SUSTAINING YOUR GAINS

Kim Stelmacovich, M.H.Sc.

Project Manager, CPSI

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

Learning Objectives

Group One:Repeat

Participants

Group Two: New

Participants

FFLS Participants

“ 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)

What is Sustainability?

The Value of Time Series Dataand SPC Run Chart Rules

Change or Improvement?

8

3

0

1

2

3

4

5

6

7

8

Before Change (Week 4) After Change (Week 11)

Change or Improvement?

Change or Improvement?

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

SPC Run Chart Rules

Sustainability Workbook Tool

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

SPC Run Chart Rules

A Shift

Bed Turns on Target Unit

A Shift con’ta

vera

ge

# o

f d

ays

Average Acute LOS Med 5C Normal cases Discharges to LTCIndividuals

Set 1: UCL = 18.79, Mean = 8.92, LCL = -0.94 (not shown) (1 - 12) (mR = 2) (Lloyd Nelson option)

UCL

Mean

Median line = 7.78

2007-1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12

4

6

8

10

12

14

16

18

A Trend

An Astronomical Data Point

What Does Sustained Improvement Look Like?

Source: Saskatchewan Health Quality Council

ALOS on Target Unit

Sustained Improvement

Sustainability = 10 – 15 consecutive data points

Rule of Thumb

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 .

FFLS Improvement Aim

…Demonstrated a 20% improvement in their baseline measures and sustained for 3 consecutive months

FFLS Improvement Aim cont

** Need 7-12 more data points to

verify sustainability **

Beyond Measurement: Putting it all Together

The Sustainability Process

Improve Care

Are Improvements

Sustained?

Hard Wire Gains

Improve Care

Improve Care

Are Improvements Sustained?

Are Improvements

Sustained?

Hard Wire Gains

Hard Wire Gains

•People•Processes•Organization

NHS Institute, 2011

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”.

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.”

How to Hardwire: Audit Your Practice!

Outcome Audit

Infection Rate Hand Hygiene

Patient Satisfaction with meals Time required to distribute meals on unit

Falls Incidence Number of falls risk screening tools completed on admission to unit

Staff Satisfaction Number of interruptions to nurse during medication rounds

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

How to Hardwire: Communication

• Communication Systems• Training/education/re-education• Facilities/Equipment• Job Descriptions• Policies and Procedures• Project Plans/Budgets/Timelines

NHS Institute, 2011

Source: Saskatchewan Health Quality Council

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?

How to Hardwire: Communication

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

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 Director reinforces successes and opportunities for improvement on her walkabouts on the unit.”

The Sustainability Process

Improve Care

Are Improvements

Sustained?

Hard Wire Gains

"One worthwhile task carried to a successful conclusion is worth half-a-hundred

half-finished tasks".

Malcolm S. Forbes

Questions?