programs to reduce mrsa infections.8.28.10.symposium on healthcare associated infections
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Presentation entitled: Symposium on Healthcare Associated Infections UT Southwestern Medical CenterDallas, Texas Saturday, August 28, 2010TRANSCRIPT
PROGRAMS TO REDUCE MRSA INFECTIONS
Symposium on Healthcare Associated Infections
UT Southwestern Medical Center
Dallas, Texas
Saturday, August 28, 2010
Brad Doebbeling, MD, MSc
Professor of Medicine, Epidemiology, & Biomedical Engineering, Indiana University School of Medicine
Senior Scientist, IU Center for Health Services Research, Indianapolis VA COE, Regenstrief Institute,
Indianapolis
Award Number: HHSA290200600013I, Task Order No. 4
Capacity for Impact High priority project to avert illness, suffering,
and death
Unique International Collaborative Learning community of practice (7 hospitals) Electronically and culturally interconnected International consortium
Effectiveness -- Reduced rates 60-85% Pittsburgh VA RWJ Sites Phase 1 Indy
“Collaboration” – What does it mean? “Coming together is a beginning. Keeping
together is progress. Working together is success.” – Henry Ford.
“Teamwork divides the task and multiplies the success.” - Unknown
“Teamwork is the ability to work together toward a common vision; the ability to direct individual accomplishment toward organizational objectives. It is the fuel that allows common people to attain uncommon results.” – Andrew Carnegie
Framework
Birth
Maturity
Creative Destruction
Renewal
For more information on the ecocyle go to http://www.plexusinstitute.org/edgeware/archive/think/main_aides9.html
Panarchy or Ecocycle Model of Change
Network or group level
A change in conversation A change in routine A change in resource commitment or influence
Institutional level
A change in culture A change in laws A change in resource distribution/availability
Organizational level
A change in strategiesA change in procedures A change in resource distribution/availability
Individual level
A change of heart A change of habits A change of ambition
“Getting To Maybe: How the World is Changed”Frances Westley, Brenda Zimmerman, Michael Patton, 1996, Random House Canada
Strategy
1. Fostering Change
2. Communication & Collaboratives
3. Local, Focused Implementation
4. Frontline Staff Engagement
5. Organizational Learning
6. Support, Resources & Accountability
7. Feedback & Reinforcement
Tranformative Change: 7 Effective Strategies
Qualitative Thematic Analysis, Healthcare Associated Infections (HAI) Initiative Assessment Program , AHRQ ACTION, HHSA290200600013I , 2010
Infection control a regional problem, requiring coordinated effort
Created citywide electronic notification system to prospectively track all known patients with MRSA
Track over 17,000 patients with a h/o MRSA infection or colonization across Indianapolis.
Delivered 2698 admission alerts on patients with a history of MRSA, 19% from another institution.
20 infection control providers (ICPs) spanning 16 hospitals
Kho, Lemmon, Dexter, Doebbeling AMIA 2008
Alerts
0
50
100
150
200
250
300
350
400
Alerts
An Operational Citywide Electronic Infection Control Network
Unique Strategy for Sustained Organizational Change Combining Lean and Positive Deviance
Lean from manufacturing○ Major QI Approach in Healthcare
Positive Deviance (PD)○ Experts within organization
Opportunity to learn & innovate- ○ Challenges and synergies
MRSA Phase Two What is Positive Deviance?
Technique to engage front line staff in owning & improving processes and sustaining change
Based on identification of practices of used by ‘positively deviant’ staff/departments
Critical for staff involvement/buy-in
Integrated Lean/PD approach
DevelopFuture State
Process
Process ControlStrategy
Baseline Current
Processes
Identify Operational
Barriers
Define the Problem
Discovery
Action
Creative Kickoffs Multiple
kickoff meetings to maximize participation
Very serious and very fun
Staff Engagement
Partnership Meetings Monthly meetings
with volunteers D&A’s Brainstorm solutions Discuss ideas
Resource Group (RG)Rolling boulders out of the way,
quickly responding to requests from CG
Core Group (CG)Convenes Cross-Unit meetings,
grant coordination
Other Units supported
with D & A Dialogue
ICU/MICU supported w/ Active Surveillance + D & A
Dialogue
Special Groupssupported
with D & A Dialogue
Solutions that MUST have Resource Group support
Vast majority of the action
happens on this end of the
iceberg
Fastresponse
One Is Too Many Partnership
One Is Too Many
Diverse Core & Resource Groups
ICP manager Director of Quality Nurse educators from two
intervention units Lean expert OD expert Nurse project coordinator
• VP Nursing • C00• ID MD• System office grant manager (ACT
project)• Two coaches from Plexus
Goal to ‘discover’ the issues and potential solutions, then take ‘action’ ASAP.
Informal meetings with front line staff to discuss current status of the process.
Incorporate as many front line staff as possible.
It is easier to “act your way into a new way of thinking” than to “think your way into a new way to acting”
Discovery and Action Dialogues
Discovery & Action Dialogues Seven facilitators trained
in the first month
Jumped in the deep water with 20 minutes of training
Transmission Disaster Response Teams Transmission Disaster
Response Teams D&ADs dialogues and
leader rounds linked with specific transmission cases to build collective mindfulness within and across units.
Sharing Results Community
briefing Making sense
of maps on the units
Clinical leaders
Admin leaders
Where am I? Is our network smarter than MRSA?
Social Network Mapping + Culture Survey Dreaming up
& researching questions
Social networking software
Creating a “family of measures”
Social Network Analysis Reveals communicative
patterns of complex groups and teams
Identifies the strength and frequency of connections
(e.g., with whom and how often do you communicate about reducing MRSA)
Describes current network in general & MRSA Bundle implementation in particular
Whom would you like to include or see involved in future MRSA prevention work?
Organizational Benefits of Change Staff developed skills and
processes
Documented, standardized processes
Isolation signs and chart stickers
Documented protocols for Active Surveillance & Prevention
Patient, family and staff education materials and methods
Partnering in Data Collection, Analysis,
Reporting Document impact in standardized language
Characterize efforts and strategies that work and disseminate nationally
Engagement of teams & coaches planning and conducting
Dissemination strategies- capturing stories, social networks, engagement, outcomes
Document ROI Impact
Reduction in MRSA isolates in an ICU
Literature Cost Savings (per Infection):
$ 6,916 - $35,000
Active Surveillance & Precautions Cost: Max $ 610 per infected patient (10%)
Methods challenging
Working with teams (& CFOs) to capture these data in meaningful way
Source: The Impact of Methicillin Resistance in Staphylococcus Aureus Bacteremia on Patient Outcomes: Mortality, Length of Stay, and Hospital Charges, Cosgrove, et al, February 2003
Vision for Data Services – R&D Needed
Increased use of Electronic Data
Less effort on SurveillanceMaximize return on surveillance efforts
More effort on active InterventionResults Oriented
Actionable Information &Value-added services
Standardized, Accurate Measurement
Optimized Outcomes- Clinical & Financial
Conclusions Start small, build on success. Organizational change & sustainability
strategies needed. Change initiatives need both top-down
support and bottom-up engagement. Collaboratives foster teamwork! Resource and data intensive. Enthusiasm builds from within
because redesign teams own it! Informatics tools helpful –needs
R&D
“Collaboration” – What does it mean? “Alone we can do so little; together we can
do so much.” – Helen Keller
“Strength is derived from unity. The range of our collective vision is far greater when individual insights become one.” – Andrew Carnegie
“Collaboration equals innovation.” - Michael Dell
Acknowledgements Funding from AHRQ
Testing Techniques to Radically Reduce Antibiotic Resistant
Bacteria HHSA2902006000131 (Completed) Healthcare Associated Infections (HAI) Initiative Assessment
Program HHSA290200600013I (Current) Implementing and Improving the Integration of Decision
Support into Outpatient Clinical
WorkflowHSA2902006000131(Current) Funding from AHRQ and CDC
Testing Spread and Implementation of Novel MRSA-Reducing
Practices HHSA290200600013 (Current) Thanks to our collaborators, partners, providers, patients!
Thank You!
Questions? Contact Brad Doebbeling [email protected] Indiana Transforming Healthcare
Research Initiative (INTHRI.org)
http://fightmrsa.blogspot.com