Improving Patient Flow, Experience And Efficiency

Transcription

1 Session Code C3 This presenter has nothing to disclose Improving Patient Flow, Experience And Efficiency Professor Tom Downes Clinical Lead for QI Sheffield Teaching Wednesday 13 th April :30-16:30

2 GREAT CARE IS DISCOVERED, NOT DECIDED

3 This session: Flow basics Case study How to improve flow Improving Flow programme

4 Health Foundation report

5 Measuring system dynamics Flow in the DEMAND for water Amount of water in the bath the WORK IN PROGRESS How long it takes to fill a CYCLE time How long from water entering the bath until leaving through the drain - the LEAD time Flow out the SUPPLY of water to the next system

6 FLOW improvement - The structure SDSA Standardise Treatment - PDSA Diagnosis - Change Ideas Value Vision Assessment involve Values Visualisation

7 Case study: Flow of frail older patients

8 Sheffield: Population of 580k and growing 43% of households vulnerable to significant financial stress Single vertically integrated adult health care provider Single Social Care provider Sheffield Teaching Hospitals: One of largest FTs in England - 1bn turnover and 16k staff Large tertiary provider around one-third of activity

9 George

10 A complex system problem

11 2003 Toyota Corolla

12 The Big Room (Oobeya)

13 Service Improvement GSM Matron General Manager For Medicine Discharge Liaison Physiotherapist Secretary Community Services manager Social Services Manager Senior registrar Physiotherapist gives an account of the test of change to get a patient home on the day they were discharged by the Geriatrician

14 Measuring system dynamics Flow in the DEMAND for water How long it takes to fill a CYCLE time Amount of water in the bath the WORK IN PROGRESS How long from water entering the bath until leaving through the drain - the LEAD time Flow out the SUPPLY of water to the next system

15 PDSA tests of moving from post take to on take Let me introduce George 82 years old Lives independently and wants to continue doing so Widowed 5 years ago Has mild dementia Daughter lives locally Losing weight + poor mobility

16 PDSA tests of moving from post take to on take

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18 Frailty Unit

19 Frailty Unit opens Outcome measure: 34% increase in discharge within 1 day

20 Frailty Unit opens Length of stay for frailty unit patients reduced by more than 4 days

21 In-hospital mortality dropped by over 13% Frailty Unit opens

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23 Discharge to Assess (D2A)

24 D2A starts Reduction of 6 days waiting on implementing D2A

25 D2A starts Sustained 30% reduction of LoS

26 30% reduction of inpatient falls on pilot ward D2A starts

27 In last one year >9000 patients discharged to home support in 1.1 days compared with 5.5 days

28 Whole system reduction in LoS of patients aged >65y

29 How to improve flow

30 Two Types of Knowledge Subject Matter Knowledge Improvement Science Coaching

31 Subject Matter Knowledge Discovering great care Improvement Science Coaching

32 Improving FLOW: Roadmap Change Ideas Brainstorming Build a Big Room Themes Post-it Frenzy Global Aim Change Concepts Benchmarking and visits Process/Value Stream Map Fishbone Spaghetti Diagrams Selection criteria & Multivoting Specific aim Change idea Define measures A P S D A P S D A P S D Standardise Pre- Phase Coached weekly meetings Patient stories System data Reflective learning

33 POST IT FRENZY

34 Improving FLOW: Roadmap Change Ideas Brainstorming Build a Big Room Themes Post-it Frenzy Global Aim Change Concepts Benchmarking and visits Process/Value Stream Map Fishbone Spaghetti Diagrams Selection criteria & Multivoting Specific aim Change idea Define measures A P S D A P S D A P S D Standardise Pre- Phase Coached weekly meetings Patient stories System data Reflective learning

35 The Big Room (Oobeya)

36 Improvement in health care is 20% technical and 80% human Dr Marjorie Godfrey The Dartmouth Institute

37 Improving FLOW programme

38 Improving FLOW programme Team coaching 1 year action learning training Cohort 1 12 care pathways 24 Flow coaches RAND Europe evaluating

39 Improving FLOW programme 12 care pathways Skin Cancer Stroke MaxFax Cancer Frail Older patients Acute medicine Diabetes Chronic Pain # Neck of Femur COPD Acute Paeds Ob/Gyn GI Surgery Each care pathway has a Big Room co-coached by 2 Flow coaches (a clinician and external manager)

40 Improving FLOW programme Cohort 2 starts October 2016 in 3 hospitals

41 Summary Improving flow: Better patient experience Lower cost Improved safety Complex adaptive systems require an iterative/prototyping redesign process The skills can be taught

42 Join the Sheffield Microsystem Coaching Academy for our second expo! 2 inspiring days of sharing, learning & networking including: - Keynotes by Richard Bohmer, Maren Batalden and other national and internationally renowned QI leaders - Learn about the MCA, Ward Collaborative and Improving FLOW - Interactive sessions to build quality improvement knowledge and skills MCA expo th & 7th June 2016 Sheffield

43 Thank