Unindo forças:

implementação e

disseminação

de programas de

segurança do paciente

HIAE-IHI Symposium

3-5 November 2013

Pedro Delgado

Diretor Executivo

IHI

@pedroIHI

Congratulations…A brilliantplatform!

Great work in all of these in some places

Just noteverywhere

An opportunity

1. Pioneers & legacy

2. Implementation & Spread - how

3. New norms -‘Culture eats strategy forlunch’

What will you do bythis Friday?

1. The content , and its packaging

2. The data : real time, useful, available

3. A segmentation -to-spread plan

4. Pace: testing and learning

5. Leadership commitment

Critical success factors

CSF 1: The content ,

and its packaging

WEALTH OF CONTENT

About 3,720,000 results (0.24 seconds)

About 122,000,000 results (0.26 seconds)

About 3,380,000 results (0.24 seconds)

About 152,000,000 results (0.23 seconds)

About 11,200,000 results (0.27 seconds)

About 1,970,000 results (0.24 seconds)

Adoption is a SOCIAL thing!

A better idea…

…communicated through a social network…

…over time

Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press.

Relative

Advantage

Relative

AdvantageSimpleSimple TrialableTrialable CompatibleCompatible ObservableObservable

Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press.

Accelerating adoption

A system - Everyone knows the connections and their contribution

CauseEffect Drives

Outcome

(aim)

Primary

drivers

Secondary

drivers

CSF 1: The content ,

and its packaging• 5 attributes ‘checklist’

• A systemic view

• Simple, snappy ‘how to’ guides (evidence,

method, stories)

* Economies of scale and collaboration

CSF 2: The data - real

time, useful, available

Seek usefulness,

not perfection

(a esperança não é um plano)

A clear aim

56% reduction

7.65

3.46

5.67

Real time measurement for learning

Rituals to learn (huddles, and other habits) –generative conversation spaces

CSF 2: The data : real

time, useful, available• A clear aim - process and outcome data

(dynamic view) to learn and improve, real time

• Rituals to learn

• Availability and usefulness to engage

* Collaboration to accelerate improvement

CSF 3: A

segmentation -to-

spread plan

“Up to 70% of improvement projects never spread.”

Eccles R, Miller Perkins K, Serafeim G. How to Become a Sustainable Company. MIT Sloan Management Review 2012; 53(4): 43-50.

For the spread of new ideas to happen in a timely fashion, the

spread process needs to be managed

Start-up:months 1 – 8

Total Pop’n:

Under 5 Pop’n:

Nov 2007

Wave 1:months 9 – 22

350,000

60,000

Jul 2008

Wave 2: months 23 – 63

5 million

500,000

Sept 2009

Wave 1R:months 58 – 89

11 million

1.7 million

Aug 2012

Start Small, Scale up Rapidly with Change Package

No of. QI Teams: 30 258 350 369 >1,046

Jan 2013

Wave 3: months 24 – 89

11 million

1.7 million

Oct 2009

Wave 4:months 63 – 89

22 million

3.3 million

*Referral project launch41 Referral Teams

Where will you start? (unit or

units). Where will you go next?

What is your timeline for

coverage and completeness?

Which theatre (s) / OR (s)?

General Medical?

Fractures, Care of Elderly, Surgical?

Are you ready to spread?

� Intention to spread the work in organization?

� Topic of interest is a key initiative?

� Senior Leader responsible and accountable?

� Initial (pilot) team is relatively self- sufficient?

CSF 3: A segmentation -to-

spread plan• Defining a starting point / place, and the sequence that

follows through coverage and completeness

• Diagnosing spread readiness

• Manage spread

* Collaboration to accelerate improvement

CSF 4: Pace - testing

and learning

“I hear and I forget; I see and I remember;

I do and I understand ” (Confucius)

‘Montar bici’

DESIGN DESIGN DESIGN DESIGN

A abordagem típica …

IMPLEMENTAÇÃO(fracasso?)

Muitasreuniões de planejamento …

DESIGN

DESIGN DESIGNDESIGNDESIGN APPROVE!

O mundo real

¿Qué intentamos lograr?

¿Cómo sabremos que un

cambio es una mejora?

¿Qué cambios podemos hacer

para obtener mejoras?

Actuar Planificar

Estudiar Hacer

Cuando

combinamos

las 3

preguntas

con …

El ciclo

PHEA…

El Modelo de Mejoramiento (Langley et al, 1996)

DESIGN

Abordagem de melhoria da qualidade

IMPLEMENTAÇÃO(êxito)

Poucasreuniões de planejamento …

APPROVE

O mundo real

TEST & MODIFY

TEST & MODIFY

TEST & MODIFY

Learning & Ownership

Aim: 50m by end of day

Predicciones:

• Se va a caer varias veces

• Distancias cortas en principio

• Confianza progresiva

Chinese proverb

不闻不若闻之，闻之不若见之，见之不若知

之，知之不若行之；学至于行之而止矣

“I hear and I forget; I see and I remember; I do and I understand”

-Confucius

CSF 4: Pace - testing

and learning • Build the capacity to improve

• Test, fast – and learn along the way

• Develop improvement capability –

reusable skills

CSF 5: Leadership

commitment“ The responsibility for adopting aims and

overseeing measures cannot be

delegated ”

A new kind of leadership

• Safety at the top – pragmatic approach

• Hierarchies and multidisciplinaryteamwork

• Its MY responsibility / It’s everyone’s responsibility

• Data driven decision making & learning

1. The content , and its packaging

2. The data : real time, useful, available

3. A segmentation -to-spread plan

4. Pace: testing and learning

5. Leadership commitment

Critical success factors

COLLABORATE

Build a

learning

system for

improvement

• National

• Regional

• Local

Transparency – the effect…Ejemplo: adopción de la guías para el tratamiento de síndrome coronario agudo

6

5

4

3

2

20092008200720062005

+13%

+22%

Los 34 hospitales de ‘abajo’

Todos los hospitales (69)

+7%

RIKS-HIA

Quality Index1

1. The quality index from RIKS-HIA measures Swedish hospitals adherence to national guidelines (best practice) regarding Acute coronary syndrome (ACS). The index is based on nine different process metrics which are described in the appendix. 2. Defined as hospitals given the three lowest grades when data became public for 2006 (0,5; 1,0; 1,5). 3. Data on individual hospital performance was first published in the 2006 RIKS-HIA annual report. From 2006 onwards the public and the media could easily access the data and compare individual hospital performance. Source: RIKS – HIA Annual Reports 2005 – 2009, BCG Analysis

+40%

Prior to 2006 hospitals were not named in

public report. Scientists could identify

individual hospitals by translating codes3

After 2006 data on individual hospital

performance was published triggering

significant media and public attention

No looking back…

Uso de teléfonos celulares

Cinturón de seguridad

Fumadores pasivos

Computadores personales

Música

(começar antes que você esteja pronto)

5 CSFs and…

1. Collaborate – build

a learning system &

share

2. Transparency

3. Change norms

What willyou do by

this Friday?

What will your legacy be?

Less harm forall Brazilians

Change starts with you

Our conversation in 2014…and

the vision to move from 16% to…

Obrigado…boa sorte!www.ihi.org

pdelgado@ihi.org

@pedroIHI