The Daily Huddle: Getting the Front Line on Board for Quality National Health Leadership Conference Halifax, NS June 4, 2012 1
General Footprint Regional Leadership Medical Education About Us: Credit Valley Hospital-Trillium Health Centre: Mississauga, Ontario (in the Greater Toronto Area) 1,237 Beds (Acute, Mental Health, Rehab, CCC) 228,113 ED/UCC Visits 52,603 Inpatient Discharges Ranked #1 in terms of size in the province 566,717 Outpatient Visits 1,187 Physicians 7,670 Employees 2,134 Volunteers $879,000,000 Total Revenue (All Sources) From Birth to Aging Maternal / Child Seniors Health and Specialized Geriatrics Palliative Care Specific Clinical Specialties Cancer Cardiovascular Renal (acute) Stroke & Neurosciences Genetics UTM Medical Students Other Medical Trainees (FY2011/12) 250 200 150 100 50 0 216 162 108 54 2011/2012 2012/2013 2013/2014 2014/2015 500 400 300 200 100 0 395 Credit Valley 288 Trillium 2
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Hardwiring Quality into our Everyday Work Strategic Performance Reports Strategic Performance will be monitored at the Board, Corporate, Program & Unit levels Used to report overall progress to Board BOARD LEVEL Strategic Plan Report: Executive Dashboard Big Dot Measures Report CORPORATE LEVEL SRC Reports: Big Dot Measures Report Used to track progress and make decisions on changes required to achieve improvements PROGRAM LEVEL Program Steering Reports: Program on a Page Program Scorecard Used to plan, take action and drive change at the program and unit level UNIT LEVEL Quality Board & Daily Huddle 44
The Quality Board & Daily Huddle: Team Engagement to Achieve Quality Improvement Purpose To align and enable clinical teams to achieve their quality improvement goals through engagement, focus and measurement. 5
Quality Board & Daily Huddle: A joint Strategy Management Office and Quality, Performance and Risk Management Department Initiative PROJECT TEAM Cheryl Hoare Coordinator, Strategy Management Office David Girard and Narinder Mundi Analysts, Strategy Management Office Barb Young Quality, Safety and Risk Consultant, Medicine/Cardiology Chris Zettler Patient Care Manager, Medicine/Cardiology Samantha D Amico Clinical Educator, Medicine/Cardiology James Yuan Decision Support Consultant, Medicine/Cardiology Louise Van Zeller Communications Sandra Taveras Designer With sincere thanks to the Medicine/Cardiology (3B) pilot project team and staff for their help designing and trialing the Quality Board & Daily Huddle 6
Overview of Quality Board & Daily Huddle OBJECTIVE: To achieve our quality, access and sustainability performance targets by creating a clear line of sight between our strategic goals and the work that individuals do each day. Daily measurement and monthly trending together with focused actions in 3 areas at once, help front-line staff improve IMPLEMENTATION STRATEGY Pilot area - Medicine/Cardiology Unit: July-Oct. 2010: Planning and development Oct. 2010 April 2011: Implementation and evaluation April July 2011: 3 wave roll-out to all inpatient and out-patient clinical areas
Clinical Quality Board Implementation Timelines: April July 2011 Wave 1 Pilot a Grouped Approach Wave 2 Wave 3 April 11 May 13 May 2 June 01 May 23 July 15 Medicine Units Critical Care Rehabilitation Complex Continuing Care Out-patient Cardiopulmonary Surgical Program Maternal Child Program Ambulatory Clinics Endoscopy Diabetic Care Centre Mental Health Program Out-pt Renal Clinics Out-pt Cancer Clinics Emergency Department April May June Wave 1: Pilot Implementation Approach Start: April 11 Launch May 9-13 Wave 2 Start: May 2 Launch May 24-June 1 Wave 3 Start: May 23 Launch July 11-15 Planning Board Launch 8
The Quality Board is displayed publically and invites patients and families to look at how we are improving quality hospital care 9
Focused actions, daily measurement and monthly trending help teams achieve results Using PDSA Methodology At the 5 minute daily huddle, teams answer a focused yes/no question and document a red/green for each calendar day on the Quality H Results are trended monthly so teams understand if their new tactics are working or whether a new approach is needed 10
Quality Board Huddle in Action 11
Quality Board & Huddle Evaluation: Quality Improvement Results on Medicine/Cardiology Quality Improvement Results Feb. 2011 Pre-implementation 4 Months Post-implementation The percentage of indwelling catheters that no longer meet medical criteria 31% 1.1-2.1% Hand hygiene compliance rate 64% 83% *Pressure wound prevalence (raw number) 13 (point prevalence number, Oct. 2010) 1-4 (new pressure wounds per month) 12
Quality Board & Huddle Pilot Evaluation: Staff Feedback We Learned From Staff April 2011 Pre-implementation Post-implementation They are aware of how to contribute to achieving our strategic goals 68% 100% There are opportunities for them to contribute ideas towards quality improvement 73% 85% They are aware of relevant hospital news 63% 95% 75% believe that the Quality Board (QB) & Huddle have increased their knowledge around best practice 65% believe that the QB & Huddle have influenced their daily practice They struggle to attend huddle when they are short staffed Keeping the huddles short is important so they can return to patient care quickly Having the huddle at a consistent time each day helps them to plan their care around Huddle time Sources: On-line survey; observation studies; individual interviews 46% survey response rate (n 36) 13
Evaluation One Year Later Objectives: Quality Board Status Lessons Learned Sustainability Plan Evaluation Methodology: 1. PDSA study 2. Post-implementation survey 3. Focus Group: Data review Lessons learned Discuss sustainability plan Status: 23/30 focus groups complete (77%) Target completion date: December 5 2012 Average staff response rate to online surveys: 41%
Preliminary Key Findings: The Benefits What the benefits are: Huddle Staff collaboration and recognition Issue resolution (manager present) Information and best practices shared Indicators What the benefits are: Provide a structured way to implement change Create awareness and increase knowledge Peer accountability Positive feedback from patients
Preliminary Key Findings: The Challenges Huddle Long huddles due to increased scope as huddles have become a forum for sharing organizational messages Lack of staff engagement/attendance both at huddles (can be due to patient care priorities) and in the indicator development process Indicators May not be meaningful for staff who already perform well, for clinicians whose practice is not impacted by the selected metrics or when the selected indicators are subjective/not truly measureable If the people huddling do not have actual control over the indicator, changes to practice may not happen
Preliminary Key Findings: Suggestions for Improvement Huddle Do not use huddle time for lengthy problem solving; if suggestions arise, engage individuals further after huddle time Indicators Further explain Big Dots and the purpose of the Quality Board so the value is fully understood Develop a process for changing indicators at appropriate intervals Implement shared indicators between units to improve flow
Next Steps Clinical Support Services In the Planning Stage Diagnostic Imaging Laboratory Pharmacy Sustainability Goals: Analyze quality improvement results & implement improvement tactics (PDSA cycles) Implement standard process for how new indicators are selected and implemented Establish program level accountability for Quality Boards
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Contact Information Cheryl Hoare, RN, BScN, MN, PNC(C) Patient Care Manager Mother Baby Unit, High Risk Pregnancy, Breastfeeding and Women s Health Clinics Credit Valley Hospital/Trillium Health Centre, Credit Valley Site 2200 Eglinton Avenue West Mississauga, ON L5M 2N1 905-813-1100 ext. 6346 choare@cvh.on.ca Rhonda Warrian, RN, MN, CHE Patient Care Program Director Surgery and Ambulatory Care Credit Valley Hospital/Trillium Health Centre, Credit Valley Site 2200 Eglinton Avenue West Mississauga, ON L5M 2N1 905-813-2509 rwarrian@cvh.on.ca 20