Presenters: Michelle Graham & Mike Davidge
18 April 2012
Dark ages to renaissance
– rebirth of stroke care in Wales
Insert name of presentation on Master Slide
Dark ages to renaissance
Acute Stroke care
in Wales:
 6,300 admissions in
2010/11
 Age standardised
admission rate was 127 per
100,000 population
 28 day mortality was 18.7%
over period 2008- 2011
Source: Google
Dark ages to renaissance
The journey
The Malvern Hills mark the border between
Worcestershire and Herefordshire
This is our journey, what is yours?
Dark ages to renaissance
1st viewpoint:
Burning platform
Dark ages to renaissance
2006 Sentinel Audit
Overall Key Indicator Score 2006
12 indicators: 100 = maximum possible score
2012
80
70
2011
60
50
2010
40
30
2009
20
10
2008
0
2007
2006
Dark ages to renaissance
The 2007 letters
2012
2011
2010
2009
2008
2007
2006
Dark ages to renaissance
Dr Tony Rudd, who
assessed services
in Wales, England
and Northern
Ireland two years
ago, said services
in Wales were
"scandalously bad".
Dark ages to renaissance
Discussion
What is your burning platform?
Do you have one and if not, can
you create one?
Introduce yourself to your
neighbour and tell them about
your project and your burning
platform. Then let them tell you
about theirs.
Dark ages to renaissance
IHI Breakthrough Series
(6 to 18 months time frame)
2nd viewpoint:
A good process
Participants (10-100 teams)
Select
Topic
(develop
mission)
Expert
Meeting
Prework
Develop
Framework
& Changes
Planning
Group
Dissemination
P
A
P
D
A
S
P
D
S
LS 2
LS 1
A
AP1
AP2
D
S
LS 3
AP – Action Period
Email (listserv)
Visits
Publications
Congress
AP3*
Supports
LS – Learning Session
Holding the
Gains
etc.
*AP3 –continue
Phone Conferences
reporting data as
needed to
document success
Assessments
Monthly Team Reports
© 2004 Institute for Healthcare Improvement
Dark ages to renaissance
A good process
IHI Breakthrough Series
(6 to 18 months time frame)
2012
2011
2010
2009
Participants (10-100 teams)
Select
Topic
(develop
mission)
Expert
Meeting
2008
Prework
Develop
Framework
& Changes
Planning
Group
Dissemination
P
A
P
D
A
S
P
D
LS 2
LS 1
A
S
AP1
AP2
D
S
LS 3
2007
AP – Action Period
2006
Dark ages to renaissance
Email (listserv)
Visits
Publications
Congress
AP3*
Supports
LS – Learning Session
Holding the
Gains
etc.
*AP3 –continue
Phone Conferences
reporting data as
needed to
document success
Assessments
Monthly Team Reports
© 2004 Institute for Healthcare Improvement
The evidence
2012
2011
2010
2009
2008
2007
2006
Dark ages to renaissance
3rd viewpoint:
the right support
Dark ages to renaissance
Early lessons
2012
2011
2010
2009






Identify teams
PDSA’s - small and locally relevant (ownership)
Reinforce the improvement message
Learning sets and team lead meetings
Data, data, data
Most important: SUPPORT, SUPPORT,SUPPORT
2008
2007
2006
Dark ages to renaissance
Discussion
What improvement process are
you following? Do you have the
right people to support the
project?
Continue the conversation with
your neighbour. Tell them about
the process and the people you
are using. Then let them tell you
about theirs.
Dark ages to renaissance
% patients who have a manual handling assessment in first 72 hours
Stroke patients
from Jan 2009 to May 2009
Length of Stay
Stroke patients
from Jan 2009 to May 2009
Weeks
20/05/2009
06/05/2009
22/04/2009
% compliance with First 3 Days bundle
Stroke patients
from Jan 2009 to May 2009
20
18
16
No target
35
08/04/2009
25/03/2009
11/03/2009
25/02/2009
11/02/2009
28/01/2009
14/01/2009
% patients
4th viewpoint:
Effective data
100
90
80
70
60
50
40
30
20
10
0
14
12
10
25
8
Days
30
6
20
4
15
2
0
10
Jan 2009
Mar 2009
Months
5
0
Patients
Dark ages to renaissance
Feb 2009
Apr 2009
May 2009
7 steps to measurement
1 Decide aim
2012
2 Choose measures
2011
3 Define measures
2010
2009
2008
6 Review
measures
7 Repeat
steps
4-6
2007
2006
Dark ages to renaissance
5 Analyse &
present
4 Collect
data
Data collection plan
1 Decide aim
2012
2 Choose measures
2011
3 Define measures
2010
2009
2008
6 Review
measures
7 Repeat
steps
4-6
2007
2006
5 Analyse &
present
Dark ages to renaissance
4 Collect
data
For each data item:
 Format
 Who records this
 At what point
 Where is it stored
 How reliably do we
collect
 Issues to resolve
The Excel data tool
1 Decide aim
2 Choose measures
3 Define measures
2012
2011
6 Review
measures
2010
7 Repeat
steps
4-6
4 Collect
data
5 Analyse
& present
2009
2008
2007
2006
Dark ages to renaissance
Using the data
 How to interpret
sessions
 A common language
between clinicians
and managers
1 Decide aim
2012
2 Choose measures
2011
3 Define measures
2010
2009
2008
6 Review
measures
7 Repeat
steps
4-6
2007
2006
Dark ages to renaissance
5 Analyse &
present
4 Collect
data
Discussion
What is your approach to using
data? Do frontline teams want to
use it? Do they have the ability to
use it?
Continue the conversation with
your neighbour. Tell them about
how you support teams to use
their own data. Then let them tell
you about what they do.
Dark ages to renaissance
The last lap
ALL OUR DUCKS ARE IN A ROW!
2012
 Continued support
2011
2010
2009
 “Intelligent” Targets
 Serendipity
2008
2007
2006
Dark ages to renaissance
 From Pilot to Performance
Journey’s end?
1. First Hours Bundle
100.0%
90.0%
80.0%
70.0%
60.0%
2012
1
2
3
4
5
50.0%
2. First Days Bundle
40.0%
2011
30.0%
100.0%
20.0%
90.0%
10.0%
80.0%
0.0%
70.0%
60.0%
50.0%
Values
Mean
2010
UCL 40.0% LCL
30.0%
20.0%
10.0%
0.0%
3. First 3 Days Bundle
2009
Values
Mean
UCL
LCL
100.0%
90.0%
80.0%
70.0%
2008
60.0%
50.0%
4. First 7 Days Bundle
40.0%
2007
30.0%
100.0%
20.0%
90.0%
10.0%
80.0%
0.0%
70.0%
60.0%
50.0%
2006
Values
Mean
UCL
40.0%
LCL
30.0%
20.0%
10.0%
0.0%
Dark ages to renaissance
Values
Mean
UCL
LCL
Summary
IHI Breakthrough Series
(6 to 18 months time frame)
Participants (10-100 teams)
Select
Topic
(develop
mission)
Prework
Develop
Framework
& Changes
Expert
Meeting
Planning
Group
Dissemination
P
A
P
D
A
S
P
D
LS 2
LS 1
A
S
AP1
AP2
D
S
LS 3
Congress
AP3*
Supports
LS – Learning Session
Email (listserv)
Visits
AP – Action Period
Holding the
Gains
Publications
etc.
*AP3 –continue
Phone Conferences
reporting data as
needed to
document success
Assessments
Monthly Team Reports
© 2004 Institute for Healthcare Improvement
2012
2011
2010
2009
2008
2007
% compliance with First 3 Days bundle
Stroke patients
from Jan 2009 to May 2009
20
18
16
14
12
2006
10
8
6
4
2
0
Jan 2009
Feb 2009
Mar 2009
Months
Dark ages to renaissance
Apr 2009
May 2009