Rules for Healthcare Transformation Frameworks and Tools v1
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This document outlines frameworks and tools for healthcare transformation. It discusses three frameworks: 1) system thinking which focuses on improving systems rather than individuals, 2) applying concepts from high reliability organizations (HROs) like aviation to achieve extremely low error rates, and 3) system redesign which restructures care delivery processes and outcomes. The document also introduces tools for transformation including standardized protocols, monitoring, and latent error detection. The overall message is that new rules and a multi-framework approach are needed to transform healthcare and improve outcomes.
Rules for Healthcare Transformation Frameworks and Tools v1
- 1. Rules for Healthcare Transformation: Frameworks and Tools Dr. Imad Salah Ahmed Hassan MD (UK) FACP FRCPI MemAcadMedEd (UK) MSc (UK) MBBS Consultant Physician & Pulmonologist, Head of Section, Department of Medical Protocol Chairman, Knowledge Translation Committee, Department of Medicine (2008-2016) KAMC, Riyadh, Kingdom of Saudi Arabia
- 2. Aims of This Presentation Reveal to the Audience the “Reality” and Shortcomings of todays Healthcare Systems. Define Transformation The New Rules in Healthcare The THREE Frameworks for Transformation Introduce some of the “Resources & Tools for Transformation”
- 4. Time cover story - May 1, 2006 Q: What Scares Doctors? A: Being the Patient
- 5. How dangerous is health care? Less than one death per 100 000 encounters Nuclear power European railroads Scheduled airlines Amusement Park (USA) One death in less than 100 000 but more than 1000 encounters Driving Chemical manufacturing More than one death per 1000 encounters Bungee jumping Mountain climbing Health care
- 7. EMRO AFRO report 2011 Source: Patient safety in developing and transitional countries, New insights from Africa and the Eastern Mediteranean , WHO, 2011
- 8. Quality: The primary aim is patient safety 1 in 10 patients harmed in hospital care 14 out of every 100 patients is affected by HAI 2% patients subject to surgical complications for the 234 million surgical operations performed every year 20-40% health spending wasted due to poor quality of care and safety failures Sources: WHO global report on evidence on patient safety 2008, WHO 10 facts for patient safety accessed 2015
- 9. What are your AIM? Change or Transformation Transformation
- 11. CHANGE VS. TRANSFORMATION Change fixes the past. Transformation creates the future
- 12. CHANGE VS. TRANSFORMATION Change fixes the past. Transformation creates the future IN ACTION In CHANGE mode, the desire to improve the past directs what we do. The past sets boundaries and constrains possibilities. CHANGE makes the system better. In TRANSFORMATION mode, the future directs your actions and only the limits of imagination and courage constrain possibilities. TRANSFORMATION causes new systems to emerge.
- 13. The Rules for a New Era in Healthcare: 24 RULES
- 14. Structure: Old and New Healthcare Models Old Organization by Specialty Service by silos of Specialists New Organization by disease and its associated co- morbidities and health needs Integrated Service by Multi-Disciplinary Teams (Team-based Care)
- 15. Structure: Old and New Healthcare Models Old Duplication of Service Single Consultant led clinical teams New Centers of Excellence (in the right geographic area). Two-Consultant led teams
- 16. Structure: Old and New Healthcare Models Old The administration leads change The system reacts to needs New All parties-administration, employees, patients-are engaged, encouraged and empowered to become change agents. Needs are anticipated
- 17. Process: Old and New Healthcare Models Old Decision-making is left to the Individual (professional autonomy- based on experience and training) Care failures are managed through the health force New Protocolized/Standardized Care: Using Evidence- based decision making tools Care failures are managed through the System (System Thinking)
- 18. Process: Old and New Healthcare Models Old Care is based primarily on patient visits Clinical input is dictated by the professionals e.g. once daily ward round etc. New Care is continuous (Hospitals without walls/Community or Home Healthcare Services) Clinical input is dictated by the patient needs: multiple e.g. 2- daily ward rounds
- 19. Process: Old and New Healthcare Models Old Consistent/Continuous Consultant-led/expert input or presence is not the rule Mixed in-patient/out- patient Commitments New Consultant-led services with 24 hour Consultant presence or accessibility Focused in- patient/out-patient Teams
- 20. Process: Old and New Healthcare Models Old 5-day working week with poor week-end cover Care-inputs/ Management Decisions are professionally controlled New Continuous high- quality In-patient Services (Hospitalist Services) Patient dictates the care-inputs (Patient- centered Care)
- 21. Process: Old and New Healthcare Models Old Patient Information is a record Do no harm is an individual responsibility New Patient information is shared (IT) Safety is a system property (Robust safety promoting/ harm preventing interventions)
- 22. Process: Old and New Healthcare Models Old Care focuses on the acute illness Primarily Paper-based New Care is holistic covering both disease and patient needs: therapeutic and preventative interventions Primarily Electronic
- 23. Outcome: Old and New Healthcare Models Old Not always measured Measures the process New Always measured Measures the outcome
- 24. Outcome: Old and New Healthcare Models Old Focus on professional outcomes Focus on Patients’ satisfaction New Focus on Patient- oriented outcomes (patient values) Focus on both Staff and Patients’ satisfaction
- 25. Outcome: Old and New Healthcare Models Old Secrecy Cost reduction is a priority New Transparency Waste reduction is a priority
- 26. Basic Frameworks in HCT “a set or series of interconnected or interdependent parts or entities that act together in a common purpose or produce results impossible by action of one alone”.
- 27. Health Care Model: Donabedian Model Process Structure Outcome Six Ds: Death Disease Disability Discomfort Dissatisfaction Destitution (cost) Care ProcessAnatomy •Pathways •Protocols •Physician orders •Nursing Care •Housekeeping •Transport •Staff •Departments •Equipment •Supplies •Environment
- 28. To improve the system, change the system… “Every system is perfectly designed to achieve exactly the results it gets” President & CEO, Institute for Healthcare Improvement Phillips, D F. New look reflects changing style of patient safety enhancement, Journal of the American Medical Association, 1999, 281 (3): 217–219. Framework No.: 1: SYSTEM THINKING
- 30. How dangerous is health care? Less than one death per 100 000 encounters Nuclear power European railroads Scheduled airlines Amusement Park (USA) One death in less than 100 000 but more than 1000 encounters Driving Chemical manufacturing More than one death per 1000 encounters Bungee jumping Mountain climbing Health care
- 31. What is an HRO? HROs are organizations with systems in place that are exceptionally consistent in accomplishing their goals and avoiding potentially catastrophic errors. http://www.ahrq.gov/qual/hroadvice
- 33. • The likelihood of being injured seriously enough to require overnight hospitalization for treatment is 1 in 24 million. • The chance of being fatally injured is 1 in 750 million. (Based on an average of five rides per guest). • Studies show 10-1 failure rate is the current level of performance in most health care organizations, while it is 10-6 in aviation passenger safety. Safety is the Amusement Park Industry's Number 1 Priority
- 34. Safety & Reliability “Reliability” = Number of actions that achieve the intended result ÷ Total number of actions taken “Unreliability” = 1 minus “Reliability” It is convenient to use “Unreliability” as an index, expressed as an order of magnitude (e.g. 10-2 means that 1 time in 100, the action fails to achieve its intended result)
- 35. Three-level Design of Safe and Reliable Systems of Care: Prevent-Identify-Mitigate 10-1 Error Rate: Design the system to prevent failure (A breakdown in operation or function): Standardize/Protocolize Care 10-2 Error Rate: Design procedures to make failures visible when they do occur so that they may be intercepted before causing harm: Monitor Care/Redundancy in Care 10-3 Error Rate: Design procedures for mitigating the harm caused by failures when they are not detected and intercepted: Latent-Error Detection & Correction
- 37. What is System Redesign? System redesign is a new concept in healthcare reform. It entails specific redesign in care delivery both in its structure and in its process in order to re-align a faulty system and improve outcomes. The whole structure or process of care is redesigned to an “ideal process” based on evidence.
- 38. Structure• New Division e.g. KT Division • New Team e.g. Trauma, Burn, Breast Cancer, Diabetic Septic Foot, Asthma etc. • Revised Job-description e.g. Monitors Process• Redesign Training Programs: Competency Based • Computerized Decision Support Systems • Electronic Orders/Pathways/Protocols and Reminders e.g. Enhanced Recovery after Surgery Protocol • SBAR • Checklists Outcome • Patient Satisfaction Surveys • Staff Satisfaction Surveys
- 39. Ideas
- 44. Summary To attain HCT New Rules for Healthcare Delivery must be brought into our current practice Outcome Process Structure
- 45. Summary HCT is attainable through the integration of System Thinking, System Redesign and the Application of the Concepts distinctive of High Reliability Organizations: Standardization / Protocolization Timely- Monitoring Latent- Error Detection High-Reliability Organizations System Redesign System Thinking HROs
- 47. Links: My References 1. http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/20 01/Crossing-the-Quality- Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf 2. https://innovations.ahrq.gov/ 3. https://hbr.org/2013/10/the-strategy-that-will-fix-health-care 4. https://www.aci.health.nsw.gov.au/make-it-happen/centre-for-healthcare- redesign/surgery-redesign-training-program 5. https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0016/320272/E mergency_Surgery_Redesign_Toolkit_for_Implementation.pdf 6. https://www.kingsfund.org.uk/publications/reconfiguration-clinical- services/summary/acute-medical 7. http://www.ihi.org/resources/Pages/IHIWhitePapers/EngagingPhysicians WhitePaper.aspx 8. https://www.ncbi.nlm.nih.gov/books/NBK43618/ Patient Safety in 2025