I-PASS Handoff Program: Use of a Campaign to Effect Transformational Change.
I-PASS Handoff Program: Use of a Campaign to Effect Transformational Change.
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DOI：
10.1097/pq9.0000000000000088
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发表时间：
2018-07-01
影响因子：
1.1
通讯作者：
Sectish, Theodore C
中科院分区：
文献类型：
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作者：
Rosenbluth, Glenn;Destino, Lauren A;Sectish, Theodore C
背景：众所周知，在医疗保健系统内实现行为改变是非常困难的。I-PASS交接包的成功实施以及随后医疗差错和可预防不良事件的减少代表了学术医疗中心成功转型变革的一个例子。目的：我们设计了一项活动，以支持和提高2011年至2013年9个研究中心对I-PASS交接包的使用。根据Kotter的转型变革模型，我们利用当地数据和机构授权建立了紧迫性，现场领导与机构领导、关键教师和首席居民建立了当地指导联盟。我们通过品牌活动创建和传达我们的愿景，并通过征求反馈和采取行动以及支持系统更改来授权他人采取行动。现场领导者通过表彰参与I-PASS的居民、巩固改进和制度化新方法来规划并创造短期胜利。结果：I-PASS的实施是成功的，医疗错误率和可预防的不良事件发生率得到了大幅改善。来自最初的I-PASS研究的数据继续推动着一场全国性的运动，其中包括患者安全和儿科领域领导者的国家认可。势头已显着增加，以支持指导实施的I-PASS移交程序在超过35个学术医疗中心在北美。结论：I-PASS提供了一个例子，通过教育干预和变革管理相结合，以解决阻力/障碍，支持一个强大的运动实现转型变革。我们鼓励学术医学界的其他人考虑使用变革模式，包括运动，以支持医疗保健改善计划。
BACKGROUND: Behavior change is notoriously difficult to achieve within health care systems. Successful implementation of the I-PASS handoff bundle with subsequent decreases in medical errors and preventable adverse events represents an example of successful transformational change within academic medical centers.OBJECTIVE: We designed a campaign to support and enhance uptake of the I-PASS handoff bundle at 9 study sites from 2011 to 2013.METHODS: Following Kotter's model of transformational change, we established urgency using local data and institutional mandates, and site leaders built local guiding coalitions with institutional leaders, key faculty, and Chief Residents. We created and communicated our vision using a branded campaign and empowered others to act by soliciting and acting on feedback and supporting systems changes. Site leaders planned for and created short-term wins by recognizing residents who engaged with I-PASS, consolidated improvements, and institutionalized new approaches.RESULTS: Implementation of I-PASS was successful, with achievement of substantial improvements in rates of medical errors and preventable adverse events. Data from the initial I-PASS study have continued to drive a national campaign that has included national recognition by leaders in the field of patient safety and pediatrics. Momentum has increased significantly to support mentored implementation of the I-PASS handoff program at over 35 academic medical centers across North America.CONCLUSIONS: I-PASS provides an example of transformational change achieved through a combination of educational interventions and change management to address resistance/barriers, supported by a robust campaign. We encourage others in academic medicine to consider using change models, including campaigns, to support health care improvement programs.