Tools for Sustainability: Premortem and Scorecard: Slide Presentation
AHRQ Safety Program for Mechanically Ventilated Patients
Slide 1: AHRQ Safety Program for Mechanically Ventilated Patients
Tools for Sustainability: Premortem and Scorecard
Slide 2: Learning Objectives
After this session, you will be able to–
- Define sustainment and spread.
- Plan key actions for sustainment.
- Prioritize needs for successful sustainment.
- Identify risks to sustaining your efforts with Premortem Tool.
- Design a scorecard with adaptive and technical indicators to measure performance as part of your sustainability efforts.
Slide 3: Sustainment Is...
- What you do to continue to build on your successes.
- How your efforts to change culture and improve safety persist.
- When you apply the process for improving care for mechanically ventilated patients to new challenges.
Slide 4: Adaptive or Technical?
Adaptive
CUSP
Technical
Ventilator-Associated Events (VAE) Prevention
Image: Two hands shaking flanked by Adaptive CUSP and Technical VAE prevention.
Slide 5: Why Worry About Sustainment?
- Avoid recidivism, or backsliding.
- Respect probability of failure over time.
- Recognize risks to sustaining progress:
- Staff turnover.
- Overlying priorities.
- Organizational changes.
Slide 6: Definition of Spread1
"Spreading takes the process from the narrow, segmented population(s) or group(s) and broadens it to include all the population(s) or group(s) that will use the process."
"Formalizing a process provides a reference to others: those new to the organization and those in the organization needing clarity about the specifics of the process."
Image: A team of providers is shown steadily growing to include a range of providers, patients, and family members.
1. North Carolina Center for Hospital Quality and Patient Safety. North Carolina Prevent Catheter-Associated Urinary Tract Infections Collaborative. 2010.
Slide 7: What Do Effective Teams Look Like?
Effective teams–
- Hold regular meetings.
- Include active provider champions who partner with others.
- Have executive leadership support.
- Believe that progress is possible.
- Continuously invent ways to create engagement.
- Maintain frequent communication.
Slide 8: What Sustainment Strategies Work?
- Stick to formal processes:
- Test changes on small scale first.
- Measure and make data-driven decisions.
- Maintain access to continuous feedback:
- Require current data to validate progress.
Slide 9: What Sustainment Strategies Work?
- Secure time and resources:
- Formalize job responsibilities for patient safety improvement work.
- Dedicate financial resources and personnel, including protected time.
- Make data support available.
- Take care of your team:
- Plan for team growth and turnover.
- Offer highly engaged team members professional development opportunities.
Slide 10: We Are Ready To Sustain: Now What?
- Readminister Staff Safety Assessment at least every 12–18 months.
- Learn from defects at least once each quarter.
- Share results and stories with frontline staff.
- Orient all new staff to the Science of Safety.
- Continue updating staff on patient safety activities.
- Continue collaborative activities.
- Revisit the "right team mix" and augment needs as team and projects evolve.
Slide 11: Sustainability and the Premortem
Sustainability and the Premortem
Slide 12: Problem Statement
- Projects fail for many reasons.
- This safety project is no exception.
- Recognize potential barriers and complications to aid project implementation.
- Anticipate problems in order to help teams sustain improvements.
Slide 13: Preparing To Lead2
- In a postmortem, an autopsy is performed to learn why a patient died.
- While it may be helpful, it does not help the central figure in the medical drama—the patient.
Image: Illustration of a foot with a toe tag.
2. Klein G. Performing a Project Premortem. Harvard Business Review Sept 2007. https://hbr.org/2007/09/performing-a-project-premortem. Accessed Aug 22, 2015.
Slide 14: Preparing To Lead2
- Identify potential barriers and vulnerabilities.
- Build intuition and sensitivity to future problems.
- Encourage team members to speak up during planning stages.
- Prepare proactive approach to address concerns.
2. Klein G. Performing a Project Premortem. Harvard Business Review Sept 2007. https://hbr.org/2007/09/performing-a-project-premortem. Accessed Aug 22, 2015.
Slide 15: Preparing To Lead2
The Premortem Exercise helps you–
- Imagine the project has failed.
- Brainstorm contributing factors that led to this failure.
- Develop plans to mitigate these barriers to sustaining success.
2. Klein G. Performing a Project Premortem. Harvard Business Review Sept 2007. https://hbr.org/2007/09/performing-a-project-premortem. Accessed Aug 22, 2015.
Slide 16: Premortem Exercise
Step 1:
- Imagine that you are 2 years into the future, and despite all of the team’s efforts, the mechanical ventilation safety program has failed—catastrophically.
- Many things have gone completely wrong.
- Ask your team:
- What does the worst-case scenario look like for you and your patients?
Slide 17: Premortem Exercise
Step 2:
- Generate the reasons for this failure to sustain improvements.
- Spend 10 minutes recording the reasons that could cause this failure.
- Ask your team:
- What could have caused our project to fail?
Slide 18: Premortem Exercise
Step 3:
- Identify the level of concern for each reason.
- Use a scale of 1 to 5.
Image: A line scale displays the level of concern. The scale runs from lowest to moderate to highest level of concern. The scale is numbered from 1 to 5.
Slide 19: Premortem Exercise
Step 4:
- Prioritize your list of potential reasons for failure.
- Address the top two or three concerns.
- Ask your team:
- What specific actions can you take to avoid or manage these concerns?
Slide 20: CUSP Premortem Summary
- Two years out, what does the worst-case scenario look like?
- What could have caused your project to fail?
- What specific actions can you take to avoid or manage these issues?
Slide 21: Discussion
- Set goals for sustainment—what do you want to maintain?
- Target the potential risks for failure to achieve sustainment goals.
- Remember that sustainability is a process, not a project.
Slide 22: Discussion Questions
- What aspects of the project are you planning on sustaining and how?
- What challenges do you predict for sustaining progress?
- How will you address these challenges?
Slide 23: Designing a Scorecard for Sustainability
Designing a Scorecard for Sustainability
Slide 24: Action Plan
Followup from Learning From Defects:
- Review Learning From Defects tool with your team.
- Identify a defect in your intensive care units.
- Select and work on one defect per quarter.
- Consider participating in morbidity and mortality conferences.
- Post the stories of reduced risks (include data!).
- Celebrate your success.
Slide 25: Checking Your Progress
- Create collective awareness of what’s working and what’s not working.
- Celebrate what makes the team strong and effective.
- Tackle remaining barriers proactively.
Slide 26: Scorecard Parameters
Take stock of team variables every 6 months.
Variables:
- Frequency.
- Attendance.
- Training.
- Defects.
- Stability.
- Safety culture.
Questions (The second column lists questions for each variable):
- Does your team meet enough to achieve goals?
- Does your team have sufficient participation to facilitate group goals?
- Is the entire staff trained in the science of safety?
- Are you learning from defects? Are any of your improvement plans driven by data?
- Has turnover in key positions affected your progress?
- How many safety climate responses are positive? Does the staff know you are hearing them?
Slide 27: Sustainability Scorecard (Adaptive)
Image: A table depicting an example of a sustainability scorecard for adaptive interventions.
Slide 28: Sustainability Scorecard (Technical)
Image: A table depicting an example of a sustainability scorecard for technical interventions.
Slide 29: Sustainability Scorecard (Technical)
Image: A table depicting an example of a sustainability scorecard for technical interventions.
Slide 30: Keeping an Eye on Culture
- Revisit your pre-engagement safety culture assessment and action plan.
- Share results and progress with your frontline staff.
- Validate the hard work of your frontline staff.
Slide 31: Nurture Your Safety Culture
It’s the soil, not the seed.
—Louis Pasteur
Slide 32: Questions
Image: Six colored hanging tags with question marks on them.
Slide 33: References
1. North Carolina Center for Hospital Quality and Patient Safety. North Carolina Prevent Catheter-Associated Urinary Tract Infections Collaborative. 2010.
2. Klein G. Performing a Project Premortem. Harvard Business Review Sept 2007. https://hbr.org/2007/09/performing-a-project-premortem. Accessed Aug 22, 2015.
