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October 2009 E-zine

Quality Tip: Confusion in the Nomenclature of Collaborative Improvement

Part One

If we are to organize around collaborative improvement, we must share a common language. Here are a few terms that are used to exchange information about improvements in care:

BUNDLES

As defined by Wiktionary:

  1. A group of objects held together, as by tying or wrapping.
  2. Something wrapped or tied up for carrying; a package.

According to IHI1, a bundle is a structured way of improving the processes of care and patient outcomes: a set of evidence-based practices – generally three to five – that, when performed collectively and reliably, have been demonstrated to improve patient outcomes. It is not simply a list of desirable changes.

In a bundle, the measures are all-or-none (Nolan & Berwick, 2006). All practices must be applied all the time; three out of four practices would not capture the spirit of the concept.2 For an example of a bundle, see Central Line Bundle. This is a set of five ideas to help prevent “catheter-related blood stream infections,” deadly bacterial infections that can be introduced through an IV.

CHECKLISTS

A checklist is a list of items to be noted, checked, remembered or done. In healthcare, it is used to prescribe the critical steps needed to execute procedures correctly. A checklist can contain many elements, and have many owners/responsible persons. The checklists helped with memory recall and also made explicit the minimum, expected steps in complex processes. The checklists established a higher standard of baseline performance.3

For a specific example, see reality check for checklists, commonly used in safety.

TOOLKITS

In TIPQC, we are assembling toolkits for improvement. Toolkits are all inclusive packages to help facilitate improved clinical outcomes, excellent patient care, and efficient resource allocation. They can be any collection of aids that support quality in health care. These could include bundles, checklists, scorecards, films, educational materials, fact sheets, sample letters, assessment tools, posters, references, and more.

None of these concepts substitute for culture change, and none will be successful without careful consideration of culture. TIPQC toolkits are assembled to facilitate system analysis and change implementation on the local level. TIPQC projects are run to facilitate collaborative sharing of lessons learned during implementation.

Footnotes
  1. IHI - What Is a Bundle? ^
  2. http://emjournalclub.googlepages.com/AllorNone.pdf ^
  3. Atul Gawande’s “The Checklist” from the Annals of Medicine ^

Happy Birthday To TIPQC

birthday

As we turn one year old, TIPQC has much to celebrate:

Fall Regional Meetings

The TIPQC team just completed visiting all 5 regions as we shared strategies to enhance the efficiency of our change teams by learning strategies to increase the effectiveness of our team meetings. Many teams are beginning to see level 4 improvements (according to the IHI’s Collaborative Assessment Tool) in thermal management measures! As we seek further improvement, teams are looking for missing participants & perspectives that are needed to successfully implement changes. Many important insights were shared about the benefits of involving obstetricians, anesthesiologists, and hospital administration in the temperature project—and the need to actively include families on the team was highlighted.

Parkridge East Temperature Team
Parkridge East Temperature Team: Debbie Poplin, Linda Gibson, Teresa Walker, Bridget Hayes & Sonya Collins

To download the power points go to: http://www.tipqc.org/meetings

Project Highlights

NICU–Admission Temperature Project

The 21 NICU hospital teams (One more hospital is joining the project, giving us 22 teams!) have had four phone huddles and three learning sessions. The next huddle will be on October 28 where we will share our “mid-term” results! We look forward to each hospital sharing. Bring a family member to join your team! Get your “family champion” and watch for the family member training on November 11, 2009.

Projects Being Piloted

OB—Reducing Elective Deliveries before 39 Weeks

The Davidson County pilot is beginning in October, data entry training is just around the corner. Preliminary results will follow shortly!

NICU—CLABSI Reduction

The CLABSI pilot is also beginning in October with data entry training after each pilot center completes the application and local IRB review.  Applications to join statewide spread of this project are expected this winter. Watch your TIPQC ezine for updates!

NICU—Human Milk Feeding Project

The Med, MCJCH at Vanderbilt, Parkridge East, and East Tennessee Children’s Hospital met on September 21 in Nashville to refine the tool kit and data structures. Another webinar will be held in October to finalize the tool kit with pilot startup shortly thereafter. They hope to have the project ready for state-wide enrollment at the Annual Meeting in March 2010.

Project(s) Being Developed

OB—Breastfeeding Awareness Campaign

This group of state leaders has met five times, and is developing a state-wide project.

For more information on all projects: http://www.tipqc.org/projects.

FAMILY & Patient Corner

Please invite your family member to join the Temperature team. Send all names and emails for the training on Wednesday, November 11 at 2 PM CST. Please also have your hospital family champion join the call. For additional resources for encouraging family centered care, please see the power point “The Value of Families” at http://www.tipqc.org/meetings.

Upcoming Conferences

Mark your calendar now for the Annual State TIPQC Meeting on March 3-4, 2010.

Please note that we have added a calendar feature to our website, where these dates and others can be found at http://www.tipqc.org/calendar.

Watch the web for updates throughout the month.

Sincerely,
Brenda Barker, MEd
Peter Grubb, MD
M. K. Key, PhD

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