This course provides students with a set of tools and methodologies to plan and initiate a Problem Solving or Quality Improvement project. The first module presents methods for selecting, scoping and structuring a project before it is even initiated. It also introduces the project classifications of implementation and discovery. The second module describes the A3 problem solving methodology and the tool itself. Further in that same module, the student is shown tools to identify problems in flow, defects, and waste and to discover causes, brainstorm, and prioritize interventions. Module 3 shows a methodology within the implementation class. These methods are designed to overcome emotional and organizational barriers to translating evidence-based interventions into practice. The fourth and last module looks at one more way to approach improvement projects in the discovery class. These tools are specifically for new, out-of-the-box design thinking.
Identifying Local Barriers
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来自 Johns Hopkins University 的课程
Planning a Patient Safety or Quality Improvement Project (Patient Safety III)
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从本节课中
Translating Research Into Practice
This module explains the Translating Research into Practice (TRiP) model. It is a methodology to facilitate the adoption and use of evidence-based therapies. This model itself uses a collaborative knowledge translation model for wider sharing of knowledge into practice.
与讲师见面
Bob Hody
In this video we're going to continue to talk about
our practical strategy for translating evidence into practice,
and in particular, we're going to focus on the second step of
this model identifying local barriers to implementation.
We'll continue to use our story about preventing
central line-associated bloodstream infections to give context to this practical model.
To identify local barriers,
our human factor experts recommend three different strategies.
Number one, observe staff performing the interventions.
Number two, walk the process yourself to
identify the defects in each step of intervention implementation.
And then third, enlist all stakeholders to share concerns and
identify potential losses or gains associated with intervention implementation.
In other words, talk to the frontline staff.
Our frontline staff has a tremendous amount of wisdom about what happens within
organizations and why it is that
patients aren't receiving the evidence-based therapies they should.
Our role in leading these quality improvement efforts is to understand what
those local barriers of implementation are so we can better
design our intervention to address some of these local barriers.
In our story about preventing bloodstream infections,
we identified five evidence-based practices,
but one of the things that we've recognized was that providers
weren't consistently providing that evidence-based care.
And again, we knew that providers cared
deeply and they wanted to do the best that they can,
there must be a reason why they're not providing these evidence-based therapies.
We summarized the evidence,
we identified five key best practices from
the overall CDC guidelines
for the prevention of central line-associated bloodstream infections,
but yet still we recognize that patients weren't receiving
those evidence-based therapies so we had to dig a little bit deeper.
And when we talked to frontline staff,
when we walked the process,
and we participated in the care of patients,
particularly during this process of inserting central line,
we gained additional important insights.
One of the things that we recognized that it was the providers
had to go to eight different places to get
all the equipment and supplies that they needed to
comply with insertion practice guidelines.
Essentially, we were making it difficult for providers to do the right thing.
So, we needed to address these issues by
making it easier for providers to do the right thing,
and the way that we did that was we created a central line cart.
We brought all the equipment together in one place
essentially making it easier for providers to do the right thing.
In addition, we needed to create independent checks based upon our discussions with
providers and walking the process at the point of care and during times of stress.
Often times, providers forgot what they were supposed to be
doing so we created redundancy in the system.
We engaged our nursing staff by creating a central line checklist.
This checklist engaged our nursing colleagues to be actively involved
in the point of care and to help ensure that patients receive the therapies they should.
For the evidence-based practice about making sure that
we ask everyday whether those lines could come out,
we didn't have a great process.
Rather, we left it up to individual providers to determine whether
that care was necessary or that line was an imminent and important part of care.
But yet, that system is perfectly designed to achieve
the results that it does and we lacked redundancy in that system.
So to address this issue,
we brought together a group of stakeholders.
We tried to gain consensus about who exactly needed a central line.
That process was exceedingly difficult and not surprisingly,
we really couldn't gain consensus from providers about who needed
a central line because there are
no clear evidence-based guidelines to guide that decision.
Instead, what we decided to do was we added to
our checklist a question about whether that line could be removed every day.
This daily goals checklist is used on every patient every day in
the inpatient ICU setting and has been adapted to many other settings.
This is perhaps one of the most versatile and important tools that we
use within our intensive care unit to
ensure that patients receive the therapies they should.
For the prevention of central line-associated bloodstream infections,
we simply asked the question,
"Can any tubes, lines,
or drains be removed today?"
And we were committed to asking that question for every patient everyday.
If someone on the care team thought that that central line was an important part of care,
no problem at all.
We're not going to have a debate.
We're not going to have any arguments.
Instead, we're going to ask again the next day,
Is this line an important part of care?
And we're going to continue to ask that question every day until that line could be
removed to minimize the risk of that
patient developing a central line-associated bloodstream infection.
The next step of the TRIP Model is measuring performance
and making sure that we get that feedback to frontline staff.
The reality is that many of our frontline staff,
though they care deeply,
without a doubt they care deeply about patient care,
they're not aware of current performance.
Whether we don't do a good job of measuring how
often we provide the evidence-based therapies they should
or we don't do a great job of making sure that
our frontline staff really understand how well we're performing.
We'll be talking a lot more about measuring
performance and giving feedback to staff in another video.
