ICU COLLABORATIVE IMPROVEMENT MODEL Learning Session I

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ICU COLLABORATIVE IMPROVEMENT MODELLearning
Session I

• Jack Scharf MBA ,FACHE, CPHQ
• Vice President Quality Management
• Atlantic Health System

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Breakthrough Collaborative

• An Improvement Method that relies on SPREAD
• and adaptation of existing knowledge to multiple
• settings to accomplish a common goal.
• A Breakthrough Collaborative is NOT
• Research for new knowledge
• Single Setting Focus
• Small changes to existing systems

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Key Attributes of Collaborative Success

• Action-Oriented
• All teach, all learn
• Create a sense of family and support

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Key Elements of Breakthrough Improvement

• Will to do what it takes to change to a new
  system
• Ideas on which to base the design of the new
  system
• Execution of the ideas

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Three Fundamental Questions for Improvement

• What are we trying to accomplish?
• How will we know that a change is an improvement?
  
• What changes can we make that will result in
  improvement?

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What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make
that will result in improvement?
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The PDSA CycleFour Steps Plan, Do, Study, Act

• Also known as
• Shewhart Cycle
• Deming Cycle
• Learning and Improvement Cycle

Act
Plan
Study
Do
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What Are We Trying to Accomplish?

• Developing the team aim statement
• Specific
• Measurable
• Strategic Importance
• Achievable but Stretch

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Establishing the Teams Aim

• Involve senior leaders of the team
• Align aim with strategic goals of the
  organization
• Focus on issues that are important to your
  organization
• Choose appropriate goals

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Establishing the Teams Aim, Cont.

• Write a clear statement of aim with numerical
  goals
• Make the target for improvement unambiguous

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ICU Collaborative Aim Statement

• Reduce ICU Mortality by 20 by May 31, 2005

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How Do We Know That a Change is an Improvement?

• This collaborative is about changing your
  organizations approach to improving the care and
  health of patients
• It is not about measurement.
• However

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Measurement Guidelines

• Need a balanced set of 3 to 10 measures reported
  each month to assure that the system is improved.
• These measures should reflect your specific aim
  statement specific goals
• Measures are used to guide improvement and test
  changes
• Integrate measurement into daily routine
• Plot data for the measures over time and annotate
  graph with changes

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Some Measurement Assumptions

• The purpose of measurement in the collaborative
  is for learning not judgment
• All measures have limitations, but the
  limitations do not negate their value
• Measures are one voice of the system. Hearing the
  voice of the system gives us information on how
  to act within the system
• Measures tell a story goals give a reference
  point

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Types of Measures

• Outcome Measures
• Results - system level performance
• Process Measures
• Inform changes to the system
• Balancing Measures
• Signal robbing Peter to pay Paul

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ICU Collaborative Required Goals

• Demonstrate an improvement in safety culture,
  i.e. on
• re-survey gt 50 percent of respondents will
  report a
• positive safety culture in their ICU
  environment.
• Reduce incidence of ventilator-associated
  pneumonia
• to the 25th percentile or less of CDC/NNIS
  reported
• data.
• Reduce incidence of catheter related blood stream
• infections to the 25th percentile or less of
  CDC/NNIS
• reported data.

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ICU Collaborative Required Goals

• Achieve 95 compliance with all five critical
• components of ventilator management
• PUD prophylaxis
• DVT prophylaxis
• HOB elevation
• Withholding of sedation once every 24 hours
• Readiness to extubate assessment
• Implement glucose control and mouth care and/or
• gastric decontamination as two additional
• components of the ventilator bundle

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ICU Collaborative Required Goals

• Reduce the average LOS for ICU patient
• by one day.
• 7. Reduce direct costs/discharge for ICU
• patients by 20
• 8. Increase ICU bed turnover by 20

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AIM GOALS
What are we trying to
accomplish?
How will we know that a
MEASURES
change is an improvement?
What change can we make
that will result in improvement?
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What Changes Can We Make That Will Result in
Improvement?

• The collaborative change package contains the
  key elements of high performing system
• Use the change package to identify the changes
  you want to make to your system to achieve your
  aim
• We know these changes work, but may have to be
  somewhat modified for your setting

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Measurement and Data Collection During PDSA Cycles

• Collect useful data, not perfect data - the
  purpose of the data is learning, not evaluation
• Use a pencil and paper until the information
  system is ready
• Use sampling as part of the plan to collect the
  data
• Use qualitative data rather than wait for
  quantitative
• Record what went wrong during the data collection

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COLLABORATIVE MODEL(6 to 13 months time frame)
Participants (10-100 teams)
Select Topic (develop mission)
Prework
Congress, Guides, Publications etc.
P
Develop Framework Changes
P
P
A
D
A
D
A
D
Expert Meeting
S
S
S
LS 1
LS 2
LS 3
Planning Group
Supports Email Visits Phone Assessments
Monthly Team Reports
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