SUSTAINING YOUR GAINS
Kim Stelmacovich, M.H.Sc.
Project Manager, CPSI
Learning Objectives
Learners will be able to:
– Evaluate interim project outcomes using SPC
run chart rules
– Distinguish between changes to care and
improvements to care
– Distinguish between short term improvement
and sustained improvement
– Help your team prepare for Action Period #2
using tools from the Sustainability Workbook
FFLS Participants
Group One:
Repeat
Participants
Group Two:
New
Participants
What is Sustainability?
“ When new ways of working and improved outcomes
become the norm… not only have the process and
outcome changed but the thinking and attitudes behind
them are fundamentally altered and the system
surrounding them are transformed as well.”
NHS Institute of Innovation and Improvement (2005)
The Value of Time Series Data
and SPC Run Chart Rules
Change or Improvement?
8
8
7
6
5
4
3
3
2
1
0
Before Change (Week 4)
After Change (Week 11)
Change or Improvement?
Change or Improvement?
The Value of Time Series Data
• Help you make decisions- Change or Improvement?
• Help focus on what is important
• Move you away from anecdotes and one person’s view
• Build confidence
• Will help you “sell” your ideas to colleagues
• Set the stage for improvement/identify problem areas
• Provide a common frame of reference for staff and
leadership
SPC Run Chart Rules
Sustainability Workbook Tool
SPC Run Chart Rules
Rule One: A Shift
• Six or more consecutive points either all above or all
below the median
Rule Two: A Trend
• Five or more consecutive points all going up or all going
down
Rule Three: An Astronomical Data Point
• An obviously different value; anyone studying the chart
would agree that it is unusual
A Shift
Bed Turns on Target Unit
A Shift con’t
Average Acute LOS Med 5C Normal cases Discharges to LTC
Individua ls
Set 1: UCL = 18.79, Mean = 8.92, LCL = -0.94 (not shown) (1 - 12) (mR = 2) (Lloyd Nelson option)
UCL
18
16
average # of days
14
12
10
Mean
8 Median line = 7.78
6
4
2007-1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
A Trend
An Astronomical Data Point
What Does Sustained Improvement
Look Like?
Sustained Improvement
ALOS on Target Unit
Source: Saskatchewan Health Quality Council
Rule of Thumb
Sustainability = 10 – 15 consecutive data points
FFLS Improvement Aim
By March 2012, Participating teams will have:
• Reviewed their Falls Prevention and Injury Reduction
Improvement Plans for sustaining practice change;
• Integrated sustainability strategies into their Falls
Improvement Plans;
• Collected and submitted data monthly on measures to
SHN for Falls Intervention and used this data to
monitor and facilitate sustained improvement;
• Demonstrated a 20% improvement in their baseline
measures and sustained for 3 consecutive months .
FFLS Improvement Aim cont
…Demonstrated a 20% improvement in their baseline
measures and sustained for 3 consecutive months
** Need 7-12 more data points
to
verify sustainability **
Beyond Measurement:
Putting it all Together
The Sustainability Process
Hard Wire Gains
Are Improvements
Sustained?
Improve Care
Improve Care
Improve Care
Are Improvements Sustained?
Are
Improvements
Sustained?
Hard Wire Gains
Hard Wire
Gains
•People
•Processes
•Organization
NHS Institute, 2011
How to Hardwire: Plan to Sustain!
Quotes from the Flo Collaborative (2008):
“ We will review the data collected on a monthly basis as we
move forward with our spread to all units… If we are within
our expected targets, we will begin to monitor every 2
months. In addition we are monitoring the qualitative
feedback from staff who are involved in the process to
ensure it is meeting their needs as well”.
How to Hardwire: Plan to Sustain!
“ The [auditing] system allows for assigned staff and
management to audit the accuracy and completeness of the
boards on a weekly basis… All staff can see the results of
these audits. The Unit Administrator reviews the results
and celebrates successes and addresses gaps through staff
meetings in a timely manner. The Unit Administrator also
provides weekly updates to the Program Director and the
committee of the Medical Advisory Council. The Program
Director reinforces successes and opportunities for
improvement on her walkabouts on the unit.”
How to Hardwire: Audit Your
Practice!
Outcome
Audit
Infection Rate
Hand Hygiene
Patient Satisfaction with meals
Time required to distribute meals on unit
Falls Incidence
Number of falls risk screening tools
completed on admission to unit
Staff Satisfaction
Number of interruptions to nurse during
medication rounds
How to Hardwire: Organizational
Strategies
•
•
•
•
•
•
Communication Systems
Training/education/re-education
Facilities/Equipment
Job Descriptions
Policies and Procedures
Project Plans/Budgets/Timelines
NHS Institute, 2011
How to Hardwire: Communication
•
•
•
•
•
•
Communication Systems
Training/education/re-education
Facilities/Equipment
Job Descriptions
Policies and Procedures
Project Plans/Budgets/Timelines
NHS Institute, 2011
How to Hardwire: Communication
To prevent “slippage”, it’s important that we
communicate the following to all individuals
supporting improvements to care:
•Why are we doing this?
•What will it mean to me?
•What will you do to support me?
• What do you want from me in return?
Source: Saskatchewan Health Quality Council
How to Hardwire: Job Descriptions
•
•
•
•
•
•
Communication Systems
Training/education/re-education
Facilities/Equipment
Job Descriptions
Policies and Procedures
Project Plans/Budgets/Timelines
NHS Institute, 2011
How to Hardwire: Job Descriptions
“ … The Unit Administrator reviews the results and
celebrates successes and addresses gaps through staff
meetings in a timely manner. The Unit Administrator also
provides weekly updates to the Program Director and the
committee of the Medical Advisory Council. The Program
Director reinforces successes and opportunities for
improvement on her walkabouts on the unit.”
The Sustainability Process
Hard Wire Gains
Are Improvements
Sustained?
Improve Care
"One worthwhile task carried to a successful
conclusion is worth half-a-hundred
half-finished tasks".
Malcolm S. Forbes
Questions?