[PPT] - Communication and understanding of system resilience through RAG PowerPoint Presentation

SLIDE 1

Communication and understanding of system resilience through RAG survey in EDs

Sheuwen Chuang, Hon‐Ping Ma, Che‐Hung Tsai

Sheuwen Chuang, Ph. D Health Policy and Care Research Center, Taipei Medical University, Taiwan

2015/Aug/11

SLIDE 2

2

Taipei Medical University has three hospitals

TMU hospital, 800 beds Shuangho hospital, 730 beds Wan Fang hospital, 934 beds

SLIDE 3

Study aims

1.Direct communicate with five directors of EDs to understand how they think about system resilience. 2.Compare system resilience of EDs across four hospitals 3.Try to develop an approach of implementing resilient health care based on the baseline of system resilience through a RAG survey under the QLLM framework.

3

SLIDE 4

Background – 1/2

Almost EDs in medical centers and some

regional hospitals are overcrowding

EDs in Taiwan are requested to plan a event

list that has a prepared response. The event list includes

Extraordinary events: Multiple Casualty Incident, fire

incident, violence, emergency power(air) shutoff,

Everyday clinical work

During Time Period

4

SLIDE 5

Erik Hollngel’s Resilience Analysis Grid
Assessment of four abilities of system resilience
Ability to respond
Ability to monitor
Ability to anticipate
Ability to learn
Four versions, the first version was designed

according to SOPs

Research Method – Questionnaire design

5

SLIDE 6

Questionnaire design (V1) Face validity test (3 physicians) Questionnaire design (V2)) Face validity test and interview time test Questionnaire design (V3) Test of focus group interview in one ED Questionnaire design (V4) IRB application

Research Method – Questionnaire design

6

SLIDE 7

The final version has

– Structured questions for analysis of the ability to learn – Open questions for analysis of the ability to respond, monitor, anticipate with the modification suiting for EDs’ context – maximum two hours of interview time

Research Method – Questionnaire design

7

SLIDE 8

Hospital characteristics

Hospital A B C D Contract - Level Regional Hospital Medical Center Medical Center Regional Hospital Public/Private Public (city government)/ private Public (city government)/ private Public (MoD) Public (MoHW) Beds in ED 34 26 100 20 Patient visits in 2014 98,213 65,397 65,615 59,873

No. of Health

care staff 94 75 135 48

8

SLIDE 9

Results – 1/5

Overall system resilience of EDs in four

hospitals

– ECW work:

Four hospitals have similar patter of system resilience
strength is in LEARN, weakness is in MONITOR
Hospital C has the higher resilience than other hospitals
Hospital A, B have less ANTISPATE ability than other

hospitals

9

SLIDE 10

5 0.9 3.4 5.6 1 2 3 4 5 6 7 8 9 10 5.7 0.6 4.4 6.3 1 2 3 4 5 6 7 8 9 10 7.9 3.9 8.1 8.1 1 2 3 4 5 6 7 8 9 10

Hospital C Hospital A Hospital B

5.8 2 5.9 6.2 1 2 3 4 5 6 7 8 9 10

Hospital D

RESPOND

RESPOND RESPOND

MONITOR MONITOR MONITOR MONITOR LEARN LEARN LEARN LEARN

ANTISPATE ANTISPATE

System Resilience ‐ ECW

10

SLIDE 11

Comparison of individual ability in ECW

across four EDs

– RESPOND

9 domains: Relevance，Threshold ,Response list ，

Speed，Delay，Response capability ，Stop rule ， Duration，Verification

Lack of verification is in common
Every hospital has different pattern of ability to

RESPOND

11

Results – 2/5

SLIDE 12

4.0 3.0 2.0 1.5 2.0 1.5 2.0 1.0 1.0 0.0 1.0 2.0 3.0 4.0 Relevance Threshold Response list Speed Delay Response capability Stop rule Duration Verification

Hospital A

12

Ability to respond in ECW

4.0 3.0 1.0 2.5 3.0 4.0 1.0 1.0 1.0 0.0 1.0 2.0 3.0 4.0 Relevance Threshold Response list Speed Delay Response capability Stop rule Duration Verification

Hospital B

3.0 4.0 4.0 2.5 3.0 3.0 4.0 4.0 1.0 0.0 1.0 2.0 3.0 4.0 Relevance Threshold Response list Speed Delay Response capability Stop rule Duration Verification

Hospital C

3.0 3.0 4.0 2.0 2.0 1.0 4.0 1.0 1.0 0.0 1.0 2.0 3.0 4.0 Relevance Threshold Response list Speed Delay Response capability Stop rule Duration Verification

Hospital D

SLIDE 13

Comparison of individual ability in ECW across

four EDs

– MONITOR

5 domains: Relevance，Indicator list ，Indicator type，

Relevance，Measurement frequency ，Organisational support

Lack of monitor frequency in common
Every hospital has different pattern of ability to MONITOR
Hospital C performs better monitoring in indicator list and

indicator type

Hospital A and B have less monitoring ability than other two

hospitals

13

Results – 3/5

SLIDE 14

1 2 1 1 1 1 2 3 4 Indicator list Indicator type Relevance Measurement frequency Organisational support

Hospital A

14

Ability to monitor in ECW

Hospital B Hospital C Hospital D

1 1 1 1 1 1 2 3 4 Indicator list Indicator type Relevance Measurement frequency Organisational support 4 4 1 1 2 1 2 3 4 Indicator list Indicator type Relevance Measurement frequency Organisational support 2 2 2 1 2 1 2 3 4 Indicator list Indicator type Relevance Measureme nt frequency Organisation al support

SLIDE 15

Comparison of individual ability in ECW

across four EDs

– ANTISPATE

4 domains: Relevance，Frequency ，Model ，

Communication，Expertise

Hospital D performs better anticipating than other

hospitals

Hospital A, B and C have similar patter of anticipating

ability

15

Results – 4/5

SLIDE 16

Hospital A

1.5 1.0 1.0 2.0 0.0 1.0 2.0 3.0 4.0 Frequency Model Communiaction Expertise

16

Ability to anticipate in ECW

Hospital D Hospital C Hospital B

1.5 1.0 1.0 2.0 0.0 1.0 2.0 3.0 4.0 Frequency Model Communiaction Expertise 1.5 1.0 1.0 2.0 0.0 1.0 2.0 3.0 4.0 Frequency Model Communiaction Expertise 2.5 2 3 2 1 2 3 4 Frequency Model Communiaction Expertise

SLIDE 17

Comparison of individual ability in ECW across four

EDs

– LEARN

9 domains: Selection criteria, Learning basis ,

Formalization , Training , Learning style, Resources , Pipeline, Importance, Implementation

Hospital C performs better learning than other hospitals
Four hospitals have different patter of learning ability

17

Results – 5/5

SLIDE 18

Hospital A

2 3 4 3 4 2 3 4 2 1 2 3 4 Pipeline Importance Selection criteria Learning basis Formalization Learning style Resources Implementation Training

18

Ability to learn in ECW

Hospital D Hospital C Hospital B

3 4 4 3 4 3 2 3 2 1 2 3 4 Pipeline Importance Selection criteria Learning basis Formalization Learning style Resources Implementation Training 3 3 4 3 4 4 4 4 4 1 2 3 4 Pipeline Importance Selection criteria Learning basis Formalization Learning style Resources Implementation Training 4 2 3 1 4 4 4 3 3 1 2 3 4 Pipeline Importance Selection criteria Learning basis Formalization Learning style Resources Implementation Training

SLIDE 19

Conclusion

19

1. ED has different levels of system resilience between the situation of ECW and extraordinary events. 2. Hospital with more responsibilities required by the Central government and IT capacity shows a better resilience in the four abilities. 3. The result of RAG survey provides an insight of ED’s resilience to the five hospitals (directors of ED) and facilitates a better understanding how ED’s current ability structure of resilience. 4. It is a good approach of communicating system resilience between researchers and healthcare professionals.

SLIDE 20

20

Sheuwen Chuang, Ph D Health Policy and Care Research Center, Taipei Medical University, Taiwan sheuwen@tmu.edu.tw 2015/Aug/11