Management Practices for Sustainability - Module 1: Overview

Slide 1: Management Practices for Sustainability Module 1: Overview

Slide 2: Ensuring Safety in Ambulatory Surgery

• Surgery volume in ambulatory surgery centers (ASCs) has increased rapidly¹
• The complexity of procedures continues to increase²
• ASCs have an excellent safety record³
• Surgical safety checklists can reduce accidents and infections, and are now mandated for ASCs⁴
• However, “checklist fatigue” can blunt their effectiveness⁵

Slide 3: AHRQ Safety Program for Ambulatory Surgery

• Funded by Agency for Healthcare Research and Quality (AHRQ) as part of the National Action Plan to Prevent Healthcare-Associated Infections (HAI).
• 665 registered ASCs from 47 States and DC participated in 8 program cohorts.
• Program Goals
  • Reduce surgical infection and complication rates.
  • Improve safety culture through improved teamwork and communication.
• How can ASCs maintain effectiveness of safety practices over time?

Slide 4: Sustaining Change Is Not Easy!

• Many (if not most) change implementations fail to sustain.⁶
• Few studies provide practical guidance or specific methods for sustaining changes.
• Lean health care organizations offer insights and guidance for specific management practices to monitor and sustain process changes.⁷
• The Institute for Healthcare Improvement (IHI) team studied 10 leading health care organizations that are addressing this problem head-on.⁷

Slide 5: What Does it Take To Sustain Improvement?

• IHI developed a model for sustainability focused on daily work for frontline managers and staff
• Key elements
  • Daily huddles
  • Use of visual boards at the front line
  • Problem-solving and escalation protocols
  • Integration of aims and priorities

Image: Screen Shot of the Sustaining Improvement White Paper Cover.

Slide 6: A Model for Sustainability in ASCs

• Visual board tracks safety practices and outcomes; tracks current problems with status.
• Daily 5-minute standup huddle with unit lead and staff, standard agenda, and visual board as backdrop.
• Problems are categorized and escalated to higher management, if needed.
• Problem-solving skills applied at appropriate level.
• Integration with leaders ensures alignment across levels of organization with safety goals and “cascading” standard work.

Image: It shows the interactions between the different elements of the frontline management system.  The elements include standard safety work by staff, the daily safety huddle, visual management, escalation, observation of safety work, problem solving, and integration with leaders.  The image shows how these elements are mutually reenforcing to effect sustained improvement.

Slide 7: Testing the Model

• The IHI team carried out a pilot test of the model with two volunteer ambulatory surgical centers:
  • One large center with an established quality improvement (QI) department.
  • One small center with less QI experience.
  • After prework calls and activities, IHI team spent 2 intensive days at each center helping adapt the model to their systems.
• Uptake by unit managers and staff was enthusiastic
  • Huddles persisted after the team left.
  • Larger center extended huddle to all departments, including business office.
  • One center noted a 10 percentage-point increase in patient safety culture survey, attributed to the use of management practices.

Slide 8: Key Findings from IHI’s Pilot Testing

• Huddle agenda can be accomplished in 5 minutes: short and to the point.
• Teams were able to surface and track problems such as missing items in kits and problems with reaching patients for followup.
• Visual Management can focus on the “precious few” key metrics such as days since last near miss and surgical timeout compliance.
• Senior managers have a key role in monitoring and sustaining the huddles.
• Model success relies on skills of unit managers leading huddles; skill building is critical.

Slide 9: References

1. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory Surgery in the United States, 2006. Centers for Disease Control and Prevention, National Center for Health Statistics. Accessed July 7, 2016.
2. Wallace CL, Quattrone MS. Risk management for ambulatory surgery centers. J Ambul Care Manage. 2007 Apr; 30(2) 114-15. PMID: 17495678.
3. Kent C, Metzner J, Bollag L. An analysis of risk factors and adverse events in ambulatory surgery. Ambulatory Anesthesia. 2014;2014(1):3-10. DOI: https://dx.doi.org/10.2147/AA.S53280. 
4. Aston G. Awareness of patient safety grows with increased outpatient surgeries. Hospitals & Health Networks. 9 Sep 2014. Accessed July 7, 2016.
5. Federico F. Avoiding checklist fatigue: Interview with Dr. Thomas Varghese. Institute for Healthcare Improvement blog. Accessed July 7, 2016.
6. Snee RD. The hard part: Holding improvement gains. Quality Progress. Sep 2006. Accessed July 8, 2016.
7. Scoville R, Little K, Rakover J. Sustaining Improvement. Institute for Healthcare Improvement. Accessed July 8, 2016.