This slides are modified Original Slides Presented by Akarin Nimmannit MD Thai initiative that was considerably successful R2R Made innovation/QI easy for everyone to do

1. Akarin Nimmannit MD
Manager of Routine to Research (R2R) Project
Assistant Dean for Quality Development
Faculty of Medicine Siriraj Hospital
Mahidol University

2. Definition of R2R Research
Research question:
 Originate from routine service/work
 Solve the service/work problem
 Improve the quality of service/work
Investigator/conductor
 The working staff (experiencing the problem)
 Might work with the invited expert
Result:
 Measure the significant patient health outcome or service
Surrogate outcome might not be relevant e.g. laboratory testing
result
Implementation:
 Research result must return to improve the patient care or service
Modified from the concept of Prof. Dr. Vicharn Panich, Chairman of Mahidol
University Council

3. 3

4. Routine to Research (R2R) Unit
Launched in June 2004
Health Services Research Management Unit
Missions:
Upstream to downstream
 Routine work problem  Research question
 Research proposal development
 Research proposal review (IRB-ethical clearance and grant
process)
 Research conduction monitoring
 Manuscript/ implementation (service improvement)
Knowledge management (KM) for health
services research

5. R2R Management Approach
KM based
R2R is not a “foreign body”, but a further quality
development progression.
Integration of R2R research into common
hospital quality development (CQI-PDCA)
R2R is an investment, not another burden.
R2R is voluntary work.
Overcoming the “unpleasant” experiences and
attitudes towards research
R2R does not have to be very complex.
R2R is not restricted only to the scholars.

6. Medical Institute of the Kingdom
toward International Excellence
Clinical Human Capital Innovation &
Excellence Excellence Publication
Knowledge Routine work Knowledge
Creation Translation
Clinic Support
(Front (Back office)
office)
Quality Criteria e.g. HA, JCIA & TQA
Quality Criteria e.g. HA, JCIA & TQA

7. Research Questions & Quality
Development Topics are from..
1. Workflow: Value Stream Mapping
• Care team: care process
• Laboratory: Specimen collection, preparation, obtain, handling,
storage, process, report
2. Complaints & Occurrence Reports
• What have happened
• What/How factors associated with the incidence
• What should be the solution/ What is the best way to solve the
problem
3. Indicators (process, output, outcome)
• Target, Timing
• Other institute/Best practice
• Standard criteria (HA/JCIA/ISO)
4. Organizational goal (s)

8. Knowledge Management (KM)
for R2R
Do believe R2R projects exists even before
having the term “R2R”
Inspired to learn from real success story
(sometime ‘not’ success story)
Good success story telling needs preparation
(What & Whom to be shared)
More learn, less teach

9. Case: GYN Ultrasonography
Transabdominal ultrasound has been performed for
decades
To obtain good vision, urinary bladder must have some
volume of fluid
What is the appropriate volume?
How much water should patient drink?
How long the patient bladder will be filled?
A Randomized Controlled Study
9

10. 93 GYN Pts with normal
93 GYN Pts with normal
kidney function
kidney function
Randomization
Drink Water Drink Water Drink Water
300 cc. 400 cc. 500 cc.
n =31 n = 30 n = 32
Gynecologist independently perform GYN US when
1. Patients feel incline to urinate or
2. 45 min after drinking water
Redo US every 10 mins until Gynecologists satisfy with
the quality of image

11. Average waiting time and total bladder
volume before transabdominal
ultrasound in each study group
(mean+SD)
Important finding: 300, 400 & 500 cc in 60 mins

12. Work instruction for advising the
patient for GYN US
With appointment No appointment
“an hour” before 1. Do not pass urine
appointment time 2. Drink 300-500 (10-16 oz)
1. Empty bladder cc of fluid
2. Drink 300-500 (10-16 3. Do not pass urine
oz) cc of fluid 4. Wait 45 minutes
3. Do not pass urine until
examination
Patient to the US station

13. Implementation Result
US Success rate (%)
Indicators Before 1 months 3 months
Complete as 50 60.1 89
Appointment
Complete as 70 81.1 94
instruction (No
appointment )
Satisfaction - 75.2 91

14. Waste Elimination: Defect Rework, Overproduction,
Waiting, Motion, Excessive Processing
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16. • 220 R2R projects
• 130 Finished
• >80% return to
improve services

17. Hospital Management Asia:
Human Resource Development
Train and benefit a large majority of staff
Allow employees flexibility to learn at their own
time
Improve a lot of the employee by way of effective
professional training and life long learning
Eliminate service defect, reduce waste and
improve communication
Significant result
Good composition of team
“We're Born to Learn, Not to Be Taught”
John Abbott
Author: Overschooled but Undereducated