Validate PHRU high level findings across a wider, senior audience Identify and agree the effectivene

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Lessons Learned - Workshop Objectives

• Validate PHRU high level findings across a
  wider, senior audienceIdentify and agree the
  effectiveness of enabler mechanisms in delivering
  current successes and how to take these
  forwardIdentify omissions and barriers to
  Quality MKs whole system approach and agree
  measures to tackle and overcome themAgree areas
  of priority to embed sustainability

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Workshop Outline

• 14.00 Welcome Dr Nicola Smith
• 14.05 Aiming for Higher Quality of Care and
  Longer, Happier, Healthier Lives - Graham Ball,
  Deputy C/E, MK PCT
• 14.10 Workshop Objectives and Structure -
  Alistair Robertson
• 14.20 Qualitative Evaluation, Early Findings
  Kate Saffin, PHRU
• 14.40 Group Discussion and Feedback
• 15.10 Enabling Change and Overcoming Barriers
  Groupwork
• 15.30 Gallery Feedback
• 15.50 Working towards Sustainability in
  Embedding a Whole
• Systems Approach
• 16.15 Feedback
• 16.25 Summary Dr Nicola Smith
• 16.30 Close

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1. THE CHALLENGE
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Courtesy of Bill Runciman, APSF Data extracted
from AHRQ 2006 report
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Wrong plan nearly 50 of the timeHarm a
patient with 10 of admissionsThe harm is
permanent or severe with 2 of admissionsDeath
is associated with the harm in 1/300
patientsThis amounts to 100,000 preventable
deaths since 1995 (Australia alone)Costs as much
as 1 million /hour (Australia alone)Data
courtesy of Professor Jeff Richardson, CHE,
Monash University and Professor Runciman,
Professorial Research Fellow, Patient Safety,
University of Adelaide
UK and Australia
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OR put another way

• The equivalent of a jumbo jet crashing every week
  with over 300 UK citizens on board

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2.BARRIERS

• Information and technology overload
• Growing information base
• Specialty silos
• Communication issues
• Clinical governance
• Plethora of guidelines
• Trainees, locum and agency staff
• Increasing patient safety issues
• Less patient time, more referrals
• Medical errors
• Rising cost of claims

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Reasons for resisting change

• Information problems
• Individual decision-making
• Effects of stress
• Getting the right people together
• The status quo

Getting evidence into practice
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View from the frontline

• 2. Skills
• Low levels of baseline skills in using IT
• Low levels of baseline skills in critical
  appraisal
• Insufficient time for clinicians to acquire new
  skills

• 1. Access
• Inadequate access to information
• Lack of relevant evidence

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View from the frontline

• 3. Funding
• Insufficient money to help clinicians to acquire
  new skills

• 4. Hierarchy
• Problems relating to medical and nursing
  hierarchies
• 5. Autonomy Perceived threats to medical
  autonomy

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3. TOOLS WE CAN USE

• 1. All groups involved
• 2. Characteristics of the change
• that might influence its adoption
• 3. Readiness of health professionals
• in the target group to change
• 4. Potential external barriers to change
• 5. Likely enabling factors
• (including resources and skills)

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Tools we can use Barriers scale

• Benefits of change
• Quality of research
• Access to research
• Resources
• Organisational culture
• Staffing issues
• Personal feelings

• Adopter
• Organization
• Innovation
• Communication process

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Tools we can use the power of Evidence

• 80 of physicians changed their care as a result
  of evidence - as follows
• Avoided hospitalisation in 12
• Reduced overall length of stay in hospital in 19
• Changed diagnostic tests in 51 and drug choices
  in 45
• Avoided additional tests or procedures in 49
• Adhering to evidence-based guidelines for
  treating hypertension alone could save at least
  1.2 billion annually in US

• Marshall J G. . The Rochester study.
• Fischer MA, Avorn J. Economic implications of
  E-B-based prescribing for hypertension

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Emerging themes group discussion of the findings

• What themes have resonated with you from Kates
  presentation?
• Are there any other themes you can identify from
  your own experience?

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Enabling change and overcoming barriers group
discussion

• What were/are the enablers and why were they
  effective?
• What were/are the barriers and how did/are you
  overcome them?

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Working towards greater sustainability in
embedding a whole systems approach what do we
need to focus on?