Educational Implications from the Transforming Care at the Bedside Initiative

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1 Educational Implications from the Transforming Care at the Bedside Initiative Pat Rutherford, MS, RN Vice President Institute for Healthcare Improvement AACN 2009 Baccalaureate Education Conference November 21, 2009 Chicago, Illinois

2 Session Objectives Participants will be able to: Understand key features of a process for engaging front-line staff in innovation and prototype testing which is based on the approaches to innovation developed by the Institute for Healthcare Improvement and IDEO Describe the key strategies that have been successful in transforming care at the bedside Identify high leverage changes (and tests of change) to begin transformation on medical and surgical units Describe practical strategies for integrating the how and what of TCAB into undergraduate nursing education

3 Transforming Care at the Bedside Launched in 2003, Transforming Care at the Bedside (TCAB) is a national program of the Robert Wood Johnson Foundation (RWJF) and the Institute for Healthcare Improvement (IHI) that engages leaders at all levels of the organization to: improve the quality and safety of patient care on medical and surgical units increase the vitality and retention of nurses engage and improve the patient s and family members experience of care improve the effectiveness of the entire care team

4 Quality improvement begins with love and vision. Love of your patients. Love of your work. If you begin with technique, improvement won t be achieved. A. Donabedian, M.D.

5 Deming s Thoughts on Transformation Metanoia: Reorientation of one s way of life (The New Economics. Deming, p. 95, 1993) Begins with individual More than a change Develop new habits of mind

6 Transformative Learning Not spontaneous (requires work and discipline) Creates new meaning to life, events, facts, interactions with others Results in change in perception; knowing which requires different action or structure What is the learning that creates a new habit of mind? Change perspectives and paradigms Challenge and validate assumptions Critical self-reflection Include and integrate experiences

7 System-Level Redesign Every system is perfectly designed to achieve exactly the results it gets. New levels of performance can only be achieved through dramatic system-level redesign.

8 Integration of Models, Designs, and Conceptual Frameworks IdealizedDesign TM Complex Adaptive Systems and many more

9 IHI s Idealized Design Process. the how of TCAB Link TCAB aims to the hospital s strategic plan Generate New Ideas for Prototype Testing Snorkel (adaptation of IDEO s Deep Dive ) Adapt strategies from other Industries Adapt best practices Create a Learning Community (Site Visits, Storyboard Sessions, Collaborative Learning, etc.) Test New Ideas and Measure Outcomes Implement and Spread Successful Changes

10 Seton NW TCAB Snorkel. Engaging Front-line Staff

11 UPMC TCAB Snorkel How might we.enable the patient to be the source of control? Act Plan Study Do Liberalized Diets

12 Learning from Other Industries 5S and eliminating the waste of movement

13 Learning from Other Industries eliminating the waste of movement

14 Adapting Best Practices Six Changes That Save Lives Deploy Rapid Response Teams Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction (Heart Attacks) Prevent Adverse Drug Events (ADEs) Prevent Central Line Infections Prevent Surgical Site Infections Prevent Ventilator-Associated Pneumonia

15 Adapting Best Practices Changes that Reduce Harm Prevent Pressure Ulcers Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) Infections Prevent Harm from High-Alert Medications Reduce Surgical Complications Deliver Reliable, Evidence-Based Care for Congestive Heart Failure

16 Learning Community/Site Visits Griffin Site Visit Renovations at NSLIJ

17 Learning Community and Storyboard Rounds

18

19 Use of Measurement for Learning Quantitative: Outcome measures Process measures Diagnostics Qualitative: Success stories Anecdotes Testimonials

20 Evaluating Results and Spreading Successes Change 1 Change 2 Observed Data Change 1 Change 2 Change 1 Change 2 Design Target Time Order (Monthly Data) Pilot Unit #1 Pilot Unit #2 All Med/Surg Units

21 Video Clip of Seton NW

22 TCAB Themes and High Leverage Changes.the what of TCAB Transformational Leadership Safe and Reliable Care Vitality and Teamwork Patient-Centered Care Value-added Care Processes

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26 Safe and Reliable Care Care for moderately sick patients who are hospitalized is safe, reliable, effective, and equitable. High Leverage Changes: Develop a rapid response team or early recognition system Develop hospice and palliative care programs Prevent patient injury from falls Prevent hospital-acquired pressure ulcers Reduce harm from high hazard drug errors

27 Safe and Reliable Care

28

29 Vitality and Teamwork Within a joyful and supportive environment that nurtures professional formation and career development; effective care teams continually strive for excellence. High Leverage Changes: Building capabilities of front-line staff in innovation and process improvement) Develop mid-level Managers and Clinical Leaders to lead transformation Implement a framework for professional nursing practice based on the forces of magnetism Optimize communications and teamwork amongst clinicians and staff

30 Vitality and Teamwork National RN Turnover Rates % to 16.8% % to 13.5%

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33 Patient Centered Care Truly patient-centered care on medical and surgical units honors the whole person and family, respects individual values and choices, and ensures continuity of care. Patients will say, They give me exactly the help I want (and need) exactly when I want (and need) it. High Leverage Changes: Create patient and family-centered healing environments Involve patients and family members in QI Teams Create an ideal transition home Initiate multidisciplinary rounds involving patients and family members (customizing care to patient s values, preferences and expressed needs

34 Patient Centered Care

35

36 Go and See..

37 Value-Added Care Processes All care processes are free of waste and promote continuous flow. High Leverage Changes: Create acuity-adaptable beds Optimize the physical environment for patients, clinicians and staff Eliminate waste and improve workflow in admission process, medication administration, handoffs, routine care and discharge process

38 Value-Added Care Processes

39 The Leadership Challenge Model the Way Inspire a Shared Vision Challenge the Process Enable Others to Act Encourage the Heart The Leadership Challenge Kouzes and Posner, 2002

40 Transformational Leadership Successful changes on the TCAB units will be adapted and spread to all medical and surgical units. High Leverage Changes: Establish, oversee and communicate system level aims for TCAB units and the spread of TCAB innovations Align system measures, strategy, projects and a leadership learning system Build improvement capability at all levels of the organization Get the right team on the bus CEO, CNO, CMO, CFO, and COO

41 Transformational Leadership Results of the Leadership Survey: Because of TCAB, front -line staff more likely to initiate change. (18 of 19 agree) Because of TCAB, quality improvement department works more collaboratively.(13 of 19 agree) Because of TCAB, more collaboration among department leaders. (15 of 19 agree) After collaboration ends, nurses will be less involved in change. (16 of 19 disagree) After collaboration ends, meetings will continue. (17 of 19 agree) Pilot and spread unit managers agree that TCAB innovations developed could be implemented without TCAB unit teams, but unit staff involvement in decision making on adoption contributed or contributed greatly to improving care delivery. (16 of 18 agree)

42 Composite TCAB Storyboard

43 TCAB Brochure

44 TCAB Resources RWJF s Website IHI s Website ormingcareatthebedside.htm TransformingCareattheBedside.htm AJN Supplement

45

46 Integrating the what of TCAB into Nursing School Curriculum Utilize TCAB How-to-Guides for curriculum design and as resources for current courses Engage nursing students in quality improvement projects during clinical rotations at hospitals Consider convening nursing students, medical students and pharmacy students for a patient safety or QI course (possible topics -- medication safety, interdisciplinary collaboration, discharge preparations, removing waste and inefficiencies in medication administration and/or admission assessments)

47 Integrating the how of TCAB into Nursing School Curriculum Building nursing students quality improvement capability TCAB How-to-Guide Engaging Front-line Staff in Innovation and Quality Improvement IHI resources for the Model for Improvement Institute for Healthcare Improvement. Model for Improvement. Overview and tools, including PDSA worksheet and guidelines. s/howtoimprove. IHI Open School course -- The Model for Improvement: Your Engine for Change 1b3d74d-f a4- ac29c9565ff1&catalogguid=6cb1c b-43ef-9abdd90849f183d4

48 Integrating the how of TCAB into Nursing School Curriculum Building mid-level manager capability for leading innovation and quality improvement TCAB How-to-Guide Developing Front-Line Nurse Managers to Lead Innovation and Improvement Form or join a local Chapter of the IHI Open School

49 Engaging the Next Generation of Health Professionals in Quality Improvement With Thanks to the Generous Donors The Rx Foundation The Kaiser Permanente Community Benefit The John D. and Catherine T. MacArthur Foundation The Josiah Macy, Jr. Foundation The Robert Wood Johnson Foundation

50 A survey of students taught us... 33% receive information about quality improvement in their current school curriculum 78% expressed interest in gaining these skills. 85% believed QI skills would be important to future employers 91% saw QI as important to their personal effectiveness. Source: IHI student survey, 2008

51 What did faculty want? create a modei quality improvement curriculum for health professional training schools create a virtual community for health professional students to engage them in quality training and active work include students and patients in the design focus on leadership skills in all roles; transform health care leadership

52 IHI Open School: Mission To advance health care improvement and patient safety competencies in the next generation of health professionals worldwide.

53 IHI Open School: Content Access free content Online courses Case studies Audio recordings Videos Recommended reading Contests

54

55 IHI Open School Chapter Network 173 campuses

56 IHI Open School Registered Users >10,000 students registered >1,600 faculty and deans registered IHI Open School Chapter Update 161 Chapters on 173 campuses 112 US Chapters in 39 states 49 international Chapters in 24 countries Average Chapter size: 15 students (ranging from 1-1,200 members) 43% of Chapters hold 1-2 Chapter meetings per month 78% of Chapters have Faculty Advisors Content Usage >10,000 online courses completed 54% of Chapter Leaders say their faculty use IHI Open School resources in their courses

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59 Coming Soon New courses and resources: Patient and Family-Centered Care Teamwork and Communication Population Health Operations Management Advanced courses in Patient Safety and Improvement IHI Open School Certificate of Completion Continuing Education Credits

60 Contact the IHI Open School Visit our website: Open School team: o Jill Duncan, Director (on leave until 12/09) o Shannon Mills, Community Manager o Deepa Ranganathan, Content Manager o Carly Strang, Project Manager

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