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Redesigning Acute Care for Older People: The Start of Sheffield’s Journey. Tom Downes MB BS, MRCP, MBA, MPH (Harvard) Clinical Lead for Quality Improvement Sheffield Teaching Hospitals The Health Foundation / IHI Quality Improvement Fellow 28 th November 2012. Healthcare inflation. - PowerPoint PPT Presentation
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Redesigning Acute Care for Older People:The Start of Sheffield’s Journey
Tom Downes MB BS, MRCP, MBA, MPH (Harvard)
Clinical Lead for Quality ImprovementSheffield Teaching Hospitals
The Health Foundation / IHI Quality Improvement Fellow
28th November 2012
Healthcare inflation
Rises in healthcare spending: where will it end?
Jon Appleby, BMJ 1st November 2012
• 4.3% per year over the last 30 years• Driven by technology and expectation• Only 0.4% attributable to ageing• Need to deliver over 20% more care in 5 years’ time• Need to deliver over 50% more care in 10 years’ time
UNSUSTAINABLERises in healthcare spending: where will it end?
Jon Appleby, BMJ 1st November 2012
‘We must redesign services.
Decisions about service redesign must be clinically led and clinicians must be prepared to challenge the way services - including their
own service – are organised.’
Hospitals on the Edge – The time for action
Royal College of Physicians, 13th September 2012
Day 2127 as a consultant
A ‘system’ problem
A complex system problem
2003 Toyota Corolla
Toyota Oobeya Room
How do others design complex systems?
First find a room
The Room
Board 1: The Business objectives:
GSM weekly bed occupancy from April 07 with target lines
Board Level Business objectives for GSM
Board 2: What do these objectives mean for our patients?
A Future StatediagramOf the GSM Process as it evolved
Post-it note comments from stakeholders
Board 3: How are we doing against the GSM business and patients objectives?
Board 4: High Level GSM Process through the complex
health and social care system & Board 5: Real time plan
High Level: Current State Map of the GSM process
Programme Plantime
April 01 2012
Each row presents the tasks (yellow post-its)tobe performed by each stakeholder group
Tests
Let me introduce ‘George’
•82 years old•Lives independently and wants to continue doing so•Widowed 5 years ago•Has mild dementia•Daughter lives locally•Losing weight and finding walking more difficult
PDSA tests of moving from ‘post take’ to ‘on take’
Challenge to UK geriatric medicine traditions:
Split of inpatient / outpatient care
Combined immediate delivery
of specialist MDT care
Batching patients for ‘Post-take ward round’
Real-time senior specialist review (7/7)
Bedded medical assessment unit could be unnecessary for most geriatric medicine patients
Twice weekly senior clinician ward rounds
Daily senior decision capability on every ward
MDT planning meetings
Assess needs at home once acute hospital environment no longer adding value
Porter’s Value Based Design
VALUE
What Is Value in Health Care? Michael E. Porter, Ph.D. N Engl J Med 2010; 363: 2477-2481December 23, 2010
Implementation headlines:
• April 2012
• New discharge process from assessment units
• Consultant geriatricians ‘on take’ 7 days per week
• May 2012
• Frailty Unit process initially virtually
• Frailty Unit opens mid-May
• July 2012
• Ambulatory care area for work formerly considered to be outpatient
Outcome measure: 34% increase in discharge within 1 day
Outcome measure: Bed occupancy reduced by over 60 beds
Was reduction in bed usage due to reduced admissions? No
Balance measure: Would it have happened regardless?
Balance measure: Decrease in readmissions
Balance measure: Decreased mortality
Value
Value = Outcome / Cost
Return on investment
= Saving – Investment / Investment
= (£3,000,000 - £750,000) – 140,000 / £140,000
= 2,110,000 / 140,000
= 15
• Resources have started to move to the community
• Designing hospital@hospital and home@home
Not hospital @ home
‘Improvement in health care is 20% technical and 80% human’
Marjorie Godfrey
The Dartmouth Institute
Conclusion
• Modern health care is complex• Iterative testing and prototyping is required• Cooperation between and health and social care is essential• Our journey has only just started