How Can We Prevent Surgical Complications Terri Simmonds, RN Faculty and Director, Safer Patients In

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How Can We Prevent Surgical Complications?Terri
Simmonds, RNFaculty and Director, Safer Patients
Initiative

• Magee International Forum
• April 19, 2007

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In This Session

• Introductions
• SPI Background, programme goals and strategic
  framework
• Changes, methods, and measures
• Experience from the field
• Questions

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Background The Health Foundation

• The Health Foundation is an independent charity
  that aims to improve health and the quality of
  healthcare for the people of the United Kingdom
• www.health.org.uk

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The Safer Patients Initiative

• Initially a 4.3 million initiative began in late
  2004 following a national competitive application
  process.
• Phase 1 Four acute hospital trusts
• - Conwy and Denbighshire NHS Trust (Wales)
• - Down Lisburn Health and Social Services
  Trust (Northern Ireland)
• - Luton and Dunstable Hospital NHS Trust
  (England)
• - NHS Tayside (Scotland)
• Phase 2 20 sites working in partnership, based
  across the UK.
• Working in partnership with a world leader in
  patient safety, the Institute for Healthcare
  Improvement.

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Hospitals in second phase of Safer Patients
Initiative

• 20 hospitals working in 10 partnerships
• 1 partnership in Scotland
• Dumfries and Galloway Royal Infirmary The Ayr
  Hospital
• 2 in Northern Ireland
• Royal Victoria Hospital Mater Hospital
• Antrim Area Hospital Causeway Hospital
• 1 in Wales
• University Hospital of Wales Royal Gwent
  Hospital
• 1 Wales/ England
• Maelor Hospital Countess of Chester Hospital
• 5 in England
• Bradford Royal Infirmary Airedale General
  Hospital
• Huddersfield Royal Infirmary York Hospital
• Southmead Hospital Bristol Royal Infirmary
• Royal Free Hospital The Royal London Hospital

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Key features of improvement programmes that point
to success

• Clear aim (for SPI - 50 reduction in adverse
  events)
• Measurement systems
• Leadership commitment
• Improvement at a local level through testing
• Patient focus/patient involvement
• System for spread

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The change package to reduce adverse events by 50

• The SPI change package addresses five clinical
  areas
• - Medicines management
• - Infection prevention and control
• - Peri-operative care
• - Critical care
• - Care on general wards
• All supported by an organisational wide effort to
  bring about a change in culture working at all
  levels but with a key role for senior leaders.

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Learning System Collaborative Learning Model
Model for Improvement
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What have we learned about improving safety and
leading change?

• Organisational focus on safety
• Test early and test often
• Make data capture a priority
• Build knowledge about how to create improvement
  capacity
• Patients must be involved in safety efforts
• Develop leaders

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Strategic Framework

• Create a blueprint of changes that require
  results that can not be achieved by project
  management alone.

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Multiple Centers of Gravity
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Surgical Complications
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The 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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Fundamentals for Success

• Given the depth and breath of transformation it
  required
• Engaged and committed leadership
• A transformative infrastructure
• Clear and compelling measurement system
• Collaboration across clinical and operational
  areas
• Change with spread in mind
• TRANSFORMATION

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Perioperative Work Stream
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Surgical Complications
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What we gain from academic studies is knowledge.
What we gain from experience is wisdom.
Mohandas Gandhi