Donald S. Likosky, PhD
Objective: Define the “tricks”, and provide a template for making lasting improvement in your practice.
Developing, driving and instituting change in the health care setting is a challenging, yet not insurmountable task. The first task for any team is to develop and explicitly state an “Aim”. While seemingly trivial, this is likely one of the key, yet overlooked steps for most clinical teams. Subsequent to arriving at this Aim’s statement, teams should identify other individuals to join the group who have the requisite and needed skill set for the team to achieve its aim. Next, the team is likely ready for embarking on the most gratifying of steps, or series of steps, namely change cycles. These cycles are usually called PDSA cycles, which stand for Plan, Do, Study, Act.
Aim: What is it that your team hopes to accomplish
Plan: Keep the end in mind, answering the questions of Who will do it, Where will the change occur, When will the change occur, What will we collect
Do: Try the test of change out on the next 10 patients
Study: Study the results – did the change result in an improvement
Act: Standardize the care so that this change will be lasting. Prepare for the next cycle of change
Taking an example to make this more concrete:
Aim: Reduce the postoperative transfusion rate after cardiac surgery
Plan: The team will consist of cardiothoracic surgeons, nurses, residents, anesthesiologists, and perfusionists. Team members will not transfuse patients in the postoperative setting unless the hematocrit falls below 24% for patients over 75years, or below 21% for patients less than 75years. The change in transfusion trigger will occur in the CTICU. Primary metric would be the rate of postoperative transfusions of RBC units.
Do: Institute the transfusion trigger change over the next 10 CABG and/or VR patients.
Study: Report the results of the change in transfusion trigger to all team members.
Act: If no adverse sequelae were identified, and team members are comfortable, the unit should continue with this new transfusion trigger. Team members should also discuss whether a lower trigger would be feasible/advisable.
This talk will cover the tricks of instituting change, especially focused on the feedback of data to team members to drive the pace and sustainability of change. Concrete examples will be used to seat the theory into practice.
