Care pathways explained

Transcription

1 Care Pathways 2008 Wednesday 25 June 2008 London Care pathways explained Dr. Ricard Rosique i Jové Diomedes Health Care Consultants Barcelona 1

2 The content A 5-slide introduction The basics in Care Pathways Methodology + some tips 2

3 The environment Healthcare budget Clinical Governance Accreditation Hospital Protocols Quality Plans Clin Pract Guidelines Patients Staff DRGs Care Maps Staff motivation Patients needs Benchmarking Medical liability 3

4 Challenges Hospital Patients Staff 4

5 Challenges 5

6 Challenges 6

7 Care pathways 7

8 The basics 8

9 Definition Care pathways are one of the main tools of quality management in healthcare for the standardization of healthcare processes. It has been proved that their implementation enables to decrease the variability of clinical practice. Definition of Care pathway: Multidisciplinary management tool based on healthcare plans for a specific group of patients with a predictable clinical course, in which the different tasks by the professionals involved in the patient care are defined, optimized and sequenced. 9

10 Definition Who What When Where How 10

11 Wikipedia, the free encyclopedia 11

12 Structure Gannt matrix 12

13 Structure 13

14 Scope 14

15 Objectives OBJECTIVES Care pathways QUALITY QUALITY IN IN HEALTHCARE HEALTHCARE IMPROVEMENT IMPROVEMENT PROFESSIONALS PROFESSIONALS COORDINATION COORDINATION & COOPERATION COOPERATION IMPROVEMENT IMPROVEMENT EFFICIENCY EFFICIENCY IMPROVEMENT IMPROVEMENT PATIENT PATIENT SATISFACTION SATISFACTION IMPROVEMENT IMPROVEMENT To Improve Quality, Safety and Efficiency in Care Processes 15

16 Care Process Management Care patways as a tool for Care Process Management 1) 1) Checking the compliance of of the interventions included in in the healthcare plan 2) 2) Care standards 3) 3) Clinical audit 4) 4) Identification of of improvement areas (CQI - Continuous Quality Improvement) 16

17 Culture change The development & implementation of a Care pathway means a change of organizational culture at hospitals Difficulties / Change of values 17

18 Change of organizational culture Multidisciplinary document Process review by all professionals really involved Meetings are a frame for the exchange of opinions about the patient care by the different professionals Record documents are common for all professionals Variance analysis Periodic review with follow-up of defined indicators (CQI) 18

19 Barriers Heterogeneity (patients / diagnosis) Resistance to change (organization / professionals) Few culture of teamworking and continuous improvement 19

20 Methodology 20

21 Methodology SELECTION DEVELOPMENT IMPLEMENTATION EVALUATION 21

22 Methodology Selection: Phase in which the consensus on which care procedure will be the aim of a Clinical Pathway is decided and reached. In principle Clinical Pathways should be designed for procedures: Frequent Important (high risk / high cost) With an expected clinical course 22

23 Methodology: selection SELECTION CRITERIA / Lessons Learned from Practice Existence of EBM / recommendations of good professional practices / professional references Non explained variability Outcomes far from standard Possibility to reach a professional agreement in the hospital Multidisciplinary implementation Motivation by professionals to work on a specific condition Working across organisational boundaries 23

24 Methodology PROJECT START / Lessons Learned from Practice From the beginning Leadership and commitment by Hospital Top Managers Good communication Ownership by Staff Project management / planning Resources (human + material + time) = + + $ Training and education Incentives 24

25 Key points for success SKILL INCENTIVES RESOURCES ACTION PLAN VISION INCENTIVES RESOURCES ACTION PLAN VISION SKILL RESOURCES ACTION PLAN VISION SKILL INCENTIVES ACTION PLAN VISION SKILL INCENTIVES RESOURCES CONFUSION ANXIETY GRADUAL FRUSTRATION FALSE START VISION SKILL INCENTIVES RESOURCES ACTION PLAN CHANGE 25

26 Methodology Development: Phase in which the CP is designed and the consensus is reached. The goals of this phase are: Constitute a multidisciplinary team as a Care Pathway Committee with motivation and ability of agreement Consider the general goals of the Care Pathway as the goal to be reached Complete the design of all the documentation of the Care Pathway 26

27 Methodology Development: Steps: The Project Committeee defines the Care Pathway Committees Initial Risk Assessment Previous Clinical Audit (retrospective data) Evaluation of evidence and external practices (CPG) Definition of the starting and ending point Definition of Objectives Description of Inclusion and Exclusion criteria Agenda of meetings with the Clinical Pathway Committee 27

28 Methodology Clinical Audit with retrospective data: LOS analysis for Total Hip Replacement Dies PreOP Pre-OP days OP Dies PostOp Post-OP days

29 Methodology Care Pathway Teamwork: Example / Composition of the Multidisciplinary Teamwork for the Total Knee Replacement Care Pathway: Physician/s Orthopedic Surgery Dept. Physician Anesthesiology Dept. Ward nurse Orthopedic Surgery OR nurse Physical therapist Social worker Facilitator / Consultant 29

30 Methodology Care Pathway Committee meetings CONSENSUS meetings The teamwork professionals reach agreements through the critical analysis of the diferent activities of the care process and the improvements to introduce. 30

31 31

32 Structure 32

33 Structure 33

34 New record documentation 34

35 New record documentation 35

36 36

37 37

38 Pathways e-pathways 38

39 Software for Care Pathways Management EIRA 39

40 Structure 40

41 Validation sheet 41

42 Validation sheet 42

43 Variance sheet 43

44 Care Pathway for patients: 44

45 Methodology Implementation: Preparation and start of the Care Pathway Procedures for Implementation (1): Final approval by the Teamwork to the pathway matrix and the rest of accompanying documentation Approval by Medical / Nursing Management Education / training for the rest of professionals 45

46 Methodology Procedures for the implementation (2): Development of the Implementation Plan: Decision of the start date for the Care Pathway Availability of the new record documentation Care Pathway Responsible New Risk Assessment Internal communication Training Initial testing phase Start of implementation after 1st review of the documentation 46

47 Methodology TIPS FOR SUCCESSFULLY IMPLEMENTING CARE PATHWAYS Lessons Learned from Practice (1) Adapt new record documents and avoid duplication e-pathways and HIS Leadership by Hospital Top Management / Strategy planning Hospital Coordinator for all CP Clinician Management 47

48 Methodology TIPS FOR SUCCESSFULLY IMPLEMENTING CARE PATHWAYS Lessons Learned from Practice (2) Project management / Milestones + resources Evidence Based Care Pathways / Best practice Process Management Communication, education and training strategy Quality tools for CP (ICPAT) Patient needs 48

49 Methodology 49

50 Methodology Evaluation / Follow-up: Phase in which the Care Pathway is observed, analyzed and stabilized. CP are dynamic tools. Appointment of a follow-up responsible To establish dates for periodic reviews (6-12 months) Systematic and ongoing audit Follow-up of the completion of the new record documentation Monitoring of variances Assessment and evaluation of the outcomes from the information registered in the Care Pathway documentation 50

51 Methodology Evaluation / Follow-up: Study of the impact of the Care Pathway on the care process Feedback to managers and staff regarding the follow-up of indicators / outcomes and variances Update of Care Pathway and its documentation according to: Publishing of new scientific evidence Adaptation of the record documentation Most frequent variances Achieved objectives 51

52 Methodology Analysis and Evaluation: Analysis of the Variance Sheet Variances may be: Activities carried out but not defined in the Care Pathway Activities defined in the Care Pathway but not carried out Complications Variances may appear for different reasons: Patient / Family Staff Organization 52

53 Methodology Follow-up Report: 53

54 Methodology Follow-up Report / Variances: 54

55 Methodology Analysis and Evaluation of the outcomes: 55

56 Conclusion Deming Cycle 56