Unindo forcas implementação e disseminação de programas de seguranca do paciente
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Unindo forças: implementação e disseminação de programas de segurança do paciente HIAE-IHI Symposium 3-5 November 2013 Pedro Delgado Diretor Executivo IHI @pedroIHI
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Apresentação de Pedro Delgado durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil. Pedro Delgado é MSc, Diretor Executivo do Institute for Healthcare Improvement (IHI), atua a melhoria de sistemas e redes de saúde em larga escala mundialmente e lidera o portifolio do IHI na América Latina. Antes de integrar o IHI, trabalhou para o Serviço Nacional de Saúde da Grã Bretanha na gestão hospitalar e também levou de maneira pioneira esforços de melhoria em larga escala no norte da Irlanda.
Transcript of Unindo forcas implementação e disseminação de programas de seguranca do paciente
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…
