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Transforming Interprofessional Care and Organizational Performance through
Best Practice Implementation
June 12th 2015
Tracey DasGupta, Director of Interprofessional Practice
Beth O’Leary, Program Manager
We were asked to talk about:
How we:
• Positioned Best Practice work strategically
• Leveraged & aligned with other work
• Fit this work into existing organizational priorities
Sunnybrook Health Sciences Centre • Fully affiliated with University of Toronto
• 1,200 inpatient beds / 125 critical care beds / 26 operating rooms
• 10,000 staff and 2,000 volunteers located at Bayview and Holland
• Each year we:
– Care for 1 million patients (about 70% are from outside of Toronto)
– Teach 2,000 students (from around the world)
– Conduct in excess of $100 million in research
• One of Canada’s Top 100 Employers (two years running)
• 3.2 million square feet of buildings on 95 acres of land
• We consume 13,000 cups of coffee per day!
BPSO Reflections from the Early Days
• ‘Oh my’
• Listening to others
• Images & models that resonated with us
• Spent fair bit of time planning
Alignment & Coordination of Activities
PATIENT CARE IMPROVEMENT INITIATIVES
Improved Patient Care
↑ efficiency ↑ engagement ↑ coordination
Middle Leaders
Frontline Staff
INTERPROFESSIONAL APPROACH
5
Program /
Unit
Client
Centere
d Care
Assessme
nt &
Managem
ent of Pain
Risk
Assessme
nt &
Preventio
n of
Pressure
Ulcers
Care &
Maintenan
ce to
Reduce
Vascular
Access
Complicati
ons
End of
Life
Care
During
the
Last
Hours
& Days
Preventio
n of Falls
& Fall
Injuries in
the Older
Adult
Corpora
te Corporate
TECC
M2 CVICU
CRCU
D4 ICU
B5 ICU
C5
D5
Ross Tilley
Burn Centre
ER
Holland
MSK
3E & Special
Care
6E
7E
Client Centered Care to support roll out of each practice Local implementation to align to specific units Director Sponsor for each BPG
Green = Corporate Implementation Blue = Broad Practice Change Yellow = Focused Quality Improvement
BESTPRACTICE IMPLEMENTATION
Q22 0 1 2
Ju ly –
Se p t
Q3 Oct –
De c
Q42 0 1 3
Jan –
M ar
Q1Ap r –
Ju n e
Q2Ju ly -
Se p t
Q3Oct –
De c
Q42 0 1 4
Jan –
M ar
Q1Ap r – Ju ne
Q2Ju ly -
Se p t
Q3Oct - De c
Q42 0 1 5
Jan –
M ar
P C C
GIM HOL
P AIN P AINSURV
RESULTs
GIMB4 , C 4 ,
D2 , D4
HOL3 E, 6 E, 7 E
SK IN & WOUND TEC C C VIC U
C RC URTBC
B5 IC UD4 ICU
C OM MC 4
SC HULD3
ONCC2 , C6, D6
EOL ONCC 2 , C6, D6
VETK 1 E / K 1C
FALLS HOL3 E, 6 E, 7E
C OM MD2
SC HULD3
TEC CED
ONCC 2
ST JOHNSA3 , A4
VETK 2 E K 2 C
LTSE LTSWLFSE LGSE
LGSW LSSWLSSE
TEC CC 5
D5
VA TEC CC 5 , D5
C OM MB4
ONCC 6
SC HULD3
C IC USS
HOL3 E, 6 E, 7E
C OM MD2
Person-Centred Care Strategy Development
Stakeholder Engagement in the Development & Approval of a
Corporate Pain Policy
Corporate Implementation –Leaders / ACNRT / IP
Development of Standard Order Sets, Comfort Orders & Customized Evaluation
Corporate Implementation
Branding
We identified this was important
Wanted to reflect this not as discreet pockets of work
Rather it all fits together
Focus: Developing structures and processes to support ALL Best Practices
Clinical & PCC
Clinical & PCC
Clinical & PCC
Clinical & PCC
Professional Practice Committee Reporting Structures
Focusing on Staff as Champions
11
Champion Development / Year
100 Nursing + 25 IP Team Members
Developing a Unit Engagement Strategy And a Network Structure
Vision in 2015: To achieve a Critical Mass of > 375 staff who: Understand quality improvement
Seek best practice Use data to drive decision making Implement small tests of change
Support & sustain clinical best practice
Change Coordinator Role
KEY
13
Project Charters Standardized Communication
SBAR pic
Identify Alignments & Synergies
• With Quality & Patient Safety
• With the Office of the Patient Experience
• Operations Directors
• Accreditation – alignment of # of BPG’s
• Quality Improvement Plans
• Other – physicians, patient & family members
14
NHS Sustainability Model Source: National Health Service, UK
The Plan
• Implement 6 interprofessional best practices
• Programs to identify where there is the greatest opportunity for enhanced practice – ‘measurement units’
• Expect broad uptake across the hospital
• iLead Champions recognized as the vital link for successful implementation
• Focus on measurement
• The foundation will support all future work
THE JOURNEY
Year 1, Year 2, Year 3
PEOPLE: The iLead Champion
• Identify / Engage / Educate
PROCESS: Living Best Practice
• Data / Ongoing Education / Support
ORGANIZATION: Infrastructure
• Connecting / Networking / Profiling
Thoughts we had along the way
• Complexity theory
• Stay the course
• Stay united
• Progress not perfection
• Sense of humor is important
FAST FORWARD TO NOW
VISION
Collaborative interprofessional practice environment
that focuses on what matters and what is important to patients, where there are established processes to
ensure best practice drives what we do
and we do it well
every time…..
PEOPLE
Skilled, equipped & supported
PROCESS
Clearly defined &
understood
ORGANIZATION
Profiles & supports the
work
New Practice
Knowledge to Practice
Interprofessional Champions
Develop knowledge and skill through
participation in iLead Foundations
education
Champions come together in iLead
Connects meetings
Have Best Practice focused dialogue
Focus on data
Champions receive education & support to understand data
Champions are enabled to share
information & engage colleagues in
conversation to enhance patient care
outcomes
PROCESS Support & Sustain
an Evidence Based Culture
ORGANIZATION Connect
Champions & Integrate Best
Practices
PEOPLE Build Capacity
& Develop Leaders
iLead Champion Role
KEY
TAHSNp and Innovation Fellowship
Champion Engagement n=60
Development of iLead Champion Toolkit
Broad Engagement N= 1000
Capacity and Leadership Champion and Leadership Roles
iLead Champions learned to lead best practice implementation to improve quality of care and the patient experience 540 iLead Champions 100 interprofessional champions 4 Change Coordinators 2 RNAO Advanced Clinical Fellowships 2 TAHSNp Innovation Fellowship 1 Patient Engagement Collaborative Lead
An iLead Champion is passionate about patient care improvement and actively promotes, educates and inspires team members to
implement change and evidence based practices into every day care.
CONNECTING CHAMPIONS
MEANINGFULLY
Interprofessional Team Dialogue
Discussion in clinical areas
What is the data telling
us?
How is my unit doing relative to
other units?
How are we moving
collectively toward the
target What do we need to do to continue to improve?
iLead Champions Connect
Some Examples
Maria Teresa Salazar Marva McCalla
Swati Rathod Rebecca Liang
Will Wong Andre Feliciano Andrea Nunn
Network Events
WHY IT MATTERS
Corporate Best Practice Data Q3 2014/15 Update
iLEAD… THE CALL TO ACTION
Best Practice Dashboard
• User friendly tool for front line staff to review best practice performance data and generate local improvement plans
• Builds front line capacity of champions for quality and patient care improvement
• Enhances organizational action to enhance patient outcomes
iLead… the Call to Action
1. What is our current status?
2. How are we moving toward the target?
3. What do we need to do to continue to
improve?
Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec
Dashboard Release –
Champions receive info /
education & support
Middle Leaders create
space & support
champions to discuss &
plan next steps @ Unit /
Program levels
Successes of Unit /
Program dialogue shared
at Nursing Council & with
Best Practice Working
Groups
Champion are profiled
organizationally in regard
to enhanced outcomes
iLead Connect
iLead Connect
iLead Connect
iLead Connect
Champion B’fast
May 27th Network
Nov 25th Network
iLead Connect
iLead Connect
iLead Connect
OTHER ALIGNMENTS / SYNERGIES /
STRUCTURES
Inclusion in Quality Improvement Plans
• Person-Centred Care – 2 years – target > 93 to 95%
• Falls Risk Reduction – 2 years – focus > from 9 to > 60 patient care areas
• Quality Dying – 1 year
• Mobility / Preventing & Managing Delirium – 3 years
16-week Implementation Plan
0 20 40 60 80
100
Jan
-…
Ap
r-…
Jul-
…
Oct
-…
Jan
-…
Ap
r-…
Jul-
…
Oct
-…
Jan
-…
Overall, how would you rate the care you received at the hospital? -
Holland Centre
6E
3E
7E
Target 99%
Sunnynet Intranet Resource
Partnering with Patients and Families
Video Project Innovative interprofessional staff, student, and physician
education that supports the Person-Centred Care strategy by partnering with patients and families.
Patient and Family Forum
Create videos highlighting key messages to improve the care and the patient experience
Partner with patients and families to deliver education
Person Centred Care Processes Documentation of Care
Standardized Care Planning Tools: Questions for Team Rounds
Patient and Family Engagement Tools
Going Forward
• Other Best Practices engaging in this model – Initial 6 + Mobility, Delirium Prevention, Smoking Cessation, Diabetes, Phlebotomy,
Quality Based Procedures …
• Ongoing Quality Committee / Board reporting
• Engagement of Board Members in “Walk Abouts”
• Planning for Dashboard Releases, Connects, Network Events
• Toolkit creations
– Organization wide Person Centred Care Implementation
• Ongoing role of the Change Coordinator
• Further alignment; Best Practice, Quality, Patient Safety
THOUGHTS / QUESTIONS / WHAT DO
YOU WANT YOUR JOURNEY
TO LOOK LIKE?