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A presentation by Annette Bartley
Citation preview
Point of Care Hospital Pathways programme
Aims & Measures
Annette Bartley RGN BA (hon) MSc MPH
Faculty member
The Reality in Practice
Will
Ideas
Execution
Getting to Goal
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
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
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
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
IHI Driver diagram
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
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
Improvement begins withA clear Aim
,
Measurement & Action
The Improvement Guide, API
Aim
Measure
Action
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
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
“In God we trust.
All others bring data.”
W. E. Deming
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
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)
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
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
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
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%
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%
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
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
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
08
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
4/20
09
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
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)
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