small country big change
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Small Country Big Change. Date:. Created by: Suzanne Proudfoot. Conflicts of Interest. Nil Ko Awatea-CMDHB has paid for me to attend No-one has paid me for my advice No other Business interests connected to my work. Acknowledgements. - PowerPoint PPT PresentationTRANSCRIPT
Small Country Big Change
Date: Created by: Suzanne Proudfoot
Conflicts of Interest
NilKo Awatea-CMDHB has paid for me to attendNo-one has paid me for my adviceNo other Business interests connected to my work
AcknowledgementsLeadership at Ko Awatea and Counties Manukau Health
Staff on the ‘Pilot site’ at CMH CCC
National Clinical Lead
Data analyst
HQSC sponsorship and partnership
The participating teams
ContextPopulation 4.4 million
Auckland population 1.4 million
20 District Health Boards
25 Intensive Care Units
- Geographically widely dispersed
- Vary in size and function
ResultsBetter patient experience
Decreased hospital stay
Reduction in patient harm
Rate reduction from 3.32/1,000 to 0.4/1,000 line days over 22 months
Results 10 Non consecutive months with Zero CLAB April 2012 to January 2014 (22 months)
Rate reduction from 3.3/1,000 to 0.28 in the first 12 months and 0.4/1,000 line days over the 22 month duration
Potential CLAB prevented in 22 months 105 Savings up to $2.1 million Lives saved 10 Spread to 61 units outside of the ICUs One ward at the pilot site >900 Days CLAB free
Collaborative Structure
Select Topic
Faculty / Expert
Meeting
Identify Change
Concepts
Ko Awatea and DHB Participants
Prework
LS 1 Nov 2011
P
S
A D
P
S
A D
LS 3March 2013
LS 2 June 2012
Holding the
Gains
Spread
Halfw
ay
Sept 2011 March 2013
ContextPopulation 4.4 million
Auckland population 1.4 million
20 District Health Boards
25 Intensive Care Units
Unlocking Relationships between CLAB Prevention and Collaboratives
The underpinning philosophy of the collaborative
It is more than equipment and procedures Isomorphic pressures Develop ‘organic’ networks Reframes a social problem Uses multiple interventions to Change practice Uses data as a disciplinary force
More than Just Equipment and Procedures
It is the philosophy of the collaborative- Different units have different starting points- Quality Improvement is non-linear and the guiding
principals change as you go along.- Allows for local adaptation
Keep going back to the framework!
Isomorphic pressures
Institutional level, specialty level, Regional and National Level– Normative– Mimetic – Coercive
Develops Organic networks Effective, horizontal pathways
- Supported by the Model- Connected by the Model
Forms a community
Reframes a Social Problem Owned by ICU
PersonalisedPrevents harm to innocent people
Uses multiple interventions to change practice
Empowers everybody– Resets norms and rituals– Puts the patient in the centre of care– Builds capacity and capability
Increases accountability at all levels– Without supervision– Rewards community membership– Enables wider society (calls to centre)
Uses Data as a Disciplinary Force
Using Measurement for Quality Improvement– Is there a problem?– How big is the problem?– Look how we solved the problem– Is the problem under control?
It is more than equipment and procedures Isomorphic pressures Develops ‘organic’ networks Reframes a social problem
The underpinning philosophy of the collaborative
Uses multiple interventions to Change practice
Uses data as a disciplinary force