Sustaining your gains

1. Sustaining your gains Kim Stelmacovich, M.H.Sc. Project Manager, CPSI

2. Learning Objectives Learners will be able to: • Evaluate interim project outcomes using SPC run chart rules • Distinguish between changes to care and improvements to care • Distinguish between short term improvement and sustained improvement • Help your team prepare for Action Period #2 using tools from the Sustainability Workbook

3. FFLS Participants Group One: Repeat Participants Group Two: New Participants

4. What is Sustainability? “ When new ways of working and improved outcomes become the norm… not only have the process and outcome changed but the thinking and attitudes behind them are fundamentally altered and the system surrounding them are transformed as well.” NHS Institute of Innovation and Improvement (2005)

5. The Value of Time Series Dataand SPC Run Chart Rules

6. Change or Improvement?

7. Change or Improvement?

8. Change or Improvement?

9. The Value of Time Series Data • Help you make decisions- Change or Improvement? • Help focus on what is important • Move you away from anecdotes and one person’s view • Build confidence • Will help you “sell” your ideas to colleagues • Set the stage for improvement/identify problem areas • Provide a common frame of reference for staff and leadership

10. SPC Run Chart Rules

11. Sustainability Workbook Tool

12. SPC Run Chart Rules Rule One: A Shift • Six or more consecutive points either all above or all below the median Rule Two: A Trend • Five or more consecutive points all going up or all going down Rule Three: An Astronomical Data Point • An obviously different value; anyone studying the chart would agree that it is unusual

13. A Shift Bed Turns on Target Unit

14. A Shift con’t

15. A Trend

16. An Astronomical Data Point

17. What Does Sustained Improvement Look Like?

18. Sustained Improvement ALOS on Target Unit Source: Saskatchewan Health Quality Council

19. Rule of Thumb Sustainability = 10 – 15 consecutive data points

20. FFLS Improvement Aim By March 2012, Participating teams will have: • Reviewed their Falls Prevention and Injury Reduction Improvement Plans for sustaining practice change; • Integrated sustainability strategies into their Falls Improvement Plans; • Collected and submitted data monthly on measures to SHN for Falls Intervention and used this data to monitor and facilitate sustained improvement; • Demonstrated a 20% improvement in their baseline measures and sustained for 3 consecutive months .

21. FFLS Improvement Aim cont …Demonstrated a 20% improvement in their baseline measures and sustained for 3 consecutive months ** Need 7-12 more data points to verify sustainability **

22. Beyond Measurement: Putting it all Together

23. The Sustainability Process

24. Improve Care • Improve Care

25. Are Improvements Sustained? • Are Improvements Sustained?

26. Hard Wire Gains • Hard Wire Gains • People • Processes • Organization • NHS Institute, 2011

27. How to Hardwire: Plan to Sustain! Quotes from the Flo Collaborative (2008): “ We will review the data collected on a monthly basis as we move forward with our spread to all units… If we are within our expected targets, we will begin to monitor every 2 months. In addition we are monitoring the qualitative feedback from staff who are involved in the process to ensure it is meeting their needs as well”.

28. How to Hardwire: Plan to Sustain! “ The [auditing] system allows for assigned staff and management to audit the accuracy and completeness of the boards on a weekly basis… All staff can see the results of these audits. The Unit Administrator reviews the results and celebrates successes and addresses gaps through staff meetings in a timely manner. The Unit Administrator also provides weekly updates to the Program Director and the committee of the Medical Advisory Council. The Program Director reinforces successes and opportunities for improvement on her walkabouts on the unit.”

29. How to Hardwire: Audit Your Practice!

30. How to Hardwire: Organizational Strategies • Communication Systems • Training/education/re-education • Facilities/Equipment • Job Descriptions • Policies and Procedures • Project Plans/Budgets/Timelines NHS Institute, 2011

31. How to Hardwire: Communication • Communication Systems • Training/education/re-education • Facilities/Equipment • Job Descriptions • Policies and Procedures • Project Plans/Budgets/Timelines NHS Institute, 2011

32. How to Hardwire: Communication • To prevent “slippage”, it’s important that we communicate the following to all individuals supporting improvements to care: • Why are we doing this? • What will it mean to me? • What will you do to support me? • What do you want from me in return? Source: Saskatchewan Health Quality Council

33. How to Hardwire: Job Descriptions • Communication Systems • Training/education/re-education • Facilities/Equipment • Job Descriptions • Policies and Procedures • Project Plans/Budgets/Timelines NHS Institute, 2011

34. How to Hardwire: Job Descriptions “ … The Unit Administrator reviews the results and celebrates successes and addresses gaps through staff meetings in a timely manner. The Unit Administrator also provides weekly updates to the Program Director and the committee of the Medical Advisory Council. The Program Directorreinforces successes and opportunities for improvement on her walkabouts on the unit.”

35. The Sustainability Process

36. "One worthwhile task carried to a successful conclusion is worth half-a-hundred half-finished tasks". Malcolm S. Forbes

37. Questions?