Post on 19-Jun-2015
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FRONT LINE OWNERSHIP TO IMPROVE SAFETY IN LONG
TERM CARE AND HOME CARE Michael Gardam Leah Gitterman
Link to slides for today’s call will be posted in the chat box Call will be taped Certificate of attendance
Before We Get Started
Interacting in WebEx: Today’s Tools Interagir dans Webex : outils à utiliser
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Lots of work has been done with hand hygiene in acute care but what about long term care and home care?
Available Tools
Staff hand hygiene Patient/client hand
hygiene Environmental
cleaning cleaning multiuse
equipment Vaccination Staff sick policies
Visitor sick policies Aseptic technique catheter avoidance antimicrobial
stewardship Ventilation Surveillance Isolation
Acute care ≠Long term/home care
ICU
multiple IV lines Acute physical stress Frequent recent
wounds/broken skin barriers Frequently ventilated Frequent infections, multiple
antibiotic exposures Surrounded by very sick
people Constantly touched by
healthcare workers
Long term/home care rarely any IV lines Chronic physical ailments May have broken skin
barriers Almost never ventilated Rarely infected, much less
frequent antibiotics Much less and different
physical contact
Hand Hygiene
Moment Acute, CCC, LTC Home Care Before contact with patient or their environment
beds, chairs, patients, clients, etc
Between home visits
Before performing aseptic procedure
as it says! Ditto
After contact with body fluids
as it says! Ditto
After contact with patient or their environment
beds, chairs, patients, clients, etc
Between home visits
Some examples from WHO guidance document
Same principles as acute care
culture eats strategy for breakfast
How we think the healthcare world works:
A B How most of it really works:
W B
BLACK BOX
Simple Complicated Complex
Types of Problems
Adapted from Brenda Zimmerman
Simple problems
One size fits all Search for standardization Problem solving Checklists Best Practices
Complex problems
Social Immune response One size never fits all Multiple actions (no “one big fix”) Paradoxes exist Social Proof matters Relationships matter
This won’t work
Minimum Specifications (simple rules)
An approach to complex problems: Positive Deviance
Increasing performance
Positive Deviance in action
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RONT
INE
WNERSHIP Zimmerman et. al. Healthcare Papers, 2013
Improving safety in a complex world
Prevention Resilience
How to get here?
From here?
Principles of This Work
Work with willing participants change spreads in infinite ways Make the invisible visible Include the unusual suspects Go slow to go fast Nothing about me without me Act your way into a new way of thinking Things may get worse before they get better
This work is about the HOW rather than the WHAT
Available Infection Control Tools
Staff hand hygiene Patient/client hand
hygiene Environmental cleaning cleaning multiuse
equipment Vaccination Staff sick policies
Visitor sick policies Aseptic technique catheter avoidance antimicrobial
stewardship Ventilation Surveillance Isolation
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The Hand Hygiene Hurdles
Fall Prevention Ideas…
different socks
fall monitors
Bedside report
talking to patients
stay with patients while in
the bathroom
“busy” aprons
change blood draw
time
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
Q1 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014
Falls
per
100
0 pa
tient
day
s
Total Falls Rate, ACTIVE BOZ Units
BOZ Total Rate Linear (BOZ Total Rate) Linear (Baseline)
Culture SHIFT
Taking time to think Practice-based evidence (social proof) Stories and relationships are trusted Culture change is simple Leaders need to step back Bottom up leadership from the front-line
“Insanity: doing the same things over and over again and expecting different results.”
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igniteconsulting.net leah.gitterman@uhn.ca
michael.gardam@uhn.ca @DrMichaelGardam
Instructions to download certificate
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