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Insert name of presentation on Master Slide
Dark ages to renaissance – rebirth of stroke care in Wales
18 April 2012
Presenters: Michelle Graham & Mike Davidge
Dark ages to renaissance
6,300 admissions in
2010/11
Age standardised
admission rate was 127 per
100,000 population
28 day mortality was 18.7%
over period 2008- 2011
Acute Stroke care
in Wales:
Dark ages to renaissance
Source: Google
The journey
Dark ages to renaissance
This is our journey, what is yours?
The Malvern Hills mark the border between
Worcestershire and Herefordshire
1st viewpoint:
Burning platform
Dark ages to renaissance
2006 Sentinel Audit
Dark ages to renaissance
2006
2007
2008
2009
2010
2011
2012
0
10
20
30
40
50
60
70
80
Overall Key Indicator Score 200612 indicators: 100 = maximum possible score
The 2007 letters
Dark ages to renaissance
2006
2007
2008
2009
2010
2011
2012
Dark ages to renaissance
Dr Tony Rudd, who
assessed services
in Wales, England
and Northern
Ireland two years
ago, said services
in Wales were
"scandalously bad".
Discussion
Dark ages to renaissance
What is your burning platform?
Do you have one and if not, can
you create one?
Introduce yourself to your
neighbour and tell them about
your project and your burning
platform. Then let them tell you
about theirs.
2nd viewpoint:
A good process
Dark ages to renaissance
© 2004 Institute for Healthcare Improvement
IHI Breakthrough Series(6 to 18 months time frame)
Select
Topic (develop
mission)
Planning
Group
Develop
Framework
& Changes
Participants (10-100 teams)
Prework
LS 1
P
S
A D
P
S
A D
LS 3LS 2
Supports
Email (listserv) Phone Conferences
Visits Assessments
Monthly Team Reports
Dissemination
Holding the
Gains
Publications
Congress
etc.
A D
P
SExpert
MeetingAP1 AP2 AP3*
LS – Learning Session
AP – Action Period
*AP3 –continue
reporting data as
needed to
document success
A good process
Dark ages to renaissance
2006
2007
2008
2009
2010
2011
2012
© 2004 Institute for Healthcare Improvement
IHI Breakthrough Series(6 to 18 months time frame)
Select
Topic (develop
mission)
Planning
Group
Develop
Framework
& Changes
Participants (10-100 teams)
Prework
LS 1
P
S
A D
P
S
A D
LS 3LS 2
Supports
Email (listserv) Phone Conferences
Visits Assessments
Monthly Team Reports
Dissemination
Holding the
Gains
Publications
Congress
etc.
A D
P
SExpert
MeetingAP1 AP2 AP3*
LS – Learning Session
AP – Action Period
*AP3 –continue
reporting data as
needed to
document success
The evidence
Dark ages to renaissance
2006
2007
2008
2009
2010
2011
2012
3rd viewpoint:
the right support
Dark ages to renaissance
Early lessons
Dark ages to renaissance
2006
2007
2008
2009
2010
2011
2012 Identify teams
PDSA’s - small and locally relevant (ownership)
Reinforce the improvement message
Learning sets and team lead meetings
Data, data, data
Most important: SUPPORT, SUPPORT,SUPPORT
Discussion
Dark ages to renaissance
What improvement process are
you following? Do you have the
right people to support the
project?
Continue the conversation with
your neighbour. Tell them about
the process and the people you
are using. Then let them tell you
about theirs.
4th viewpoint:
Effective data
Dark ages to renaissance
0
2
4
6
8
10
12
14
16
18
20
Jan 2009 Feb 2009 Mar 2009 Apr 2009 May 2009
Months
% compliance with First 3 Days bundle
Stroke patientsfrom Jan 2009 to May 2009
0
5
10
15
20
25
30
35
Days
Patients
Length of Stay
Stroke patientsfrom Jan 2009 to May 2009
No target
0
10
20
30
40
50
60
70
80
90
100
14
/01
/20
09
28
/01
/20
09
11
/02
/20
09
25
/02
/20
09
11
/03
/20
09
25
/03
/20
09
08
/04
/20
09
22
/04
/20
09
06
/05
/20
09
20
/05
/20
09
% p
ati
en
ts
Weeks
% patients who have a manual handling assessment in first 72 hours
Stroke patientsfrom Jan 2009 to May 2009
7 steps to measurement
Dark ages to renaissance
2006
2007
2008
2009
2010
2011
2012
1 Decide aim
2 Choose measures
3 Define measures
6 Review measures
5 Analyse & present
7 Repeat steps 4-6
4 Collect data
Data collection plan
Dark ages to renaissance
2006
2007
2008
2009
2010
2011
2012
For each data item:
Format
Who records this
At what point
Where is it stored
How reliably do we
collect
Issues to resolve
1 Decide aim
2 Choose measures
3 Define measures
6 Review measures
5 Analyse & present
7 Repeat steps 4-6
4 Collect data
The Excel data tool
Dark ages to renaissance
2006
2007
2008
2009
2010
2011
2012
1 Decide aim
2 Choose measures
3 Define measures
6 Review measures
5 Analyse & present
7 Repeat steps 4-6
4 Collect data
How to interpret
sessions
A common language
between clinicians
and managers
Using the data
Dark ages to renaissance
2006
2007
2008
2009
2010
2011
2012
1 Decide aim
2 Choose measures
3 Define measures
6 Review measures
5 Analyse & present
7 Repeat steps 4-6
4 Collect data
Discussion
Dark ages to renaissance
What is your approach to using
data? Do frontline teams want to
use it? Do they have the ability to
use it?
Continue the conversation with
your neighbour. Tell them about
how you support teams to use
their own data. Then let them tell
you about what they do.
The last lap
ALL OUR DUCKS ARE IN A ROW!
Continued support
“Intelligent” Targets
Serendipity
From Pilot to Performance
Dark ages to renaissance
2006
2007
2008
2009
2010
2011
2012
Journey’s end?
Dark ages to renaissance
2006
2007
2008
2009
2010
2011
2012
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
1. First Hours Bundle
Values Mean UCL LCL
1 2 3 4 5
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2. First Days Bundle
Values Mean UCL LCL
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
3. First 3 Days Bundle
Values Mean UCL LCL
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
4. First 7 Days Bundle
Values Mean UCL LCL
Summary
Dark ages to renaissance
2006
2007
2008
2009
2010
2011
2012
© 2004 Institute for Healthcare Improvement
IHI Breakthrough Series(6 to 18 months time frame)
Select
Topic (develop
mission)
Planning
Group
Develop
Framework
& Changes
Participants (10-100 teams)
Prework
LS 1
P
S
A D
P
S
A D
LS 3LS 2
Supports
Email (listserv) Phone Conferences
Visits Assessments
Monthly Team Reports
Dissemination
Holding the
Gains
Publications
Congress
etc.
A D
P
SExpert
MeetingAP1 AP2 AP3*
LS – Learning Session
AP – Action Period
*AP3 –continue
reporting data as
needed to
document success
0
2
4
6
8
10
12
14
16
18
20
Jan 2009 Feb 2009 Mar 2009 Apr 2009 May 2009
Months
% compliance with First 3 Days bundle
Stroke patientsfrom Jan 2009 to May 2009