Acknowledgements. Date of publication. The purpose of this guide

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2 Acknowledgements This guide has been produced by Lisa Williams Lives Plus is run as a collaborative, involving the National Leadership and Innovation Agency for Healthcare, National Patient Safety Agency, Public Health Wales and the Clinical Governance Support and Development Unit. We wish to thank and acknowledge the Institute for Healthcare Improvement (IHI) and The Health Foundation for their support and contribution to the 1000 Lives Plus. Date of publication This guide was published in April 2010 and will be reviewed in April The latest version will always be available online on the programme s website: The purpose of this guide This guide has been produced to enable healthcare organisations and their teams to successfully implement a series of interventions to improve the safety and quality of care that their patients receive. Further Tools for Improvement guides are also available to support you in your improvement work: How to Improve A Guide to Measuring Mortality Improving Clinical Communication using SBAR Learning to use Patient Stories Using Trigger Tools Reducing Patient Identification Errors These are available from the 1000 Lives Plus office, or online at Where reference is made to 1000 Lives Plus, this includes the work undertaken as part of the 1000 Lives Campaign and the second phase of this improvement programme 1000 Lives Plus. The guide uses examples from the former NHS organisational structures, and where possible this has been acknowledged Lives Plus 14 Cathedral Road, Cardiff CF11 9LJ Tel: (029) livesplus@wales.nhs.uk Web: Twitter: We are grateful to The Health Foundation for their support in the production of this guide. 2

3 Making patient safety a priority The 1000 Lives Campaign has shown what is possible when we are united in the pursuit of a single aim: the avoidance of unnecessary harm for the patients we serve. The enthusiasm, energy and commitment of teams to improve patient safety by following a systematic, evidence-based approach has resulted in many examples of demonstrable safety improvement. However, as we move forward with 1000 Lives Plus, we know that harm and error continue to be a fact of life and that this applies to health systems across the world. We know that much of this harm is avoidable and that we can make changes that reduce the risk of harm occurring. Safety problems can t be solved by using the same kind of thinking that created them in the first place. To make the changes we need, we must build on our learning and make the following commitments: Acknowledge the scope of the problem and make a clear commitment to change systems. Recognise that most harm is caused by bad systems and not bad people. Acknowledge that improving patient safety requires everyone on the care team to work in partnership with one another and with patients and families. The national vision for NHS Wales is to create a world class health service by 2015: one which minimises avoidable, death, pain, delays, helplessness and waste. This guide will help you to take a systematic approach and implement practical interventions that can bring that about. The guide is grounded in practical experience and builds on learning from organisations across Wales during the 1000 Lives Campaign and also on the experience of other campaigns and improvement work supported by the Institute for Healthcare Improvement (IHI). Contents Introduction 4 What is the Extranet? 5 Accessing the Extranet 6 Adding a new member to a Team and 14 allocating Team role(s) New Documents and Resources 15 Measures 17 Progress Reporting 24 Joining / leaving a workgroup 30 Frequently Asked Questions 31 3

4 Introduction The purpose of this guide is to provide users with a basic introduction to the Extranet, including its functionality and a step-by-step guide to accessing and using it for service improvement. This document is not intended to be a complete reference manual. If further assistance or advice is needed, please contact the central office on (029) This guide should be used alongside the 1000 Lives Plus How to Guides to support the successful implementation of the programme s interventions. 4

5 What is the Extranet? The 1000 Lives Plus Extranet is an online tool hosted by the Institute for Healthcare Improvement (IHI). It is a restricted access, web-based application that allows geographically dispersed teams and users to collaborate on projects Lives Plus encourages organisations to share good practice and learning, and use data for improvement. The Extranet allows teams from across Wales to work together on the programme s interventions, and teams can report on their findings, collect data on key measures, and sharing what they learn. Collaboration is further enhanced with features such as discussion group, access to resources and the ability to upload documents. The Extranet can be used for several purposes, including: 1. Finding current information relating to the Model for Improvement, the 1000 Lives Plus content areas and measures. 2. Tracking your own progress by reporting data, annotating your improvement narrative and uploading PDSA cycles. 3. Sharing progress with others and learning from others by accessing improvement reports and data from other teams within your organisation or from team members from other organisations. The Extranet has two levels of functionality - Project and Team. You will be assigned a Project 1000 Lives Plus, and you will also be part of a sub-level within this project defined as a Team your NHS Organisation. In order to gain access to a Project and Team, level permissions need to be granted by the Key Contact in your organisation or alternatively contact the central office. This ensures the security of the information and data. 5

6 Accessing the Extranet Accessing the Extranet for the first time Accessing the Extranet for the first time is simple. If you are not an existing user of the Institute for Healthcare Improvement s (IHI) online community (IHI.org), you will need to register with them first to be able to access the 1000 Lives Plus Extranet: If you are on the NHS network, go to the 1000 Lives Plus intranet site. Next, click on the link for the Extranet and this will take you to Log in screen. If you are not accessing the intranet through an NHS network, go to: This will take you to the Log in screen. Next, click on Register with IHI. If you are not an existing user of IHI.Org community, click on Register with IHI: 6

7 When completing the registration form please note that your contact details will be placed on a directory which will be displayed to all registered members of 1000 Lives Plus Extranet. Therefore, it is recommended you provide work contact details only. Also, make a note of the password you record as this will be required each time you want to login in to IHI.org. Once you have registered with IHI.org, please get in touch with your Key Contact who will be able to allocate the 1000 Lives Plus as one of My Projects List. Requesting a Team Role Once you are a registered user of IHI.org, your Key Contact will add the 1000 Lives Plus to your Project List and also provide you with a Team role. There are several roles within a team and each role has different permissions. All four roles are able to upload/download documents, send messages, view content and reports. If you are having difficulties locating your Key Contact, please phone the central office (029) Different roles on the Extranet and permissions: Role Data Entry Key Contact Member Sponsor Permissions The only role which has the permission to enter data for measures. It is advisable to have more than one in an organisation. The main contact point within the team. This role can add new members, and define the measures and interventions used. It is advisable to have more than one in an organisation. A user involved with the project. No specific function within the Extranet. The leader who is responsible and accountable to the organisation for the performance and results of the community improvement team. This person is not a member of the team, but is responsible for securing the resources for the team to accomplish their aim and communicating their progress to other leaders in the organisation. 7

8 Accessing the 1000 Lives Plus Project home page After registering with IHI.org and being allocated a Team role, you will be able to access your Team s home page. There are three steps you will need to complete to do this: 1. Log on to the IHI.Org home page. ( Enter your address and password (as per your registration form) in the boxes provided and click on Log in. 2. Once you are logged in, select the last option in the menu on the left side of page entitled Extranet. If the word Extranet does not appear in menu, click Products from the menu. This will bring up Extranet in the menu. If the word Extranet still does not appear on your screen, please notify your Key Contact as they will be able to check if you have been allocated a role. Select Extranet 8

9 3. Next, select the project you want to enter from the My Projects box by clicking on the link (see the following screen display). A Project name will only be displayed in the My Projects box if you have been allocated a role within a specific Project. By selecting the 1000 Lives Plus project this will take you through to the Project s home page. There are some helpful summary user guides contained with Extranet Documents Box as highlighted above. 9

10 Navigating around the Project home page There are several tabs across the Project home page, by clicking on a tab this will navigate to the specific page selected. Project tabs are contained within the oval area highlighted below, and the following table summaries the content. 10

11 Tab Name Resources Project News Discussions Teams Workgroups Reports Page Content The resources page is set up like your personal computer directory. There are a number of folders and sub folders which contains documents that are shared across the whole campaign. Only project administrators can update this section. This section is used for sharing new news items. Not frequently used by all content areas. Discussions create and see messages. As messages distributed through discussions are sent to everyone within the project it is advisable to be mindful of the content. Once discussions are posted they can not be removed. Selecting the teams tab will take you to the list of teams. One per content area, supervised by Content Specialist. This allows any project member to view progress reports submitted by teams within the project, measures data produced by teams within the project. Another way of navigating around the Project home page is to use the boxes contained within the main body of the home page (as outlined in the red box on page 10). The Project News, Newest Project Documents and Newest Discussion boxes, display a summary of the most recent uploaded information. The All Teams box contains the list of all the names of the teams within the project. To go to your teams home page click on the relevant link. If you need to search for a specific person within 1000 Lives Plus, there is a search facility within the All Teams box. The workgroups box helpfully contains a list of links which will navigate you to a specific workgroup. 11

12 Navigating around the Team s home page The following page provides an illustration of a Team s home page. Within the oval in the left side of the internet page there is a menu which can be used to navigate to pages within the Team s home page. The boxes within the body of the team s home page (illustrated over the page) contain a number of functions which can assist you with your healthcare improvement work. 12

13 The contents and functions within the specific areas of a Team s home page are outlined in the table below. How to use these specific functions will be explained in further depth under specific functionalities. Content and functions within specific areas of a Team s home page: Screen section Name Administration Team Members Newest Resources Teams News Data Entry Newest Discussions Reports Subsection within Section Name Measure Set-Up Role Assignments Send Messages Team Profile Visit Data Deliverable Assignments Manage Aims View member details View all Current news View all Measures Changes and results New Messages View all Measure reports Function Add measures which the team can use, add custom measures. Allocate roles to new team member s. Send messages to all involved within a team page. Set up a team profile which can contain as little or as much detail as you would like to add. Not used. Not used. Add team aims. These may change over time. All members of a team and their details are listed within this box. This section contains the list of team s resources which is useful storage space assisting crossing site boundaries. This section will allow any team member to add team resources and download team resources. Current news items listed for individual teams. Optional use by individual teams. Allows users to access all teams news items listed where used. A list of all the measures selected by a team will be displayed under this heading. List both completed and pending progress reports to be completed. Where a progress report has been submitted as a completed document a green tick will appear prior to the update. Current discussions listed for an individual team. Optional use by individual teams. Allows users to access all teams discussions listed where used. View measures reported. This will produce a run chart, table containing data/annotations for each data series reported within a measure. Data can be downloaded from this section in to a Microsoft Excel spreadsheet for further interrogation. These reports can also be downloaded as a PDF and printed out. Progress reports The progress report combines both text based reporting and charts which a team has reported. 13

14 Adding a New Member to a Team and Allocating Team Role(s) A new member can only be added to a Team and allocated a role by your organisation s 1000 Lives Plus Key Contact or by a Project Administrator. Login to IHI.org and select Extranet from the menu on left side of page. To add Team members, go to your Team s home page and from the Administration block select Role Assignments. This will then take you through to the Role Assignments page. Select the role you want to assign to the user and enter that person s address. This needs to be the same address as the one they used to register with IHI.org. To notify the new participant that they have been added to the team, select the check box adjacent to the address. Click the ASSIGN ROLE button. The user will now be added to your Team and allocated the role. If the user is not registered with IHI.org, you will be prompted to create a Pending Role Assignment. Click Yes. Once the participant has registered they will be automatically added as a regular participant. Whilst allocating roles, please refer back to the different permission associated with the roles, outlined in Gaining access to the Extranet. 14

15 Adding a new document New Documents and Resources Documents can be uploaded in three main areas of the Extranet including the Resources, Team and Workgroup Resources sections. Your capacity to add a resource within specific sections of the Extranet is determined by your assigned role within the Extranet. To add a document to your Team s Resources page, firstly go to your Team s home page. You can click on the Resources tab in the menu drop-down or click on the view all link in the Newest Resource box. Both will take you to your Team s Resources page, which resembles a computer directory. 15

16 To add a resource to a specific folder place the mouse pointer over the relevant folder, then right click on the mouse. A drop down menu will appear and you will need to select add new resource. The screen below will appear. Select the resource which you want to add to the Extranet - either a document or hyperlink. You must provide the document with a name and description. To upload your document, click on the browse button. This can be located under the section File to upload. Click save and the new resource will be added to the directory. Accessing a resource Useful documents can be accessed in three areas within the Extranet, including the Resources, Team and Workgroup Resources sections. To access the documents placed on the Extranet by the central office click on the Resources tab from the Project Home page or click on view all which is located within the Newest Project Documents box on the Project Home Page. Both will take you to the Resources page, which resembles a computer directory. Resources are stored in a directory. To download resources from an open folder double click on the hyperlink to the right of the icon. The item will then download. 16

17 Measures Selecting a measure To select a measure, first click on Measure Set-Up from the Administration box on your Team s home page. Measures which have already been selected for use are under the Project Measures section. Measures which are available to be selected are in additional measures section. To activate a measure, click on the box to the left. Next, click on the button labelled activate checked measure. Please note, a group of measures can be selected and activated simultaneously. 17

18 Adding data to a measure From the team home page within the data entry section, select the measure you want to update by clicking on the measure name. From the Select Series screen click on add data. Select the correct time period and enter the data items prompted for. Next, select the Annotation type and enter a brief description of the event or change, which will appear on the chart. Click Save to finish. Labelling and adding a data series You will need to label a data series the first time you enter any data as the series name by default is called Series 1. You can also use this process to rename a series if you wish to amend the original label used. From the Select Series screen, click on Edit, make the changes and click Save. To add a new series click on the + box to the left of Add a New Series. Type in the name of the additional data series and click Save. 18

19 Creating a custom measure To create a custom measure select Measure Set-Up from the Administration area of your Team s home page. From this page, click on Add Custom Measure. Next, select the type of measure you want to create from the drop down menu. Now complete all of the sections as indicated by the screen. Remember to keep all titles short (measure, numerator and denominator names) and provide more detail in the description. This will avoid charts looking messy. Ensure you do not forget to label your Y Axis. Types of measures As well as completing the relevant titles for your measures, you will be asked to choose the type of measure. The following provides an explanation of the different categories of measures: Outcome measures reflect the impact on the patient or system and show the end result of your improvement work. For example, the rate of MRSA or the number of surgical site infection cases. Process measures reflect the way your systems and processes work to deliver the outcome you want. For example, % compliance with hand washing or the % of patients who received on time prophylactic antibiotics. Balancing measures reflect what may be happening elsewhere in the system as a result of the change. This impact may be positive or negative. For example if you have implemented changes to reduce your post operative length of stay, you may also want to know what is happening to your post operative readmission rate. Always preview your custom measure. This will allow you to check how the chart and table will be viewed. Click on the preview button which will appear at the bottom of the screen. You will be able to enter test data and this data will not be stored. Once you have tested the measure, click on the Save button which can be located at the bottom of the page. 19

20 Percentages When creating a percentage based custom measure follow the steps outlined in Creating a Custom Measure. In addition, you will need to correct the axis to display the data between the values of To set the values between uncheck the calculate min and Max Y values for graph automatically based on the data. This section is located on the bottom of the screen under Y Axis Calculation as indicated below. Do not select the LIMIT Y AXIS to 100 option. The screen will reload and allow you to set the values. Enter 0 in Min Y* and 100 in Max Y*

21 Measurement reports To create a summary report for the measures your team have selected and reported data against, go to your Team s home page. From within the Reports box, click on the Measures Report link. This will take you to another page which will contain a standard report. In addition to producing a standard report, you can tailor your report to your own requirements. The options include: Show aggregate data for project measures Include custom measures this team has created Multiple series in one graph Include archived measures To apply these options to your measures report, place a tick in the relevant boxes which can be located under reporting options. Next, click on view to refresh the report. To create a printable version of the measures report, click on View Printable Version button. If you would like to download data to Microsoft Excel, click on Download Data button. To create a PDF version of the measures report, click on Show/Hide PDF Options. There are a number of helpful options including starting charts or tables on a new page. Simply place a tick in the box, and then click on Get PDF. 21

22 Advanced measures reporting Advanced measures reporting allow users to apply run chart rules to reported measures data. There are two ways in which can access the advanced measures reporting viewing Team s data and The first method allows you to access measures reported in your team s page only. The second allows users to view own and other teams measures in the form of run charts. 1.Viewing Team s data From your Team s home page within the data entry section, click on the measure you would like to view. From the Select Series screen click on add data. Once you have selected the data series you will be taken through to an input screen which is split in to two sections: Data entry and Chart preview. The Chart Preview is the second section of the screen and you will need to click on View Run Chart which is displayed as a hyperlink above the chart in this section. This will then navigate to the advanced measures reporting screen. The Extranet will provide a summary chart and will display if any of the run chart rules apply. As highlighted by the red box. 22

23 2. Viewing other Teams data To access other teams data select Reports Tab at the top of the Project home page. Then select Measure Run Charts under Advanced Reports within the Reporting section. Selecting this option will take you through to another page, which will allow you to select the team which you are interested in. Next, select the measure which you are interested in from the drop down menu as highlighted by the green box. The Extranet will provide a summary chart and will display if any of the run chart rules apply, as highlighted by the black box. 23

24 Progress Reporting Creating a Progress Report A progress report provides a text based update or a summary of work for a Team s selected interventions. In order to complete a progress report, click on the relevant month within the Changes and Results section. This can be located in the data entry section of the team s home page. Links which have a green tick prior to the date demonstrate a report has been submitted for a given month. In this example, the next report available to complete is for February. This report should be completed prior to or on 21st March. By clicking on a link this will take the user through to the Team s progress report page. This lists the content areas and interventions which are being worked on by the team. 24

25 Current status of interventions For each intervention, Teams are able to select the status which reflects at the progress with their work: Existed Pre Collaborative: the intervention was fully implemented prior to the start of the work. Planning: setting of aims, improvement team formation and data collection planning. Testing: testing is underway in the pilot area / population Implementing: the change has been fully tested using multiple PDSA cycles and is now in the process of being implemented within the initial pilot area/population. Spread Planned: a spread plan has been developed and related activities to spread the intervention beyond the pilot area/population are being organised. Spreading: spread is underway beyond the pilot area/population. Abandoned: the organisation has elected to abandon testing the intervention. Sustaining: maintaining reliability in interventions across 100% of identified areas. In order to view the interventions within a content area, go to your Team s Progress Report page and select the + option to the left of the content area title. To select a status click on the drop down menu located under current status, as highlighted by the black box on image below. 25

26 Self Assessment Score As well as reporting on progress within a content area, teams can also provide a score on the (progress of the overall picture) in the form of a self assessment score. Each team is required to submit a self assessment score for the progress made in each reporting period. The score will range from 0.5 to 5.0. There is help available to guide the person making the assessment and this is accessed by clicking on the icon adjacent to the Self Assessment header in the Progress Report Data Entry page. The self assessment scores are as follows: Intent to Participate: The organisation has signed up to participate in the campaign Forming team: A team or teams have been formed; target populations identified; aim determined, information gathered and baseline measurement begun Planning for the project has begun: The teams have studied the How To guides for the campaign. The teams are meeting and discussions are occurring. The teams aims and measures are consistent with the campaign aims Activity, but no changes: Initial plans for the campaign have been made. The teams are actively engaged in development, information gathering, data collection and discussions, but no changes have been tested Changes tested, but no improvement: Changes are being tested in more than one of the interventions of each content area, but no improvement in measures has been noted. Data on key measures are reported and tests are connected to the content areas Modest improvement: Initial test cycles have been completed and implementation begun for more than one intervention of each content area. Evidence of moderate improvement in process measures from the monthly report. 3.5 Improvement: Some improvement in outcome measures noted, process measures are continuing to improve. PDSA test cycles on many of the interventions of each content area have been completed, changes implemented for several interventions of each content area Significant improvement: Most interventions of the content areas related to the teams aims are implemented for the initial patient population. There is evidence of breakthrough improvement in outcome measures, with the teams at least halfway toward accomplishing all of their goals. Plans for spread, consistent with the teams aims, are in place Sustainable improvement: All relevant interventions of each content 26

27 area have been implemented. Sustained improvement in outcomes measures, all of the teams goals have been achieved, and spread to a larger area of the organisation has begun Outstanding sustainable results: All goals of the teams aims have been accomplished, outcome measures are at best practice levels and spread to another patient population or area.in order to select a score, click on the drop down and choose the appropriate assessment score. In order to select a score, click on the drop down and choose the appropriate assessment score. Saving a Progress Report If you would like to save a partially completed progress report, click on Save as Draft. If you have completed the progress report, click on Save and Post as Final. If you have saved the progress report and posted as a final copy you are still able to go back in to the report to amend. Click on the date of the submitted report and this will take you to the completed report. Select Unlock and Edit Report. This will allow you to modify the report. On completion of the amendments remember to save and post the document as final. 27

28 Producing a progress report A completed progress report combines completed narrative, as well as tables and charts based upon data your team has reported. To view a completed progress report, click on the view most recent link. This is located in the Reports section of your Team s home page and will take you to another page which will contain a list of options. Once you have selected your report, there are a number of standard options that are already pre-selected for inclusion: Reporting period: Preset to most recently reported report. Detailed measures data: Shows the detailed data for each measure. Self Assessment: Includes the self-assessment and notes for the selected period. Results: Includes the results added for the selected period. There are also additional options you can choose to include in your report: Change History: This option is very useful as it provides the full reported history of a specific intervention, along with the text which has been reported against a status. Custom Team measures: This enables you to include custom team measures this team has created. If you have created custom measure you must check this option to include these measures. Combine Series: This option provides multiple series in one chart. This option is helpful, but if you have multiple data series these charts can become complicated to read. Faculty Assessment: This allows a user to show the faculty assessment and comments for the selected reporting period. 28

29 Once you have selected any additional options, click the view button to produce the progress report. The view button is highlighted below in the green box. The printing, downloading and PDF options for a progress report are listed below the reporting options, as indicated in the black oval below. To create a printable version of the progress report click on view printable version. This will open a new screen. Select File from the menu bar and then select print. To download data, click on the Download Data button, and this will then transfer your data into Microsoft Excel. To create a PDF, click on Show/Hide PDF Options and then click on get PDF. 29

30 Joining / leaving a workgroup The workgroup section of the Extranet contains useful contacts and documents for specific content areas and interventions. To join up to a specific workgroup, firstly navigate to the Workgroups page. You can either click on the Workgroup tab and or select the name of the workgroup you would like to join from the Workgroups box on the Project home page. Next, select the workgroup name hyperlink which you would like to join. Once you are in the relevant work group page you will be required to click on the hyperlink as illustrated below. To remove yourself from a workgroup, follow the same process. As above the message on the hyperlink will be slightly modified to reflect you are a current member of a specific group. 30

31 Frequently Asked Questions 1. I want to obtain access to my team s page on the Extranet. How can I gain access? Gaining access to the Extranet and your team s home page is a two part process. Firstly, you will need to register with Institute of Healthcare Improvement (IHI). To register with IHI to page 6. Secondly, you will need to obtain a role within your team s homepage. This can be done by getting in touch with your local Key Contact. 2. I want to apply run chart rules to my data. Is there Extranet a function which allows me to do this? Advanced reporting options allow you to automatically apply run chart rules to your data. To find out how to advanced reporting go to page Measures my team have created are not appearing on my measures report? Can you include custom measures within the measures report? To find out how to custom measures within your measurement report go to page Why do my custom percentage/compliance measures not start at 0 and end at 100? Can I change the Y axis to start at 0? To find out how to limit your Y axis to 0 to 100 for percentage measures go to page I want to export my data to use SPC software, how do I download my data to Excel? To find out how to download data go to page More hospitals are now reporting against specific measures. We did not clearly label our data series. Can you rename data series after data is placed against them? To find out how to name or rename your data series go to page I have logged on to the IHI.Org and used the Extranet a number of times. I have logged in to the IHI site today but Extranet option is not displayed in the usual menu. Click on the Products option within the menu on the left side of the page and this will bring up the Extranet option in the menu. If the Extranet option still does not appear, please contact you local Key Contact to check you are still registered with the team. 8. I want to track the progress of the interventions my team has worked on. Can I do this? To track progress of interventions create a progress report and to find out how to include the additional progress reporting option change history. Please refer to page

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33 Making patient safety a priority If we can improve care for one person, then we can do it for ten. If we can do it for ten, then we can do it for a 100. If we can do it for a 100, we can do it for a And if we can do it for a 1000, we can do it for everyone in Wales.