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  <head>
    <title>073-03 Improvement methods, teams and escalation, governance, patient partnership, and sustaining change</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Quality improvement and safer systems">
      <outline text="Aim and theory of change">
        <outline text="Iterative system change, not motivation alone"/>
        <outline text="Aim: population, outcome, magnitude, timeframe">
          <outline text="&quot;Improve safety&quot; is too vague"/>
        </outline>
        <outline text="Ambitious yet realistic target"/>
        <outline text="Driver diagram links aim to changes">
          <outline text="Theory explains why each change works"/>
        </outline>
        <outline text="Outcome, process, and balancing measures">
          <outline text="Baseline data before declaring improvement"/>
        </outline>
      </outline>
      <outline text="Disciplined iterative testing">
        <outline text="Plan-do-study-act: predict, test, compare, adapt">
          <outline text="Learning, not merely doing"/>
        </outline>
        <outline text="Vary shifts, staff, patients, pressure"/>
        <outline text="Small tests must not become endless pilots"/>
        <outline text="Scale needs core elements and ownership">
          <outline text="Different context may cause failure"/>
        </outline>
        <outline text="Education alone is weak">
          <outline text="Strong: eliminate, force, standardise, simplify"/>
          <outline text="Weak actions rely on vigilance"/>
        </outline>
      </outline>
      <outline text="Checklists and bundles">
        <outline text="Checklists for critical, often omitted steps">
          <outline text="Short, timed to workflow, shared pause"/>
        </outline>
        <outline text="Bundles: small set of evidence-based practices">
          <outline text="Aggregate compliance can hide one omission"/>
          <outline text="Documentation is not bedside delivery"/>
        </outline>
        <outline text="Checklist fatigue from overlapping tools"/>
        <outline text="Routine bypass: examine the rule first"/>
      </outline>
      <outline text="Medication and diagnostic systems">
        <outline text="Standard concentrations, barcodes, decision support"/>
        <outline text="Low-value alerts teach overriding"/>
        <outline text="Track pending results with explicit owners"/>
        <outline text="Show trends and unresolved abnormalities"/>
        <outline text="Portals cannot transfer responsibility"/>
        <outline text="Trigger tools select cases for review"/>
      </outline>
      <outline text="Teams and escalation">
        <outline text="Briefings, huddles, debriefings"/>
        <outline text="Graded assertiveness needs safe leader response"/>
        <outline text="Escalation policy: whom, when, alternatives">
          <outline text="Patients and families can activate review"/>
        </outline>
        <outline text="Emergency roles and closed-loop orders">
          <outline text="Hot debrief, then later system review"/>
        </outline>
      </outline>
      <outline text="Sociotechnical change">
        <outline text="Stakeholders affected, controlling, working"/>
        <outline text="Resistance may be legitimate safety concern">
          <outline text="Listening improves design"/>
        </outline>
        <outline text="Computerised orders add new error types">
          <outline text="Wrong patient, defaults, copy-forward"/>
        </outline>
        <outline text="Automation shows uncertainty, allows challenge"/>
        <outline text="Cybersecurity is patient safety">
          <outline text="Backups, segmentation, usable downtime plans"/>
        </outline>
      </outline>
      <outline text="Governance for learning and accountability">
        <outline text="Easy, confidential reporting with feedback"/>
        <outline text="Voluntary reports cannot estimate incidence">
          <outline text="Combine with review, triggers, observation"/>
        </outline>
        <outline text="Just-culture responses matched to behaviour">
          <outline text="System contribution keeps personal duty"/>
        </outline>
        <outline text="Boards need data, stories, closed actions"/>
        <outline text="Documentation can become performative compliance"/>
      </outline>
      <outline text="Patients as partners">
        <outline text="Patients confirm, but safety stays with service"/>
        <outline text="Speaking up limited by illness and hierarchy"/>
        <outline text="Co-design includes those most affected"/>
        <outline text="Support harmed patients and involved staff">
          <outline text="Staff support must not silence accountability"/>
        </outline>
      </outline>
      <outline text="Sustain, spread, and evaluate">
        <outline text="Control plans with owners and review dates"/>
        <outline text="Improvement decays when attention ends">
          <outline text="Embed in orientation, equipment, budgets"/>
        </outline>
        <outline text="Stratify to avoid widening inequity"/>
        <outline text="Spread keeps causal core, adapts form">
          <outline text="Adaptation without theory loses active ingredient"/>
        </outline>
      </outline>
      <outline text="Ethical use of resources">
        <outline text="Quality improvement keeps ethical obligations">
          <outline text="Minimise data, protect confidentiality"/>
        </outline>
        <outline text="Opportunity cost of new protocols">
          <outline text="Nursing time, delays, work shifted to patients"/>
        </outline>
        <outline text="De-implement ineffective practices"/>
        <outline text="Complete when safety persists without extra effort"/>
      </outline>
    </outline>
  </body>
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