see results! Hand hygiene, decrease HAI s, etc. Patient Safety Culture Survey Patient Satisfaction R. Lloyd. Quality Health Care: A Guide to Developing and Using Indicators. Jones & Bartlett Publishers, Sudbury, MA,

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