Day 1 Tuesday, June 4, 2013 Orange County Health Care Agency Clemens Steinbock

Transcription

1 Public Health Quality Academy Day 1 Tuesday, June 4, 2013 Orange County Health Care Agency Clemens Steinbock

2 Introductions Please briefly introduce yourself and the program you work for Question: What was the most intriguing moment on your quality improvement journey so far? 2

3 Opening Remarks Donna Fleming, DPA, MSW Chief of Operations, Public Health Services Orange County Health Care Agency 3

4 Expectations for Participants Actively continue your quality improvement project Spread the word on quality improvement by doing at least two trainings before the end of the year Be a champion for improvement and promote the culture of quality improvement Some participants may be selected to serve on the quality improvement committee 4

5 Goals for QI Training Provide a forum to present quality improvement project team updates and celebrate successes so far Promote peer sharing and networking across all quality improvement teams Enlarge the pool of qualified trainers for quality improvement across the Orange County Health Care Agency Increase the confidence of training participants in facilitating quality improvement-related training opportunities 5

6 Day 1 June 4, :00am Welcome, Introduction, and Outline of Project Expectations 9:20 Opening Remarks 9:45 Spreading and Holding Gains of Improvement 10:45 Break 11:00 Project Presentations 12:00pm Lunch 1:00 Project Presentations 1:45 QI Activity Public Goods Game 2:15 Break 2:30 New QI Ideas 3:15 QI Project Team Work (developing outline for next 3 months) 4:30 Sharing Aha! Moments & Day 1 Evaluation 5:00 Adjourn 6

7 Spreading and Holding Gains of Improvements Day 1 June 4

8 Ignaz Philipp Semmelweis Assistant of First Obstetrical Clinic in Vienna, Wiener Allgemeinen Krankenhaus, 27. February Discovered that physicians who were in contact with women who have childbed fever infect others Dr. Ignaz Philipp Semmelweis, 15. May 1850, presentation before the Imperial and Royal Society of Physicians of Vienna Dr. Ignaz Philipp Semmelweis, 1861, Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers (The Etiology, Concept, and Prophylaxis of Childbed Fever) Dr. Ignaz Philipp Semmelweis, 1862, Offene Briefe Ignaz Philipp Semmelweis, The Etiology, Concept, and Prophylaxis of Childbed Fever, translated by Codell Carter, University of Wisconsin Press, 1983

9 Semmelweis: July - October % 14% 12% 10% 8% 6% 4% 2% 0% Gortvay, Zoltau Semmelweis, S. Hirzel Verlag, Leipzig, 1976 Georg Sillo-Seidl Die Wahrheit über Semmelweis, Aviston Verlag Genf, 1978

10 Semmelweis: March 1847 Starting today, every physician and student has to wash their hands before entering the clinics. No exceptions. I.P. Semmelweis May 15th, 1847

11 March June July August September October November December January February March April Semmelweis: March March % 12% 10% 8% 6% 4% 2% Mortality Rate, %

12 Lessons Learned Two parts of an innovation/improvement: a) generate innovation and b) spread innovation Each innovation has a rate of diffusion (even successful innovations need time to spread ) Each innovation had to be proven several times to be accepted Each innovation was faced with resistance

13 The Tipping Point The name given to that one dramatic moment in an epidemic when everything can change all at once. -- M. Gladwell, The Tipping Point (2000)

14 Diffusion of Innovations Diffusion of Innovations Everett M. Rogers The Free Press, New York, 1995

15 Critical Mass and Momentum The part of the diffusion curve from about 10 percent to 20 percent adoption is the heart of the diffusion process. After that point, it is often impossible to stop the further diffusion of a new idea, even if one wished to do so. E.M. Rogers, Diffusion of Innovations (1995)

16 Number of Farmers Reaching the Tipping Point Tipping Point Year Number of Adopters of Hybrid Seed Corn in Two Iowa Communities Source: Based on Ryan and Gross (1943)

17 Percent of clinics implementing CCM Diffusion Curve in Health Care Spread of Chronic Care Model Across Clinics Total of 80 Clinics in Organization tipping point Sep- 98 Oct Nov Dec Jan- 99 tipping point Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan- 00 Feb Source: Institute for Healthcare Improvement

18 Types of Innovators Innovators - Venturesome Early Adopters - Respected Early Majority - Deliberate Late Majority - Skeptical Laggards - Traditional

19 Diffusion of Innovation Source: Ryan and Gross, Hybrid Seed Among Iowa Farmers, 1940

20 Rogers s Five Attributes of Change Relative Advantage - how much better is the new compared to the old? Compatibility - how consistent is this idea with current values, experiences, and needs? Complexity - how difficult is the new idea to understand and use? Trialability - how easy is it to test the new idea? Observability - how visible are the results of the new idea? -- E.M. Rogers, Diffusion of Innovations (1995)

21 Human Diffusion Curve Exercise 3 volunteer observers are needed to report back on key process findings 2-3 presenters to sell innovative ideas (thanks!) Audience vote with their feet

22 Rules of Diffusion by Donald Berwick Identify changes that are ready to spread Find innovators and support them Invest in early adopters and allow communication with innovators Make early adopters observable Allow re-invent innovation Trust and enable innovation Lead by Example

23 Small Table Exercise - Review at your small tables the provided scenario and strategize how to employ key diffusion/spread principles - Be prepared to share their ideas and strategies with the larger group

24 Scenario A small rural clinic has developed a reminder system that utilizes text messaging to alert clients about their upcoming appointments. In collaboration with a local community college, a free software application has been developed which links the clinic appointment system, client contact information and online text messaging. All clients with cell phones receive a 1-week and 1-day reminder about their upcoming appointments. This innovation has led to significantly higher retention rates among those patients with cell phones. Develop strategies to implement this proven innovation across all HIV programs in the entire state.

25 Closing Thoughts We are what we repeatedly do; excellence is not an act, but a habit. -Aristotle

26 Presentations of QI Projects Day 1 June 4

27 Public Goods Game Day 1 June 4 Source: Dan Ariely, Predictably Irrational, Public Goods Game, page 257.

28 New Ideas for QI

29 Group Work Plan next steps for the project. Think about next steps in the PDSA cycle. When will you meet next? How will you measure success? What will you do with the results of the current cycle (adopt, adapt, or abandon)?

30 Contact Information Jane Chai, MPH Projects Manager, Public Health Services Orange County Health Care Agency (714) Clemens Steinbock, MBA (212)