1. Welcome Back Quality Leadership Academy Session 3 “ How Do You Know it Works?” Anna Roth, RN, MS, MPH

4. Theory

6. How will we know?

8. Choosing appropriate statistics

15. Excercise

16. Report Out

17. Back in 15 minutes

18. Finding your way/Telling your story

26. Elements of a Control Chart UCL LCL X Indicator Time An indication of a special cause

27. Non-Random Rules for Run Charts

32. First 24 Observations from Red Bead Data (without outlier employee)

33. 12 Runs expect to find between 8 and 18 runs

36. On Death, Dying & Data DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE

37. On Death, Dying & Data DENIAL “ The data are wrong” ANGER “ The data are right, but it’s not a problem” BARGAINING “ The data are right; it is a problem; but it is not my problem.” DEPRESSION “ This feels too hard to do” ACCEPTANCE “ I accept the burden of improvement ”

40. Crimson Bead Company

43. “ Every system is perfectly designed to achieve the results that it achieves” Berwick: central law of improvement BMJ 1996 312:619-622

44. Discussion

45. Oversight

47. Projects Connected to Big Dots * Mortality Rate * Cost per Admission * Adverse Events * Functional Outcomes * Patient Satisfaction * 3 rd Available Appointment * Voluntary Turnover * Condition-specific, clinical process indicators * Preventive care measures * Office visit cycle time * ER to bed placement time * PACU to bed placement time * ICU to bed placement time * Bed to LTC placement time * ICU mortality * Catheter related BSI * Average ventilator days per patient * Adverse events/ICU day * Surgical Site Infection Rate * Percent of un-reconciled medications * Staff reporting positive safety climate * Percent of turnover in first year * Employee loyalty

52. “ One Patient, One List” Project Level Measure (Tier 3)

55. Driver Diagrams

56. What Changes Can We Make? Understanding the System for Weight Loss “ Every system is perfectly designed to achieve the results that it gets”

57. How Will We Know We Are Improving? Understanding the System for Weight Loss with Measures Measures let us • Monitor progress in improving the system • Identify effective changes

59. AIM Primary Driver Secondary Driver

61. Report Out

62. Tying it together

63. Transforming Care at the Bedside (TCAB) Med-Psych Workgroup Clinical Informatics ED Safety Central Line Infection Team Multidisciplinary Rounds Rapid Response Team Office Practice Team Perinatal Impact Team Total Joint Team VAP Prevention Team Perioperative Care Medication Reconciliation Team

65. System Level Aims

66. System Level Aims Primary System Aims Additional System Level Aims Zero Hospital acquired infections Patient overall satisfaction to be >90% Readmission rate to decrease by 30% Planned System Level Aims to begin by 2010 Eliminate inequality in at least ten improvement /operational areas by 25% Reduce Ambulatory Care Sensitive Admissions (ACS) to CCRMC by 15% Patient engagement on every innovation and improvement team by January 1, 2010 Develop a formal process for engagement of ethics expertise in operations and quality improvement.

67. Prophylactic Antibiotics One Hour Prior to Incision

68. Hours of Behavioral Restraint Use

69. Inpatient Psychiatry: Discharge Care Planning

70. VAP per 1000 Ventilator Days Ventilator Days were 777 in 2006 and 645 in 2007

71. VAP per 1000 Ventilator Days

72. Number of VAPs and Ventilator Days

73. CCRMC 30 Day Readmission Rates

74. Heart Failure Discharge Instructions Given

75. Heart Failure Discharge Instructions Given

77. Percent of Patients Who Received All Heart Failure Interventions at CCRMC

78. Percent of Patients Who Received All Heart Failure Interventions at CCRMC All-or-Nothing Measurement

79. Why the time is now

83. Who will if not you?

84. What can you do by next Tuesday?