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Small Country Big Change

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.

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Small Country Big Change

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  1. Small Country Big Change Date: Created by: Suzanne Proudfoot

  2. 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

  3. Acknowledgements Leadership 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

  4. Context Population 4.4 million Auckland population 1.4 million 20 District Health Boards 25 Intensive Care Units - Geographically widely dispersed - Vary in size and function

  5. Results Better 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

  6. 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

  7. P A D S Collaborative Structure Ko Awatea and DHB Participants Select Topic Prework P Identify Change Concepts Spread D A S Holding the Gains Faculty / Expert Meeting LS 1 Nov 2011 LS 2 June 2012 LS 3 March 2013 Halfway Sept 2011 March 2013

  8. Context Population 4.4 million Auckland population 1.4 million 20 District Health Boards 25 Intensive Care Units

  9. 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

  10. 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!

  11. Isomorphic pressures Institutional level, specialty level, Regional and National Level • Normative • Mimetic • Coercive

  12. Develops Organic networks • Effective, horizontal pathways • Supported by the Model • Connected by the Model • Forms a community

  13. Reframes a Social Problem • Owned by ICU • Personalised • Prevents harm to innocent people

  14. 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)

  15. 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?

  16. The underpinning philosophy of the collaborative • Uses multiple interventions to Change practice • Uses data as a disciplinary force • It is more than equipment and procedures • Isomorphic pressures • Develops ‘organic’ networks • Reframes a social problem

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