Frontline Improvement: How to Do It, How to Lead it, How to Inform It
Date: July 7-10, 2010
Location: The Hyatt Regency Riverwalk Hotel in San Antonio, Texas
Frontline is the foundation of any productivity!
The 2010 Institute built capacity for healthcare providers to shape the future of quality and safety in healthcare through translating evidence into practice. Cutting edge approaches require knowing how to inform improvement with evidence, how to employ improvement strategies, and how to lead improvement at every level. Recognizing that gains are made through convergence of evidence, organizational climate, clinician vitality, and change, this conference explored best approaches to accelerate frontline improvement.
Participants learned ‘what works’ in building care processes and supporting care providers in the evolving environment of improvement.
The Summer Institute on EBP was a direct response to the national call for healthcare providers to bridge research and quality care by preparing our workforce to redesign health systems that are safe and effective.
Presentations
The Improvement Science Research Network: Launching the Future Today
Presentation by Dr. Kathleen R. Stevens, EdD, MS, RN, ANEF, FAAN
- Patient safety and quality improvement are clearly stated national priorities. However, there are still challenges to be overcome, as seen in the reports To Err is Human, and Crossing the Quality Chasm
- The Improvement Science Research Network, an NIH-funded “Grand Opportunities” (GO) grant, aims to accelerate the development and dissemination of inter-professional improvement science in a systems and micro-systems context across multiple hospital sites
- Progress to date in the ISRN
- The ISRN will share information and promote engagement in improvement science
The Promise of Improvement Science
Presentation by Dr. Carolyn M. Clancy, MD
- The Agency for Healthcare Research and Quality is the leading funder of research, including evidence-based applications, that aims to improve health care. There has been a recent increase in research focusing on prevention of health care infections
- AHRQ’s Effective Health Care Program
- The Keystone Project: AHRQ-funded project at Johns Hopkins University and eventually expanded to 1500 lives and saved $200 million
- MONAHRQ: My Own Network, Powered by AHRQ
- New Responsibilities for AHRQ under Health Reform: Delivery System Research
Improvement Science: Theories, Research Design, and Statistics
Presentation by Jack Needleman, PhD, FAAN
- Goals for Improvement Science
- Three cases on which to reflect
- Implementing effective Improvement Science research
- Models of knowing and learning
- Theories of organizations and organizational change
- Alternatives to pre-post with (or without) control
Using Quality Indicators in Improvement Science
Presentation by Marybeth Farquhar, PhD, MSN, RN
- Current healthcare issues of concern include quality, safety, effectiveness, consistency, and rising costs.
- The National Quality Forum, established in 1999, is a nonprofit, multi-stakeholder membership organization with the mission of improving the quality of American healthcare.
- Performance measurement is central to quality improvement.
Networking for Improvement Science: Lessons from Cochrane Collaboration and Joanna Briggs Institute
Presentation by Alan Pearson, RN, ONC, DipNEd, MSc, PhD, FRCNA, FCN, FAAG, FRCN
- The power of collaboration in improvement science lies not in controlling the behavior of groups and individuals, but rather in defining/creating a situation that facilitates collective identity and enables collective output.
- Communication among health services researchers worldwide should lessen the informational and methodological gap between developed and developing countries.
Frontline Engagement in Quality Improvement
Presentation by Kathleen R. Stevens, EdD, MS, RN, ANEF, FAAN and Robert Ferrer, MD, MPH
- Workarounds, a common response to small operational failures that inevitably occur on the front lines of nursing care, can increase the risk of adverse events and create care inefficiencies.
- Engaging frontline staff in initiatives that address small problems can lead to improvements in patient safety, care quality, nurse satisfaction, and staff efficiency.
- For example, one successful front-line initiative involved the use of index-sized pocket cards to report small problems related to equipment/supplies, staffing and communication that occur during nursing shifts; pocket cards created an awareness of the frequency and type of small problems encountered on a daily basis, providing an opportunity for frontline staff and administration to engage in quality improvement.
Small Troubles, Adaptive Responses (S.T.A.R.): Fostering a Quality Culture in Nursing
The How To’s of Engaging Frontline Staff Using a Pocket Card
Small Troubles, Adaptive Responses (S.T.A.R.): Fostering a Quality Culture in Nursing
Preventing Medication Errors
Presentation by Lily Thomas, PhD, RN and Patricia Donohue-Porter, PhD, RN
- Nurses face nearly seven work interruptions per hour; typical causes of interruptions include the need to obtain medications not on the medication cart, manage staff and patient requests, attend to patients’ call bells, and answer the telephone.
- Research shows that each interruption is associated with a 12-13 percent increase in procedural failures and clinical errors; interruptions that occur during medication administration increase the likelihood of error.
- Recommendations for practice improvements include reducing the need for interruptions by increasing environmental support; making the interruption visible so that personnel can view consequences; and sharing the cognitive burden of resuming the interrupted task among several people.
Team Performance for Patient Safety
Presentation by Heidi King, MS, FACHE and Mary L. Salisbury, RN, MSN
- TeamSTEPPS is an evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and other teamwork skills among healthcare professionals.
- Tools and strategies include (but are not limited to) communication via briefs, huddles, and debriefs; delegation and prioritization of tasks; use of the SBAR structured communication format; adoption of the situational awareness model and shared mental model; conflict resolution; and closed-loop communication.
- Focusing on team behaviors involves having a shared vision, delineating clear roles and responsibilities, ensuring strong team leadership, optimizing resources, engaging in a cycle of feedback, and managing and optimizing performance outcomes.