Breakthrough projects Obtaining substantial improvements in patient care'

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Breakthrough projects Obtaining substantial
improvements in patient care.

• Caroline van Weert
• Dutch institute for healthcare improvement, CBO

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DUTCH INSTITUTE FOR HEALTHCARE IMPROVEMENT, CBO

• Not for profit,
• Non governmental,
• Hospitals participate voluntarily,
• We support, they do the work,
• To attain substantial and lasting improvements in
  patient care,
• In cooperation with patient groups,
• By supporting healthcare providers - professional
  s, - healthcare organizations,
• Founded by professionals and hospitals, 25yr ago.

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Improvement in patient care

• We know what to doguidelines and best practices
• It is hard to put in practice

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RESISTANCE TO CHANGE !
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Breakthrough program is

• Effective and
• Enjoyable

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5 yr. BT gt200 participants, 80 hospitals

• 2000
• Adult Intensive care 9
• Delay in Emergency 9
• 2001
• Adult Intensive Care (2) 14
• Delay in Emergency (2) 9
• Medication safety 12
• Postoperative infections 9
• Wait and delay on outboardfor diabetic feed
  andorthopaedic knee 9

• 2002
• Stroke service transmural 14
• 2003
• Stroke service transmural (2) 9
• Advance access outboard, 13
• Medication Safety 12
• Postoperative infections 12
• Triage on Emergency 16
• COPD 9
• 2004
• Diabetes transmural,Mammacare (2) and Heart
  failure

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What is Breakthrough?

• In a BT collaborative several teams from
  different organizations form a temporary
  collaborativethey strive at ambitious
  improvements in patient care through the
  implementation of existing knowledge and best
  practices.

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Breakthrough, what makes it work ?

• Focus on the system
• Lack of knowledge is most of the cases not a
  crucial factor but to make it happenshort span
  of time,facilitate
• Peer experts
• Setting the goals in results
• not invented by me
• Multidisciplinary approach teamwork
• Competition, social pressure the spotlight
• Make progress visible, feedback

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Breakthrough, the model
Participants
Prework
Select Topic
Pre-session
Change Concepts Priorities
P
A
P
A
P
A
D
S
D
S
D
S
Expert Group
LS 3
Follow up
LS 1
LS 2
Supports E-mail Extranet Visits Assessments
One Page Reports
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The Rapid Cycle Improvement Model (Nolan)First
step three questions
1.What are we trying to accomplish? (AIM)
2.How do we know that a change is an
improvement? (MEASUREMENT)
3. What changes will result in an improvement?
(INTERVENTIONS)
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When you want to built a ship, dont ask people
to get wood and nails, to plan and make
schedules, but teach them to long for the endless
sea (Antoine de Saint-Exupéry)
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Smart Goal setting

• Not better care
• Not less pain after operation, but
• 85 of patients first 24 hrs. after operation,do
  have a pain score lt 4 (VAS)we reach before nov.
  2005 (current 35 lt 4)

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The Rapid Cycle Improvement ModelNext step
three ore more times the cycle
again and again
plan
act
study
do
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Try, try and try

• Pitfalls
• Too academic approach (plan only)
• No feedback on results,
• Discuss with people thinking otherwise.Most
  times it helps you to understand (check)
• Try again, differently

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Planning, participants perspective

• Nov. 2003 mailing
• Jan. 2004 information sessions
• Febr. Intake
• April. Pre-session
• June 1st 2 day learning conference
• Nov. 2cd learning conference
• April 2005 3th learning conference

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It can be done reduce hospital stay
(Eindhoven)Goal 1-6-03 median stay is 14 days
Actions taken protocol criteria, registration,
no selection, planning capacity
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10 succesfactors (as far as we know)

• Evidence combined with best practices
• Learning with peers
• Selfmanagement
• Setting clear aims measures
• Exchange of results

• Monitoring, timepress., competition
• Teamwork
• Commitment of management
• Involvement of clinicians
• Time, money, people

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Further reading

• www.ihi.org and www.cbo.nl
• Paul Rasch, p.rasch_at_cbo.nl
• Stan Janssen, s.janssen_at_cbo.nl
• Dutch institute for healthcare improvement, CBO
• Lets Breakthrough together in Europe !

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Score1 non-starter2 activity but no change
3 modest improvement4 significant
improvement5 benchmark
Outcome assessment
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15
13
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ED 1, 2 ICU 1, 2 Medication safety, POWI, Flow
Score at LS 3 (after six months)