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Point of Care Hospital Pathways programme Aims & Measures Annette Bartley RGN BA (hon) MSc MPH Faculty member

Aims & Measures

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Page 1: Aims & Measures

Point of Care Hospital Pathways programme

Aims & Measures

Annette Bartley RGN BA (hon) MSc MPH

Faculty member

Page 2: Aims & Measures

The Reality in Practice

Page 3: Aims & Measures

Will

Ideas

Execution

Getting to Goal

Page 4: Aims & Measures

Transitions

Williams Bridge ‘ Transitional Management

Change is situational and can happen quickly

Transition is psychological and is much slower

* Adapted from the Transition Process by William Bridges

Page 5: Aims & Measures

Transforming Patient Experience

Metanoia: • Reorientation of one’s way of life

(The New Economics. Deming, p. 95, 1993)• Begins with individual• More than a change• Develop new habits of mind

Page 6: Aims & Measures

Programme aims

• Improve patient’s experience of care in hospital so that all patients receive a consistent & reliable quality of care

• Improve relatives experience so they can have confidence in the quality of care their loved one’s receive

• Demonstrate that the well being of staff is important not just for its own sake but for the sake of patients

• Keep patient experience of care as high on the quality agenda as safety, clinical effectiveness and finance

Page 7: Aims & Measures

Themes

1) Leadership & Values

2) Staff effectiveness & well being

3) Patient & Family centred care

4) Reliable care processes( and environment)

5) Co-ordinated collaborative evidence based care

Page 8: Aims & Measures

IHI Driver diagram

Page 9: Aims & Measures
Page 10: Aims & Measures

Improving the patients pathway of careGenerating light…not heat!

Create a sense of urgency

Frontline engagement

Partnership with patients and families

Build reliable processes

Reduce harm, waste and variation

Measurement for Improvement

Page 11: Aims & Measures

Improvement requires

Measurement & Action

Clear Aims

Quality Patient Care

Safe & Effective Patient Experience

Clarity about purpose

“what happens to me”

Clinical Outcome

Explanation of procedure/risks

involved

Choices offered/ patient/carer engagement

- Understanding aftercare/self care - Compliance assured - Lifestyle change

- Where to get help

Admission/ Referral

Assessment/ Treatment

Intervention/ Treatment

Discharge Plan/ Exit System

External ‘process’/journey Human ‘internal’/experience Rights Based

Approach

Role of the healthcare professional

What has been done to patient

Impact on patient

Expectations

Anxiety

Empathy /Engagement

NHS Forth Valley

Page 12: Aims & Measures

Improvement begins withA clear Aim

,

Measurement & Action

Page 13: Aims & Measures

The Improvement Guide, API

Aim

Measure

Action

Page 14: Aims & Measures

AIM Aims infuse meaning and hope in our lives,

they create a target to achieve and inspire and motivate us to achieve it.

How good do you want to be and by when?

Make your aims SMART• Specific

• Measurable

• Achievable

• Realistic

• Timely

Page 15: Aims & Measures

Purpose of Using Data & Measuring

The purpose of measuring is to answer critical questions and to guide

intelligent action.

Cliff Norman- Associates in Process Improvement

Page 16: Aims & Measures

“In God we trust.

All others bring data.”

W. E. Deming

Page 17: Aims & Measures

S+P=0S=Structure

The environment in which health care is provided

P=Process

The method by which health care is provided

O=Outcome

The consequence of the health care provided

Avedis Donabedian Physician

Page 18: Aims & Measures

Three Types of Measures

Outcome Measures: Voice of the customer or patient. How is the system performing? What is the result?

Process Measures: Voice of the workings of the system. Are the parts/steps in the system performing as planned?

Balancing Measures: Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures? (e.g. unanticipated consequences, other factors influencing outcome)

Page 19: Aims & Measures

Measurement Guidelines

A few key measures that clarify a team’s aim and make it tangible should be reported, and studied by the team, each month

Be careful about over-doing process measures for monthly reports

Make use of available data bases to develop the measures

Integrate data collection for measures into the daily routine

Plot data on the key measures each month during the life of the project

Page 20: Aims & Measures

Measurement Guidelines

The question - How will we know that a change is an improvement? - usually requires more than one measure

• A balanced set of five to eight measures will ensure that the system is improved

• Balancing measures are needed to assess whether the system as a whole is being improved

Page 21: Aims & Measures

When will my data start to move?

• Process measures will start to move first.• Outcome measures will most likely lag behind

process measures.• Balancing measures – just monitoring – not

looking for movement (pay attention if there is movement).

Expectations for Improvement

Page 22: Aims & Measures
Page 23: Aims & Measures

Key Aims

1. Increase the amount of time nurses spend in direct/value added care to 70%

2. Reduce hospital acquired pressure ulcers by 50%

3. Reduce in hospital patient falls by 50%

4. Increase patient satisfaction >95%

5. Increase staff satisfaction >95%

Page 24: Aims & Measures

MeasuresOutcome

1. Percentage of time nurses spend in direct/value added care

2. Incidence of Hospital acquired pressure ulcers

3. Falls rate/ Incidence

4. Patient satisfaction score >95%

5. Staff satisfaction/ well being score >95%

Page 25: Aims & Measures

MeasuresProcess

1. Percentage compliance with risk assessment /falls & pressure ulcer

2. Percent compliance with SKIN bundle /Intentional Rounding

Balancing

3. Length of Stay

4. Complaints

5. Staff turnover /Sickness rates

6. Budget implication

Page 26: Aims & Measures

Visual Measurement

1 2

3 4

5 6 (3)

7 8 (1) 9 10 11 12

13 14 15 16 17 18

19 20 (1) 21 22 23 24 (1)

25 (1) 26

Days since last... 27 28 (1)

___ days 29 30 31

Page 27: Aims & Measures

Ward 14 (was 11)

0

12

3

4

56

7

89

10

30/0

6/20

08

21/0

7/20

08

11/0

8/20

08

01/0

9/20

08

22/0

9/20

08

13/1

0/20

08

03/1

1/20

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24/1

1/20

08

15/1

2/20

08

05/0

1/20

09

26/0

1/20

09

08/0

2/20

09

14/0

2/20

09

02/0

3/20

09

23/0

3/20

09

13/0

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04/0

5/20

09

25/0

5/20

09

15/0

6/20

09

Period

Indi

vidu

al V

alue

Special Cause Flag

Ward 9 Comparisons Percentage of Time by Activity

16.5

7.7

10.712.9

9.9

42.3

19.8

2.5

6.2

12.9

7.7

50.9

15.4

3.6 3.1

13.8

5.0

59.1

4.8 4.9

8.2

16.3

5.5

60.2

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

Discussion Interruptions Motion Other Admin Patient Care

%ag

e of

Tim

eMay-08

Oct-08

Feb-09

Jul-09

Page 28: Aims & Measures

Engaging Heart & Minds

‘If you want to build a ship do not gather men together and assign tasks. Instead teach them the longing for the wide endless sea’ (Saint Exupery, Little Prince)

Page 29: Aims & Measures

You are this Hospital. You are what people see when they arrive here.

Yours are the eyes they look into when they’re frightened and lonely. Yours are the voices people hear when they are in the lifts and when they try to sleep and when they try to forget their problems. You are what they hear on their way to appointments that could affect their destinies and what they hear after they leave those appointments.

Yours are the comments people hear when you think they can’t. Yours is the intelligence and caring that people hope they’ll find here. If you’re noisy, so is the hospital. If you’re rude, so is the hospital. And if you’re wonderful – so is the hospital.

No visitors, no patients can ever know the real you, the you that you know is there — unless you let them see it. All they can know is what they see and hear and experience.

And so I have a stake in your attitude and in the collective attitudes of everyone who works at Cooley Dickinson Hospital. We are judged by your performance. It is judged by the care you give, the attention you pay and the courtesies you extend.

Thank you for all you are doing. CEO Cooley Dickinson Healthcare Org