Click the link to watch the recording webinar http://bit.ly/17NfgC1 Description of the Call: Dr. Gardam will be discussing his pioneering efforts in the use of the behavioral change approaches, including ‘positive deviance’ and ‘front line ownership’ to lead safety improvement work and how this relates to preventing falls. The presentation will include an interactive activity to help you and your teams understand how these approaches can be used in your organization.

1. INNOVATIVE
APPROACHES TO
PREVENTION OF FALLS—
POSITIVE DEVIANCE AND
FRONTLINE OWNERSHIP
Guest Presenter: Dr. Michael Gardam

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5. Your Presenters and Faculty
Nadine Glenn--CPSI
Dr. Michael Gardam
Hélène Riverin--CPSI
Gina Peck--CPSI
Susan McNeill--RNAO
Verity White--RNAO

6. From where are you joining?
Use your pointer.

7. Using Front-Line Ownership
to Prevent Falls
Michael Gardam
University Health Network

8. “Insanity: doing the same things over
and over again and expecting
different results.”
8

9. With which statement do you most agree?
A. Improved education can solve most quality
and safety issues;
B. Healthcare workers generally know what
they need to do but for whatever reason,
they don’t do it;
C. Improving quality and safety invariably
requires more money;
D. Standardized tools and processes will
efficiently bring about change.

10. Traditional Healthcare Culture
•
•
•
•
•
•
Need to get things done immediately
Evidence-based practice (scientific proof)
Information and data are trusted
Culture change is complicated
Leaders need to ‘step-up’
Top-down leadership
Zimmerman et. al. Healthcare Papers 2013

11. How we think the healthcare world works:
A
B
How it really works:
W
BLACK BOX
B

12. In a Linear World
• One size can fit all
• Copying best practices makes sense
• Top down leadership (“develop the
program and roll it out”) works
• Checklists work

13. In a Complex World
•
•
•
•
•
•
One size never fits all
What works here may not work there
“this is how we do things here”
There is no “one big fix”
Bottom up leadership works
Social immune response

14. Safety Strategies
① Prevention
①Resilience

15. Prevention

16. Reality

17. Resilience

18. RONT
INE
WNERSHIP
Zimmerman et. al., Healthcare Papers, 2013

19. Ownership

20. Buy in

21. How to
get here?
From
here?

22. Principles
• Participation is voluntary – everyone can opt
in or opt out
• Bottom up, top down and sideways
• Make the invisible visible
• Include the unusual suspects
• Go slow to go fast
• Nothing about me without me
• Act your way into a new way of thinking

24. Rebuilding the wheel…

25. Example: Hand hygiene
25

26. TRIZ

28. Nursing engagement

29. Ideas…
different
socks
change
blood draw
time
Bedside
report
talking to
patients
fall monitors
“busy”
aprons
stay with
patients while
in the bathroom

30. Current Collaborative Performance shows
Falls across 6 hospitals declined by 13%
In comparison to the
baseline rate, a total of
14 falls have been
prevented in 2013

31. Falls: BOZ total trend
7.0
Falls per 1,000 Patient Days
6.0
5.0
4.0
3.0
2.0
1.0
0.0
Q1 2012
Q2 2012
BOZ Total
Q3 2012
Q4 2012
Trend with intervention
Q1 2013
Q2 2013
Q3 2013
Trend without intervention

32. Culture SHIFT
•
•
•
•
•
•
Taking time to think
Practice-based evidence (social proof)
Stories and relationships are trusted
Culture change is simple
Leaders need to step back
Bottom up leadership from the front-line

33. What we have learned
• Rarely are there significant education deficits.
• Healthcare workers do know what they need
to do.
• Remarkable change can occur for no money.
• Standardize outcomes but not necessarily
processes

34. michael.gardam@uhn.ca

35. Questions?
Raise your hand
Or type your question into Chat. Remember to select “All Participants”

36. “Taking the Pulse” Poll
But wait….There’s more! Please do not exit the call without completing the poll
15-Nov13
36

37. Thank you




Dr. Michael Gardam
Registered Nurses’ Association of Ontario
CPSI—Technical hosting
All attendees who are working diligently to
make care safer
 Thank you for sharing and learning on the
Falls Community of Practise

38. Mark your Calendars for
these Upcoming Calls
 Assessing delirium: pragmatics and
confounders
– November 19, 2013– 12:00 p.m.-1:00 p.m.
EST
 The ten obstacles to Hand Hygiene
– December 10, 2013—2:00 p.m.-3:00 p.m. EST
For dial-in information, please go to:
www.saferhealthcarenow.ca