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?
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 1-3-5-all Spread: After the successful implementation in the entire prototype ward, theatre, ITU, spread changes to other wards, theatres etc. using 1-3-5-all
Clarify How We Spread: Within Hospitals and Service Lines First: a successful prototype Second: Full implementation in prototype area using 1-3-5-all (1 nurse to 3 nurses to 5 nurses to all nurses) Third: spread to 1-3-5 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?
1 test PDSA 1 test PDSA 1 test Works well with 5 MOVE ON TO IMPLEMENTATION! Implementing: One-Three-Five-All WHAT? 1-3-5-all nurses on a ward 1-3-5-all surgeons in a theatre or service 1-3-5-all pharmacists 1 day - 3 days - 5 days - all days 1 shift - 3 shifts - 5 shifts - all shifts
Spreading: One-Three-Five All WHAT? 1-3-5-all ward 1-3-5 surgeons in a theatre or service 1-3-5-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
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
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
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
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
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