Transcript Presentation Title - Florida Hospital Association

You Don’t Have to Write Like Hemingway:
How to Communicate Your Quality Journey
Denise Remus, PhD, RN
Cynosure Health
What is Quality Writing?
What is Quality Writing?
Clear
Compelling
Concise
Scott White, The Five C’s of Quality Writing: http://www.articlesbase.com/non-fictionarticles/the-five-cs-of-quality-writing-73769.html
Consistent
Correct
What Does HRET and FHA HEN Expect?
• Completion of Progress Report - Tool to communicate
plans, progress and results (short-term, long-term) of
your quality improvement project to stakeholders
• Update monthly
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Applying the Five C’s to Progress Reports
Clear
• Understandable
• Do not use jargon
• Be careful of abbreviations
• When read by someone who is not
familiar with the project will they
“get it”?
• Does your Aim Statement include
What (metric), How Good
(expected improvement) and By
When?
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Applying the Five C’s to Progress Reports
Concise
• Be precise – do not overwrite
• Remove extra words, for
example instances of “that”
• Full sentences are not needed
• Does your text fit within the
space without reducing font
size?
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Applying the Five C’s to Progress Reports
Compelling
• Why is it important?
• Use motivating language
• Reflect a sense of urgency
• Consider your elevator
speech
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Applying the Five C’s to Progress Reports
Consistent
• Tests of change
• Are you updating tests of
change?
• If abandoning a test, is
there a lesson learned?
• Linkage to next steps?
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Applying the Five C’s to Progress Reports
Correct
• All content accurate and
current
• Self-assessment score
reflects current status
• Run charts
• Outcome metric
• Process metric
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A 6th “C” for Progress Reports
Complete
• All information provided
• Date
• Hospital Name
• State
• Self-Assessment Score
• Team Member list
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Let’s Review . . .
Clear
Compelling
Concise
Consistent
Correct
Complete
Where Can we Improve?
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Self-Assessment Score
Where are you?
1) Forming a Team to
Planning
2) Activity with No or
Little Changes
3) Modest Improvement
to Improvement
4) Significant to
Sustainable
Improvement
5) Outstanding
Sustainable Results
Tests of Change
Test—Implement—Spread
S = Spread to
I = Implement
T = Test small
scale, 1 patient, 1
nurse, etc.
only after
successful testing
under a variety of
conditions
other units once
after successful
implementation /
sustained
performance
Baseline Data
Measures
Outcome
Process
• Examples:
• Examples:
– Turn every 2 hours
– HAPU
– Antibiotic timing
– SSI
– Teach back
– READMISSION
• Want rates to go down! • Want rates to go up!
Run Charts and Control Charts
• Tools to determine if improvement strategies have
had the desired effect
• Intended to understand variation over time and
whether controlled or special cause
• Consider:
– How much data do you have?
– Skill set and tools available to display data
Creating Charts – Line Graph
• If less than 10 data points, make a simple line graph
• Can use CDS – monthly data points
• Current capability is only print image but future updates will
allow download of graph
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Creating Charts – Run Charts
• If 10 to 12 data points, can convert to a run chart
–
–
–
–
–
Plot time along x-axis
Plot variable along y-axis (watch scale)
Label X and Y axes
Calculate & show median
Add other info; annotate changes
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Annotated Run Charts
• Annotate test of change and other process
changes that may effect data
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Creating Charts – Control Charts
• > 12 data points (ideally 15 or more)
• More sensitive than run charts
• Adds control limits to determine if process is stable
(common cause variation) or not stable (special cause
variation)
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Increasing Data Points
• If possible, collect additional data to
increase the number of data points available
to monitor the potential impact of change
• 15 - 20 patients
• 15 - 20 days
• 15 - 20 weeks
• 15 - 20 months
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Progress Report Examples
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Project Title: Surgical Site Infections
Date:
Aim Statement
Increase compliance with appropriate
antibiotic timing and weight dosing
administration of the appropriate antibiotic
prior to surgery by10% by December 31,
2012 and 20% by December 31, 2013.
Because surgical site infections are
:associated with significant patient morbidity
Project Champion: XXXXX
Senior Leader Sponsor: XXXXX
Self Assessment Score (1-5) = _____
Lessons Learned
Run Charts
Even though we have a low SSI
rate we know that we have
improvement in this area due to
chart abstraction and compliance
rates with both dosing selection
and timing
and mortality this is an important project to
monitor and improve. Surgical site
infections are the 3rd most reported health
care associated infection.
Changes being Tested,
Implemented or Spread
 Educate physicians to the
appropriate antibiotic selection and
weight dosing national guidelines.
Educate physicians and nurses
on appropriate antibiotic selection,
dosing, timing , and infusion
duration to decrease incidence of
surgical site infections.
Recommendations
and Next Steps
•Educate surgeons and anesthesiologists on the
appropriate use of prophylactic antibiotic for
surgical procedures based on national guidelines.
•Educate and involve all surgical nurses on the
appropriate use of prophylactic antibiotic for
surgical procedures based on national guidelines.
•Develop an audit tool that will identify noncompliance by selection, dosing, timing , infusion
duration, and practitioner Display data to improve
compliance, patient safety and quality of care.
Team Members
XXXXXX
XXXXXX
XXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
© 2012 Institute for Healthcare Improvement
Reducing Elective Delivery <39 Wks Gestation
XXXXX and XXXXXX
XXXXXX Hospital XX State
Date: June 12, 2012
Self Assessment Score (1-5) = _____
Aim Statement
Run Charts
Aim: Provide reliable & safe perinatal
care processes to effectively reduce
elective deliveries prior to 39 weeks
gestation to <3% by December 2012.
Elective Deliveries <39 Weeks
Gestation
40.00%
30.00%
Why is this project important?:
Elective delivery prior to 39 weeks
gestation, in the absence of a
medical condition is frequently
associated with higher level of
nursery care for the newborn.
Changes being Tested,
Implemented or Spread
•Implement medical
reason for delivery < 39
weeks form that must be
completed prior to
scheduling an induction or
cesarean section. (T)
Lessons Learned
•Gradual improvement
over time but need for a
hard stop policy to reach
goal
Recommendations
and Next Steps
20.00%
10.00%
0.00%
CY10 CY10 CY10 CY11 CY11 CY11 CY 11
q2
q3
q4
q1
q2
q3
q4
• We will work with
Executive Champion to
obtain support for a hard
stop policy
Next Steps:
Shoulder Dystocia
RATE
(Balance Measure)
•Create hard stop policy
for elective delivery <39
weeks
Team Members
5.00%
0.00%
CY2012 01 CY2012 02 CY2012 03
JAN
FEB
MAR
XXXXX, Executive Champion
XXXXX, Physician Champion
XXXXX, Project Leader, Data
XXXXX, Quality Leader
XXXXX, Perinatal CNS
XXXXX, L&D Manager
XXXXX, L&D Director
© 2012 Institute for Healthcare Improvement
Now is the Time to Share Your
Story…
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