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ISS Service Innovation Leadership Seminar, 28 March - "Design Thinking and Service Innovation - The Khoo Teck Puat Hospital's Journey" by Mrs Chew Kwee Tiang, CEO, Khoo Tech Puat Hospital
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Innovation in Healthcare- Our Journey Thus Far
Mrs Chew Kwee TiangChief Executive Officer, Khoo Teck Puat Hospital
Alexandra Health System
KTPH
Yishun Community
Hospital
Community Based Care
Villa Francis Nursing Home
& Others
Old Folks’ Homes
Yishun Polyclinic &
Others
Woodlands MedicalCentre
GPs
2
Regional Health Systems in Singapore
We are Alexandra Health System!
Regional Health Systems in Singapore
We are Alexandra Health System!
3
Alexandra Health
Vision“Help our people live a long and healthy life and support them with thoughtful and dignified care to the end.”
Mission“Provide good quality, affordable and hassle-free healthcare with science, love and wisdom.”
Tagline“Touching lives, Pioneering Care, Making a Difference”
TransformingHealthcare Delivery
Design Challenge:
5
Insight Into Healthcare Needs of Patients
6
Pre-illness Illness Post-illness
Health Maintenance• Vaccination• Public Health Education• Health Screening• Workplace Health promotion
Illness Care• Cost effective, efficient care
- systems processes - clinical pathways
Health Recovery• Skills-for-life• Homecare support• Follow-up support
Head-to-Toe Lifelong AnticipatoryHealthcare of Whole Person
7
Fast Medicine
Slow Medicine
Cruise Medicine
(Assembly Line)
Khoo Teck Puat Hospital Woodlands Medical Centre (2017)
Yishun Community Hospital (2016)
8
PopulationClassification
Managing The Population In The North
Well Healthy
Well UnhealthyUnwell
Unhealthy(Early Stage)
Unwell Unhealthy(Late Stage) Frail and Dying
Population Health Programmes Ageing In PlaceCare Model
Pre-illness
Illness
Post-illness
KTPH YCH WMC
Acute care &Chronic Disease Management
Wellness Centre/ Community
GPs, Polyclinic, KTPH Nursing HomesSetting of Care
Yishun Community Hospital
9
4 Design Concepts
1. Health Promoting
2. Improve community health
3. Enable ageing in place
4. Design hassle-free experience
10
Health Promoting Hospital
11
Design Concept 1
The Thinking Behind The Design
Be The
CHOICE
ARCHITECT
RELATEREPEATREFRAME
Shape
The
PATH
12
Innovation : Create a Living Lab at KTPH
13
Workplace Health
Health for Life System
Personal Health Record Risk Stratification Corporate Health Report
Lifestyle Maintenance(Low Risk)
Lifestyle Modification(High Risk)
Disease Modification(Chronic Disease)
1. Overview of employees’ health status
2. Determine target Interventions
3. Focused resources on relevant staff
Measure outcomes, progress report, etc
inputs
outputs
Health Risk Assessment
Biometric Parameters/Lab Inx
Clinical Practice Guidelines
Current Evidence
HR inputs
14
Determinants : Philosophy, Value, Attitude, Knowledge, Discipline
15
16
PARTICIPATION
2380 staff
77%
PARTICIPATION3088 staff
85%
17
Annual Staff Health Screening
Individual Health Screening Reports
• Patient Portal• View all your health screening results• Visualize your health status over the years
18
Improve Community Health
19
Design Concept 2
Health Education in the Community
• Mini Medical School
• Workplace health programmes
• Community health programmes
Mini Medical School 1st Run Jan 2013LIVE! Programme in workplace and community
20
Sharing Best Practices With Workplaces
190 WHP
Practitioners
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Sembawang Shipyard Onsite Diabetes/HBa1C & Eye Screening & Tele-consultation
Service Innovation: Facilitated Network @ Sembawang Shipyard
Foot Screening & Skills for Life
Global Healthy Workplace Award 2013
23
Piloting Population Health: A Transformation @ Sembawang & Choa Chu Kang
IN SHORT, TO CHANGE SOME 140,000 PEOPLE IN 3 YEARS
In three years, we target to support at least 50% of screened residents age 40 years and above to take greater personal
responsibility for their health.
24
Ageing In Place
Design Concept 3
25
Subsidised
Private
Fiscal year 2010 Fiscal year 2011
The Impetus To InnovateA Local Challenge – High Bed Occupancy at KTPH
26
70% of health determinants can be changed or modified
Socio-economic pressures
Unsafe homes
Self-medication
PolypharmacyUntrained caregiver
Things we would never see until we made home visits – and those we can change
Determinants Of Health Can Be Modified
27
Service Innovation: Setting Up Community Wellness Centre And Nursing Post
28
29
Discharge triage Transitional Care Programme
Patients that requires continued medical support at home after discharge
Community Nurse Programme
Care plan
Allied Health support
TherapistsDietitian
Pharmacist
Clinical supportGP
PalliativeEarly Review
Clinic
Social supportFinancial
VolunteersDomestic support
Community Nurse Post1. Community engagement2. Early disease detection &
management
An Integrated Discharge Plan In The Community
29
Home modificationEnhancement for
Active SEniors (EASE)
Collaboration with grassroots &
community agencies
Home help
Community Case
Management Service
Home medical & nursing
Temporary domestic help upon
early discharge
Integrated Single Point of Contact
AIP Partners
30
Before home visits-- After home visits
Average no. of admission for a single FF
Average length of stay for a single FF
Pilot Study: Early Results400 patients completing 6 months of care
6.17 days
3.5 admissions
1.2 admissions
5.94 days
47%
No Readmission
31
Design Hassle-free Experience
Design Concept 3
32
Know What The Patients Value
Treat/Advise Treat/Advise DiagnoseDiagnose
Respect for patients’ dignity
Clear and accessible information
Integrated care and services
Consistent, good quality care and services
Cost effective care
33
Provide a level of patient care
and service good enough for
our own mothers, without the
need for special arrangements.
34
Define Hassle-free Hospital
Doing things right for the patients, and delivering value safely, from the time he enters, till he gets out of the hospital.
-wait -delay- reworks
luevalue
Wow!
35
Innovation is for improving our patients’ experience and it is everyone’s responsibility.
Share a Common Understanding of Innovation
Patients Flow Fast & Yet Safe
Enhanced Allied Health Services such as Radiology, Lab, Pharmacy etc
37
Patient Value Stream (SOC, DEM)
We Know You
Know meDiagnose
meTreat me Advise
me
Patient Flow
Patient Education
Head-to-Toe Diagnosis/Treatment
Anticipatory Care
20mins 20mins 20mins0 mins
0 mins 0 mins 0 mins
60mins
Information / Material Flow
Know me Recognise me
Direct meDiagnose me
Track meTreat me
Advise meClose encounter with
me
38
39Pt Info
Transport
Investigations(Outpatient)
Medications
TCU
Portering
Transport
Investigations
Treatment
Diet
Pt Info
Nursing care
Portering
Diet
Pt Info
Nursing care
Surgery
Portering
Preparation
Transport
Nursing care
Investigations
Treatment
OT Listing
Pt Info
Diet
Pt Info
Investigations
Treatment
Clerking
Nursing care
Pt Info
Orientation
Portering
BMU
Financial Counselling
Dressing
Lab test
Investigations
Pt InfoAssessment
Pt Info
Clerking
A & E Triage Registration Wait for Consult ConsultationPost Consult Treatment
Discharge
Inpatient Admission
Nursing Assessment
MedicalAssessment
Pre-Operation Operation Day Post Operation Recovery
Discharge
Admission for Acute Illness
1. Medicine consists of systems, processes and interdependencies
2. Patients’ requests are not requests of parts of us, but requests of the whole
3. To make any significant impact, the change must include all
Why Is Change So Difficult In Healthcare?
39
Visual Management At The Emergency Department
Consult
Info Board
Triage
40
Current Way of Admitting A Patient In DEM
Front counter staff needs to use 6 different softwares to admit one patient to the ward
Financial Counselling
Hospital Patient Management & Billing
System
Checking Insurance
A&E Careline System
Bed Management System
Medisave 41
World view: top part
Bed Management: Overview of Bed Status
42
Bed Management
43
Bed Census
44
Dr orders test in SCM
Phlebo takes & dispatches blood
Lab receives & processes blood
Blood result available in SCM
Problem:“Nurse disintermediation” syndrome.
• Nurse totally out of the loop!• Because NO more paper trail & visual cues.• Lab orders and results no longer visible unless
nurses watch SCM all the time.
45
Electronic Lab Order Workflow
Problems
• CT/MRI orders with Patient Consent not easily tracked
• Nurses unable to chase doctors to obtain consent
• Numerous calls (at least 2-3 calls) needed between ward nurses and Radio dept to check consent/IV plug/fasting status, fix appt and arrange patient transport.
Dr orders MRI in SCM
Dr explains procedure & takes consent from patient
Nurse faxes completed consent to Radiology Dept
Radiology calls back to give MRI appt
Radiology calls at appt time to send patient down
MRI result in SCM
46
Electronic CT/MRI Order Workflow
Nursing AndonRadiology Andon Pharmacy Andon
SCM47
13 Andon ‘Eco-Systems’
Lab Order status
Lab Result status
Rad Order status
Consent status
ECG order
Discharge tracking
Nursing Andon
49
Andon Board for Pharmacy
49
C-I
VO
C 2
01
2
Handling PatientsHandling Patients
Quick LinksQuick Links
AppointmentsAppointments
Planned Appointment
Currently Warded
Regular Patient
C41 PSA JamilahPreviously AttendedHealth Screening
Building Patient Journey through C-IVOCC
-IV
OC
20
12
Medical Care Me
Recognize and
Direct Me
Know Me
Discharge Me
Keep in-touch with
Me
SAP
FICO
SCM
PFS
SAPISH
iHFL
SCMSA
PISH
iHFL
SCM
SCM
SAPISH
SAPISH
Phase 1
Data from Multiple SourcesSAP, SCM and iHFLData from Multiple SourcesSAP, SCM and iHFL
iPharm
MRMS
MRMS
PFS
ELPIS
51
Computerised, Integrated View of Customer (C-IVOC)
• Know me
• Identify me
• Direct me
• Track me
• Clear the way for me
• Close the encounter with me
• Stay in touch with me
Thomas*
52
Use Of Technology To Improve Service At Multiple Touch Points
Experimentation in teletriage and teleconsult
Queue ViewerBed Management System
MMS – Wound Care
Self Registration
53
Grab a bite!
Paging Service
Home Sweet Home
Pre-Appointment
Remindervia SMS/Letter
Appointment Day Registration
Blood Test
Consultation
Post Consult ServicesAppointme
nt & Payment
Pharmacy
“WOW @ Specialist
Outpatient Clinic ”
Preparing you for Hospital
Admission
Height & WeightChaperon
Your Your experience experience starts here starts here
Waiting for
Consultation
Meal Voucher
Touching Lives, Pioneering Care, Making A Difference,
Designing Touchpoints
54
Design Approach
FOCUS ON PATIENT EXPERIENCE
Patient Value Met
• Quality • Respect • Information• Care integrated• Effective
Outcome Achieved
•Diagnose, treat, advice•Better, Faster, cheaper,•safer
Value stream
•Identify Value•Value Stream•Flow•Pull•Pursue Perfection
workplace
•Location•Layout•Automation•Human factor•Health promoting
Service/Care Processes
•Model of care•Care standards•Service standards
Customer Experience
•AH Service Ways•Touchpoint •Care point
Design
Line of visibility
DESIGN THINKING
WHAT THEY WENT THROUGH
HOW THEY FELT DURING THEIR EXPERIENCE
IDENTIFY PROCESSES THAT NEEDS TO SUPPORT THESE PATIENT SERVICES
LINE OF VISIBILITY
55
Our Approach
1. Agree on what is patient Value.
2. Articulate patient value streams.
3. Identify service touch points (WOW)
4. Act on functional, mechanic and humanic clues
5. Take small steps in rapid succession.
6. Do what you can with what you have.
7. Learn, teach, design and do.
56
•Do what you can with what you have
•Little touch points count
Teaching & training aid for patient and staff
57
Silent clock Anti-slam device Night light
Message boardFloral headboard
Electronic patient locator
Ideas From Staff & Patients
Ergonomic food tray
58
Apples and Blankets
Ideas thatSave lives
59
| Design Thinking in AHS|Eye Clinic
Patient Waiting Experience
60
INTRODUCTIONBACKGROUND: TO SOLVE WAITING TIME ISSUES
OUR FINDINGS: THE WAIT HAS TO BE JUSTIFIED“Patients do not mind waiting, as long as they know what, why and how
long they are waiting for.”
61
INTRODUCTIONBACKGROUND: TO SOLVE WAITING TIME ISSUES
OUR FINDINGS: PATIENT’S VALUE HAS TO BE MET“I felt very shiok after the doctor did such a thorough check on me, no
wonder I had to wait so long! It was worth it!”
62
INTRODUCTIONREFRAME THE PROBLEM STATEMENT
IT’S ABOUT ENHANCING THE
EXPERIENCE OF THE WAIT
AND DELIVERING VALUE TO
THE PATIENT
WAITING
TIME/TURN
AROUND TIME IN
THE CLINIC
ORIGINAL PROBLEM REFRAMED PROBLEM
63
RESEARCH FINDINGSWHAT DO PATIENTS VALUE?
KTPH HEALTHCARE INNOVATION AND RESEARCH
COMPETENCYCONCERNCLARITY
To help patients feel more empowered in their experience.
To help patients feel like they are being cared for.
To assure patients that they are in good hands.
(e.g. providing a suitable waiting room environment, testing environment, the human touch)
(e.g. eliminating inconsistencies, information communicated to the patients)
(e.g. seamless processes, communication within staff and healthcare system, well-equipped machines)
64
OBSERVATION FINDINGSCLUES TO PATIENTS’ ANXIETY AND NEED FOR SIMPLICITY
NEED TO KNOW THE NECESSARY“ She was telling me so many things inside, I don’t think I can remember all of them, so I
wrote the important details on my hand so that I won’t forget.”
PATIENT’S PERSPECTIVE
PATIENT’S PERSPECTIVE
“I don’t like the feeling of missing out on things I should have told the doctor after I leave the
consult room, that is why I am writing down all my problems while I wait for my turn.”
AFRAID TO LEAVE OUT INFORMATION
65
RESEARCH FINDINGS
“I was trying to cooperate, but he was just dripping until the drops keep rolling down my face. He
asked me to look up, but I wasn’t sure how up is up.”
HAVING THE RIGHT ENVIRONMENT
PATIENT’S PERSPECTIVE
STAFF’S PERSPECTIVE
“From my past experience working in other eye clinics, it is a common problem to get elderly to
do the dilation drops as it is harder for them to lift up their heads.”
DIFFICULT FOR ELDERLY PATIENTS
NOT GUIDED IN THEIR EXPERIENCE TO COOPERATE WITH US
66
PROTOTYPEBUTTERFLY ON CEILING AS VISUAL CUE
1st Prototype 2nd Prototype
Without Target
With Target67
OTHER PROTOTYPINGEXPERIMENTS IN THE EYE CLINIC
DILATION TROLLEY ORIENTATION GUIDE
68
Job Shadowing Training Nursing Home NursesTelemedicine Exposure
Telemedicine at Nursing HomesCare Delivery Innovation
Dream Ward Service Innovation in the Wards
Mood lightingOne click
control
Flexible security
One-click room service
KTPH Navigator
Ward notifications
Visual Nurse call
Personal Calendar
Patient Message
Board
Upcoming features Health Services
Keeps track of patient’s weight without getting them out of the bed
71
In-bed Patient Weighing System Improving Nursing Work Efficiency
Hopscotch How to Play InstructionsFitness Drive-through Stations
Health Promoting Innovations
• Match and exceed the best performers• Standards set by other industries• Lowest infection rate• Shortest length of stay• Lowest average bill size
Learn From Everyone
Kameda Medical Center, Japan
Mayo Clinic, Rochester, USA
Aravind Eye Hospital, India
73
Learn From Everyone
74