This course provides students with a set of tools and methodologies to plan and initiate a Problem Solving or Quality Improvement project. The first module presents methods for selecting, scoping and structuring a project before it is even initiated. It also introduces the project classifications of implementation and discovery. The second module describes the A3 problem solving methodology and the tool itself. Further in that same module, the student is shown tools to identify problems in flow, defects, and waste and to discover causes, brainstorm, and prioritize interventions. Module 3 shows a methodology within the implementation class. These methods are designed to overcome emotional and organizational barriers to translating evidence-based interventions into practice. The fourth and last module looks at one more way to approach improvement projects in the discovery class. These tools are specifically for new, out-of-the-box design thinking.
The Four E's
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From the course by Johns Hopkins University
Planning a Patient Safety or Quality Improvement Project (Patient Safety III)
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From the lesson
Translating Research Into Practice
This module explains the Translating Research into Practice (TRiP) model. It is a methodology to facilitate the adoption and use of evidence-based therapies. This model itself uses a collaborative knowledge translation model for wider sharing of knowledge into practice.
Meet the Instructors
Bob Hody
In this video, we're going to continue to explore
our practical motto for translating evidence into bedside practice.
Specifically, we're going to go talk about the most complicated step,
what we call the four Es.
Within any quality improvement project,
we recognize that there are a number of important things
that need to happen for these efforts to be successful.
Number one, we need to engage different stakeholders to help
them understand why these interventions are critically important.
Number two, we need to educate
different stakeholders to ensure that they know the evidence
supporting the interventions that we seek to
implement in an effort to improve patient outcomes.
Number three, each stakeholder needs to have a clear plan for execution where we design
an intervention targeting the barriers that we identified in
earlier steps and we create efforts to standardize care,
to create independent checks and reminders,
essentially trying to make it easier for providers to do the right thing.
And then finally, we need to have a phase where we evaluate our current performance.
We give the feedback to our frontline staff and other stakeholders and regularly assess
how well our intervention is being implemented
and if patients are receiving the evidence-based therapies they should.
Now, with any quality improvement project,
oftentimes within our healthcare organization,
there are many different stakeholders that play
an exceedingly important role in the success of a quality improvement project.
In our model for translating evidence into practice, specifically,
we focus on a couple of different stakeholders and we coach teams when we're working with
them in our large scale collaborative to help begin to
address each of these important stakeholders.
There are executive leaders within our organizations.
They certainly have an exceedingly important role
in the success of a quality improvement program.
We have team leaders who are trying to lead these important quality improvement efforts.
And then, of course, we have our frontline staff that
are actually delivering the evidence-based therapy.
And each of these stakeholders come into
the process with an exceedingly different lenses.
They see the world oftentimes in a much different way and though they each come into
our quality improvement project with
different lenses and different language and different vocabulary,
each of the stakeholders need to be engaged to
understand how this intervention is going to make the world a better place.
Each of these stakeholders need to have a clear plan for education or they need
to be educated on exactly what their role is and what we need to do,
what we're asking them to do.
They need to have a clear plan for execution or
clear delineation of what exactly we're asking them to do.
And then we need to have a plan for evaluation to feed back
our performance results to each of these important stakeholders.
How may we apply these attributes to
our story of preventing central-line associated bloodstream infections?
Well, we convened a group of
important stakeholders to identify the best available evidence.
We shared with the group the insights that we had gained
by walking the process and talking to frontline staff.
We shared with them our plan for simplifying the system by creating a central-line cart,
making it easier for providers to do the right thing.
Implementing a daily goals checklist to ensure every day,
we ask whether that line was an important part of care or whether it could be removed.
And now, we needed to make sure that all of
our stakeholders were on board and that we had a clear plan,
moving forward, to engage all important stakeholders,
including our executive leaders,
our team leaders as well as our frontline staff,
we told stories of patients who had been harmed
needlessly as a result of these preventable complications.
We shared with them not just the central-line associated bloodstream infection rate,
but we talked a lot about the number of patients that had been harmed over the past week,
over the past month as a result of our current performance.
And this strategy of telling stories was
exceedingly helpful for engaging frontline staff as
well as our senior executive to know that
these efforts indeed could make the world a better place.
We educated our providers in a number of
different ways to ensure that they knew the evidence-based therapies.
We created a clear plan for execution and we
asked each stakeholder for their specific role.
Executive leaders, for example,
we asked them to make sure that the organization had
a clear goal or a target
for prevention of central-line associated bloodstream infections.
And then we had to have a plan for evaluation where we would collect our current data
for central-line associated bloodstream infection rates
and we would post it within public places,
within our ICUs for healthcare providers as well as
our executives who are rounding within the ICU to make sure that they
truly knew how well we were doing towards our goal of
preventing central-line associated bloodstream infections.
By far, the fourth step or ensuring that patients
receive the evidence-based therapies with our four Es, Engagement,
Education, Execution and Evaluation is, by far,
one of the most challenging steps of
this practical model for translating evidence into practice.
But nevertheless, I think that this model will help give you
some guidance if you're focusing on a project for ensuring
that patients receive the evidence-based therapies they should or if you're supporting
an organizational effort to make sure that
patients receive the evidence-based therapies they should.
We've used this motto for translating evidence into practice,
working with thousands of hospitals across the US and in
other countries to prevent important healthcare associated infections,
including central-line associated bloodstream infections,
ventilator-associated pneumonia.
And we've begun to explore how this model
could be used for preventing other complications,
such as deep vein thrombosis and
surgical site infections in patients undergoing colorectal surgery.
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