Apresentação de Pedro Delgado durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil. Pedro Delgado é MSc, Diretor Executivo do Institute for Healthcare Improvement (IHI), atua a melhoria de sistemas e redes de saúde em larga escala mundialmente e lidera o portifolio do IHI na América Latina. Antes de integrar o IHI, trabalhou para o Serviço Nacional de Saúde da Grã Bretanha na gestão hospitalar e também levou de maneira pioneira esforços de melhoria em larga escala no norte da Irlanda.

1. Unindo forças:
implementação e
disseminação
de programas de
segurança do paciente
HIAE-IHI Symposium
3-5 November 2013
Pedro Delgado
Diretor Executivo
IHI
@pedroIHI

2. Congratulations…
A brilliant
platform!
Great work in
all of these in
some places
Just not
everywhere

3. An opportunity
1. Pioneers & legacy
2. Implementation & Spread - how
3. New norms -‘Culture eats strategy for
lunch’

4. What will you do by
this Friday?

5. 1. The content, and its packaging
2. The data: real time, useful, available
3. A segmentation-to-spread plan
4. Pace: testing and learning
5. Leadership commitment
Critical success factors

6. CSF 1: The content,
and its packaging

7. WEALTH OF CONTENT
About 3,720,000 results (0.24 seconds)
About 122,000,000 results (0.26 seconds)
About 3,380,000 results (0.24 seconds)
About 152,000,000 results (0.23 seconds)
About 11,200,000 results (0.27 seconds)
About 1,970,000 results (0.24 seconds)

8. Adoption is a SOCIAL thing!
A better
idea…
…communicated through a
social network…
…over
time
Rogers, E. M. (2003).
Diffusion of innovations. New
York, Free Press.

9. Relative
Advantage
Relative
Advantage
SimpleSimple TrialableTrialable CompatibleCompatible ObservableObservable
Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press.
Accelerating adoption

10. A system- Everyone knows the connections and their contribution
CauseEffect
Drives
Outcome
(aim)
Primary
drivers
Secondary
drivers

11. CSF 1: The content,
and its packaging
• 5 attributes ‘checklist’
• A systemic view
• Simple, snappy ‘how to’ guides (evidence,
method, stories)
* Economies of scale and collaboration

12. CSF 2: The data - real
time, useful, available
Seek usefulness,
not perfection

13. (a esperança não é um plano)
A clear aim

14. 56% reduction

15. 7.65
3.46
5.67

16. Real time measurement for learning

18. Rituals to learn (huddles, and other habits) –
generative conversation spaces

19. CSF 2: The data: real
time, useful, available
• A clear aim - process and outcome data
(dynamic view) to learn and improve, real time
• Rituals to learn
• Availability and usefulness to engage
* Collaboration to accelerate improvement

20. CSF 3: A
segmentation-to-
spread plan

21. “Up to 70% of improvement
projects never spread.”
Eccles R, Miller Perkins K, Serafeim G. How to Become a Sustainable
Company. MIT Sloan Management Review 2012; 53(4): 43-50.
For the spread of new ideas to
happen in a timely fashion, the
spread process needs to be
managed

22. Start-up:
months
1 – 8
Total Pop’n:
Under 5 Pop’n:
Nov 2007
Wave 1:
months
9 – 22
350,000
60,000
Jul 2008
Wave 2:
months
23 – 63
5 million
500,000
Sept 2009
Wave 1R:
months
58 – 89
11 million
1.7 million
Aug 2012
Start Small, Scale up Rapidly with Change Package
No of. QI Teams: 30 258 350 369 >1,046
Jan 2013
Wave 3:
months
24 – 89
11 million
1.7 million
Oct 2009
Wave 4:
months
63 – 89
22 million
3.3 million
*Referral project launch
41 Referral Teams

23. Where will you start? (unit or
units). Where will you go next?
What is your timeline for
coverage and completeness?
Which theatre (s) / OR (s)?
General Medical?
Fractures, Care of Elderly, Surgical?

24. Are you ready to spread?
Intention to spread the work in organization?
Topic of interest is a key initiative?
Senior Leader responsible and accountable?
Initial (pilot) team is relatively self- sufficient?

25. CSF 3: A segmentation-to-
spread plan
• Defining a starting point / place, and the sequence that
follows through coverage and completeness
• Diagnosing spread readiness
• Manage spread
* Collaboration to accelerate improvement

26. CSF 4: Pace - testing
and learning
“I hear and I forget; I see and I remember;
I do and I understand” (Confucius)

27. ‘Montar bici’

29. DESIGN DESIGN DESIGN DESIGN
A abordagem típica…
IMPLEMENTAÇÃO
(fracasso?)
Muitas
reuniões de
planejamento…
DESIGN
DESIGN DESIGNDESIGNDESIGN APPROVE!
O mundo real

30. ¿Qué intentamos lograr?
¿Cómo sabremos que un
cambio es una mejora?
¿Qué cambios podemos hacer
para obtener mejoras?
Actuar Planificar
Estudiar Hacer
Cuando
combinamos
las 3
preguntas
con …
El ciclo
PHEA…
El Modelo de Mejoramiento (Langley et al, 1996)

31. DESIGN
Abordagem de melhoria da qualidade
IMPLEMENTAÇÃO
(êxito)
Poucas
reuniões de
planejamento…
APPROVE
O mundo
real
TEST &
MODIFY
TEST &
MODIFY
TEST &
MODIFY
Learning & Ownership

32. Aim: 50m by end of day
Predicciones:
• Se va a caer varias veces
• Distancias cortas en principio
• Confianza progresiva

33. Chinese proverb
不闻不若闻之，闻之不若见之，见之不若知
之，知之不若行之；学至于行之而止矣
“I hear and I forget; I see and I remember; I
do and I understand”
-Confucius

34. CSF 4: Pace - testing
and learning
• Build the capacity to improve
• Test, fast – and learn along the way
• Develop improvement capability –
reusable skills

35. CSF 5: Leadership
commitment
“The responsibility for adopting aims and
overseeing measures cannot be
delegated”

36. A new kind of leadership
• Safety at the top – pragmatic approach
• Hierarchies and multidisciplinary
teamwork
• Its MY responsibility / It’s everyone’s
responsibility
• Data driven decision making & learning

37. 1. The content, and its packaging
2. The data: real time, useful, available
3. A segmentation-to-spread plan
4. Pace: testing and learning
5. Leadership commitment
Critical success factors

38. COLLABORATE
Build a
learning
system for
improvement
• National
• Regional
• Local

39. Transparency – the effect…
Ejemplo: adopción de la guías para el tratamiento de síndrome coronario
agudo
6
5
4
3
2
20092008200720062005
+13%
+22%
Los 34 hospitales de ‘abajo’
Todos los hospitales (69)
+7%
RIKS-HIA
Quality Index1
1. The quality index from RIKS-HIA measures Swedish hospitals adherence to national guidelines (best practice) regarding Acute coronary syndrome (ACS). The index is based on nine different process
metrics which are described in the appendix. 2. Defined as hospitals given the three lowest grades when data became public for 2006 (0,5; 1,0; 1,5). 3. Data on individual hospital performance was
first published in the 2006 RIKS-HIA annual report. From 2006 onwards the public and the media could easily access the data and compare individual hospital performance.
Source: RIKS – HIA Annual Reports 2005 – 2009, BCG Analysis
+40%
Prior to 2006 hospitals were not named in
public report. Scientists could identify
individual hospitals by translating codes3
After 2006 data on individual hospital
performance was published triggering
significant media and public attention

41. No looking back…
Uso de teléfonos celulares
Cinturón de seguridad
Fumadores pasivos
Computadores personales
Música

42. (começar antes que você esteja pronto)
5 CSFs and…
1. Collaborate – build
a learning system &
share
2. Transparency
3. Change norms

43. What will
you do by
this Friday?

44. What will your legacy be?
Less harm for
all Brazilians

45. Change starts with you
Our conversation in 2014…and
the vision to move from 16% to…

46. Obrigado…boa
sorte!
www.ihi.org
pdelgado@ihi.org
@pedroIHI