In this video, we're going to continue to explore our practical motto for translating evidence into bedside practice. Specifically, we're going to go talk about the most complicated step, what we call the four Es. Within any quality improvement project, we recognize that there are a number of important things that need to happen for these efforts to be successful. Number one, we need to engage different stakeholders to help them understand why these interventions are critically important. Number two, we need to educate different stakeholders to ensure that they know the evidence supporting the interventions that we seek to implement in an effort to improve patient outcomes. Number three, each stakeholder needs to have a clear plan for execution where we design an intervention targeting the barriers that we identified in earlier steps and we create efforts to standardize care, to create independent checks and reminders, essentially trying to make it easier for providers to do the right thing. And then finally, we need to have a phase where we evaluate our current performance. We give the feedback to our frontline staff and other stakeholders and regularly assess how well our intervention is being implemented and if patients are receiving the evidence-based therapies they should. Now, with any quality improvement project, oftentimes within our healthcare organization, there are many different stakeholders that play an exceedingly important role in the success of a quality improvement project. In our model for translating evidence into practice, specifically, we focus on a couple of different stakeholders and we coach teams when we're working with them in our large scale collaborative to help begin to address each of these important stakeholders. There are executive leaders within our organizations. They certainly have an exceedingly important role in the success of a quality improvement program. We have team leaders who are trying to lead these important quality improvement efforts. And then, of course, we have our frontline staff that are actually delivering the evidence-based therapy. And each of these stakeholders come into the process with an exceedingly different lenses. They see the world oftentimes in a much different way and though they each come into our quality improvement project with different lenses and different language and different vocabulary, each of the stakeholders need to be engaged to understand how this intervention is going to make the world a better place. Each of these stakeholders need to have a clear plan for education or they need to be educated on exactly what their role is and what we need to do, what we're asking them to do. They need to have a clear plan for execution or clear delineation of what exactly we're asking them to do. And then we need to have a plan for evaluation to feed back our performance results to each of these important stakeholders. How may we apply these attributes to our story of preventing central-line associated bloodstream infections? Well, we convened a group of important stakeholders to identify the best available evidence. We shared with the group the insights that we had gained by walking the process and talking to frontline staff. We shared with them our plan for simplifying the system by creating a central-line cart, making it easier for providers to do the right thing. Implementing a daily goals checklist to ensure every day, we ask whether that line was an important part of care or whether it could be removed. And now, we needed to make sure that all of our stakeholders were on board and that we had a clear plan, moving forward, to engage all important stakeholders, including our executive leaders, our team leaders as well as our frontline staff, we told stories of patients who had been harmed needlessly as a result of these preventable complications. We shared with them not just the central-line associated bloodstream infection rate, but we talked a lot about the number of patients that had been harmed over the past week, over the past month as a result of our current performance. And this strategy of telling stories was exceedingly helpful for engaging frontline staff as well as our senior executive to know that these efforts indeed could make the world a better place. We educated our providers in a number of different ways to ensure that they knew the evidence-based therapies. We created a clear plan for execution and we asked each stakeholder for their specific role. Executive leaders, for example, we asked them to make sure that the organization had a clear goal or a target for prevention of central-line associated bloodstream infections. And then we had to have a plan for evaluation where we would collect our current data for central-line associated bloodstream infection rates and we would post it within public places, within our ICUs for healthcare providers as well as our executives who are rounding within the ICU to make sure that they truly knew how well we were doing towards our goal of preventing central-line associated bloodstream infections. By far, the fourth step or ensuring that patients receive the evidence-based therapies with our four Es, Engagement, Education, Execution and Evaluation is, by far, one of the most challenging steps of this practical model for translating evidence into practice. But nevertheless, I think that this model will help give you some guidance if you're focusing on a project for ensuring that patients receive the evidence-based therapies they should or if you're supporting an organizational effort to make sure that patients receive the evidence-based therapies they should. We've used this motto for translating evidence into practice, working with thousands of hospitals across the US and in other countries to prevent important healthcare associated infections, including central-line associated bloodstream infections, ventilator-associated pneumonia. And we've begun to explore how this model could be used for preventing other complications, such as deep vein thrombosis and surgical site infections in patients undergoing colorectal surgery.
