Phase 3b (Assessment (Not examined on medical leadership or QI, One SBA)…
Not examined on medical leadership or QI
Mr Glen Watson ext 11853, RHH
Ms Raquel Garcia-Cabrera ext. 12525, RHH
Karen rogstad, karen dewsnap
6 domains of quality care- safe, timely, effective, efficient, equitable, patient-centred
Passcode provided in by end of january
Links to modules required on powerpoint "Phase 3b- Medical Leadership and QI" and/or on Phase 3b handbook
CPD? = FMLM- Faculty of medical leadership and management
A leader is someone who has followers,
Leaders are extremely tolerant of diversity and do not look for carbon copies of themselves
Leaders are not afraid of strength in their associates
Team dynamics questionnaires: HRET working styles questionnaire // StrengthsFiiner 2.0 // Myers-briggs type indicator // Strength Development inventory
Use logic- collect data and evidence to present to people
Get endorsed- demonstrate support from those in power/authority
Appeal to emotions-storytelling to engage peoples hearts
Ground rules that drive the team
Willing to give and receive feedback
Clearly defined roles within a team
Team members mst have respect for each other
Pozen's six aspects of managing a team:
Setting goals for the team, agreeing on success metrics, doing a mid-flight review, consulting with key people, tolerating good faith mistakes, celebrating team victories
Purposes: Discuss and Debate, Brainstorming, Complex negotiations, Build camaraderie
Inform team of the purpose of the meeting
Planning meetings: Invite only people who really need to be at meeting, find the smallest room that fits the group (less spread out so more interaction), limit distractions, keep them short (<60-90 mins)
Good meetings: Agenda to establish clear purpose, information circulated prior to start of meeting, concentration and attention maintained, good closure to meeting highlighting what should happen next
Take initiative, investigate scale of problem, make connections between observations and driving forces causing problems, identify solutions, take action
Connect problems of powerless to strategic concerns of powerful, connect problems of powerless to hearts of thos e in power, seek powerful allies
Ask a wide variety of people/positions for potential solutions
What needs to be done? What can I do to make a difference? What are the organisation's mission and goals?
Perseverance, patience flexibility, adaptability
IHI Healthcare Improvement
Domains of quality healthcare
STEEP: Safe, Timely, Effective, Efficient, Equitable Patient-centred
Value, Access, Prevention
Every system is perfectly designed to get the results it gets
Deming system of profound knowledge:
Appreciation of a system
Variation- how can we learn from variation across region/speciality etc. how will we know when an improvement we are trying to make has had a statistically/clinically significant difference
Theory of knowledge - how do we know?
Model of Improvement
Will= will to improve
Ideas= alternatives to status quo
Execution= make it real
What are we trying to accomplish?
How will we know a change is an improvement?
What change can we make that will result in an improvement?
Plan, Do, Study, Act
Reflecting on actions and impact: adapt, adopt, discard
We have our job then we have the job of improving our job
How good, by when and for whom
Set one now, make it meaningful, an aim that can be tracked, be ambitious
Outcome measure- achieving the ultimate result?- e.g % you arrive punctually
Process measures- doing the right things to get to goal?- e.g no. days/week you set alarm to go off early
Balancing measures- changes introducing new problems? e.g level of perceived sleep deprivation
How to develop changes
Find someone better than you and ask for suggestions
Read books / papers
Find video of experts in the field and compare to yourself
Think about the theory
Change concept categories
Eliminate waste, improve workflow, optimise inventory, enhance producer-customer relationship, change the work environment, manage time, manage variation, design systems to prevent errors, focus on design of products and services
Places to find change
Ask the frontline, explore other industries
Cause and effect categories
Materials, methods, environment, equipment, people
Intro to trauma
What is Major Trauma?
ISS>15 defines a major/polytrauma
Injury Severity Score= anatomic severity scale based on Abbreviated Injury Scale (AIS)
Six areas: Head and neck, Face, Chest, Abdomen, Extremity, External
Each scored: 0 (normal), 1 (minor), 2 (moderate), 3 (serious), 4 (severe), 5 (critical) or 6 (unsurvivable)
Take top 3 scores, square each of them then add together.
Golden hour and Platinum 10 minutes
Definition: Serious and often multiple injuries where there is a strong possibility of death or disability
C=control catastrophic haemorrhage.
A= Airway with C-spine protection.
B= Breathing with ventilation.
C= Circulation with haemorrhage control.
D= Disability: neurological status.
Types of injury
Assault, Fall from standing / >2m
C spine injury, blunt thoracic/cardiac injury,
Hollow viscus perforation/solid organ injury
Sport injuries- splenic/renal injury rugby, open fractures motorcross
Incisional- cut to skin from sharp object
Laceration- burst skin
Primary structures- wave disrupts gas filled structures
Secondary- impact airborne debris
Tertiary- being thrown into something
Quarternary- anything else e.g burns
Priorities for management
Save time, Consultant led trauma team, MDT
Stop bleeding, prevent hypoxia, prevent acidaemia.