Quality Day posters 2019

KENSINGTON HEALTH QUALITY DAY POSTERS 2017

TABLE OF CONTENTS Quality and safety committed to excellence - Health and Safety ......................................................................................... 3 Ensuring standard of competency and care in cornea services - Kensington Eye Institute ............................... 4 Offering additional choices at meal time - Sodexo ......................................................................................................................... 5 Boosting life enhancement programming - North Resident Council ................................................................................. 6 Finding purpose and meaning in daily activities - Life Enhancement Team .................................................................. 7 Implementation of an automated recall system - Kensington Vision & Research Centre .................................... 8 Improvements to the patient flow - Kensington Screening Clinic ......................................................................................... 9 Developing a tracking system for coolers - Eye Bank of Canada (Ontario Division) ................................................. 10 The herb garden - South Resident Council ............................................................................................................................................ 11 Implementation of an online database system - Second Mile Club ..................................................................................... 12 End of life care kits - Nursing Team ............................................................................................................................................................ 13 Improvements to the hospice volunteer program - Kensington Hospice ........................................................................ 14 Development of a referrals tracking system - Kensington Diagnostic Imaging Centre .......................................... 15

INCREASING EFFICIENCY: IMPLEMENTATION OF A PULSE BOARD BACKGROUND The Eye Bank of Canada (Ontario divison) processes a large volume of tissue each month. As the largest Eye Bank in Canada, keeping track of tissue-processing workflow—from tissue receipt to distribution for transplant—is essential. 200 donors are received and processed each month.

Currently, tissue-processing workflow is managed by staff through an electronic donor management system, along with information from several pages within the donor chart. However, there is no “one stop shop” to decipher at what step each tissue is along the processing continuum.

WHAT ARE WE TRYING TO ACCOMPLISH? In 2019 the plan to implement a “Pulse Board” which will capture the pulse of the Eye Bank’s operations, was discussed and agreed upon for development. The objective is to allow staff and management to view the Pulse Board and easily see where each tissue is in the workflow stream, from receipt to shipment, and know what needs to be completed. All essential information needed to manage the tissue processing workflow should be available on the Pulse Board in an easy to understand and logical format.

Staff will be better positioned to function with more autonomy by understanding exactly which tasks are outstanding and when they are due. In addition, they will be able to prioritize their own work and figure out how to best allocate their time. The expectation is that the use of the Pulse Board will increase operational effectiveness at the Eye Bank.

Ultimately, this tool should prevent tissue waste due to untimely processing and follow up, and facilitate tissue allocation by understanding which donor tissue may be used in each specific transplant procedure.

WHY IS IT IMPORTANT? The Pulse Board is an important project that aims to improve efficiency of the Eye Bank. By providing a “one stop shop” Pulse Board, staff will no longer need to look in multiple places to determine where tissue is along the tissue processing workflow continuum.

WHAT IS NEXT? The Pulse Board project is currently in the planning stage of the Plan, Do, Study, Act cycle. We are collecting input from staff who will use the Pulse Board and can provide expertise on what is needed to best manage the tissue processing workflow. Once planning is complete, the change request will be submitted to Trillium Gift of Life Network.

A fall 2019 request submission will result in a spring 2020 implementation. Before Implementation we will be developing a blueprint of the board. This will involve discussions with staff to learn what they need to know most throughout the tissue-processing workflow.

Eye Bank of Canada (Ontario division) 2019 Quality Day Posters b.indd 1

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kensingtonhealth.org

3 2019-10-10 8:50 AM

IMPROVING QUALITY OF LIFE: ART THERAPY BACKGROUND In 2018, a resident was admitted to Kensington Hospice who had previously experienced and benefitted from art therapy during a stay at Princess Margaret Cancer Centre. After the resident’s passing, her husband shared how art therapy positively impacted her final days. They recognized the technique as legacy work, a means of expression, and an opportunity to collaborate together. Art therapy created quality of life moments for them as a couple.

At the time, Kensington Hospice was unable to accommodate the couple’s request for art therapy, however their experience inspired interest and validated the importance of different approaches and techniques at the end of life. Late in 2018, Princess Margaret Cancer Centre partnered with Kensington Hospice to provide Art Therapy to its residents.

WHAT HAVE WE ACCOMPLISHED? Now, Kensington Hospice welcomes art therapy as its newest complimentary therapy. This powerful tool can improve quality of life, manage symptoms, enhance communication and support legacy work.

Art therapy offers a unique and creative approach to expressing and processing challenging thoughts or feelings.

Sometimes it can be difficult to explain how you feel. Through the combination of psychotherapy and art making, individuals can utilize art therapy as a way to explore their feelings in a safe and supported environment, without having to rely on words. Art therapy is fully accessible as residents do not need to know anything about art or have artistic skill to participate. Art therapy is open to anyone looking to explore, process or sit with their experiences through art viewing, art making, creative writing or journaling.

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WHAT DID WE FIND? The Kensington Hospice is a 10-bed, palliative care home, designed to respond to the needs of residents and families facing life-limiting illness and bereavement.

Month

Apr

May

Jun

Jul

Aug

Sept

Art Therapy Sessions

17

21

32

21

12

12

Residents

8

7

8

6

5

5

The art therapy program was introduced in April and there has been a consistent response with residents.

Residents and families who were initially hesitant to partake have reported their experiences of art therapy to be “so easy”...”positive”...”life enhancing”...”deeply moving”... and...“incredibly surprising”. Sometimes, individuals feel unfit to participate in art therapy because they do not feel that they are creative. Explaining creativity as a way of problem solving can help residents and family members relax and it encourages them to engage and experiment with materials like paints, print making tools and a variety of mixed media.

In some instances, art therapy has supported residents and their loved ones together in a session. Here is one testimony from a friend of a resident at Kensington:

“He told us how art therapy, music therapy and aromatherapy opened him up to a wide range of sensations and emotions. He also expressed his appreciation for the expertise of the staff and their ability to keep him alert and comfortable.”

WHY IS IT IMPORTANT? Art Therapy can be used as a tool to help express challenging thoughts or feelings without necessarily having to talk about them. It provides a break from the clinical routines of being in a hospice, and a place to process emotional experiences in a safe and non-judgmental environment. Art therapy has been proven to reduce symptoms of anxiety, depression, stress and pain and most importantly, it serves as a way to care for the self at any stage of life.

WHAT IS NEXT? The Kensington Hospice will continue to explore opportunities regarding complementary therapies and services that demonstrate benefits for residents at the end of life and their families.

– Family friend of a resident written in a gratitude card

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kensingtonhealth.org

4 2019-10-10 8:50 AM

IMPROVING THE PATIENT EXPERIENCE: TRANSPORTATION ARRANGEMENTS BACKGROUND The College of Physicians and Surgeons of Ontario (CPSO) guidelines state that a responsible adult must always accompany a surgical patient who has received sedation for their procedure. It has become evident that two to four patients per week at the Kensington Eye Institute (KEI) do not arrange adequate transportation home after their procedure.

WHAT DID WE FIND? The team at Kensington Eye Institute completed the 5 Why’s analysis tool to discover the root-cause of the problem.

Define the Problem:

When patients do not arrange to have accompaniment for their procedure, there are delays in the clinical flow at the KEI.

1. Why is this happening?

Nurses are arranging transportation for scheduled surgical patients that do not have adequate arrangements.

2. Why?

Many patients may be confused or misinformed, and do not arrange for suitable pick-up after their procedure.

Some may also think that they can manage on their own and do not understand that legally KEI cannot perform the procedure.

3. Why?

Some patients do not have proper knowledge about the procedure and the effects that sedation can have on their central nervous system.

4. Why?

Some patients do not receive suitable pre-operative education or preparation.

5. Why?

This can result in several inconveniences to the patient such as: • Having to cancel and reschedule the surgery • Continuing the procedure without sedation, which can increase anxiety and discomfort • Repeating the pre-operative surgical booking

WHAT ARE WE TRYING TO ACCOMPLISH?

WHY IS IT IMPORTANT?

KEI aims to reduce the number of patients with inadequate transportation arrangements to zero per week by January 2020.

Transportation barriers can affect a patient’s access to health care services. Not having adequate arrangements can result in missed or delayed health care appointments.

Moreover, some patients opt to have the surgical procedure completed without sedation, which affects quality of care received due to an increase in anxiety and discomfort experienced by the patient.

KEI will begin to collect data to demonstrate whether changes result in improvement.

Measures: • Number of patients that arrive to KEI with no transportation made prior to surgery before implementing change • Number of patients that arrive to KEI with no transportation made prior to surgery after implementing change • Number of delays/interruptions to clinical flow and if they are due to transportation barriers

From the root-cause analysis, KEI will investigate: • What type of pre-operative information each surgeon is using and how it is delivered to patients • What the KEI team has control over and how to address what they do not have control over

There is no standardized communication document or education across all of the surgeon offices.

Kensington Eye Institute 2019 Quality Day Posters b.indd 3

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WHAT IS NEXT? After the completion of the planning phase of this project, the team plans to put the following potential solutions in place: • Develop and implement a process where transportation arrangements are confirmed at registration • Develop communication and education plan to inform staff of new processes • Partner with surgeons’ offices to determine consistency of pre-operative instructions and patient follow-up to ensure patient understanding

kensingtonhealth.org

5 2019-10-10 8:50 AM

ENHANCING THE PALLIATIVE AND END OF LIFE CARE PROGRAM: IMPLEMENTATION OF THE CLINICAL SUPPORT TOOL BACKGROUND

WHY IS IT IMPORTANT?

The Palliative Care Program at Kensington Gardens uses a comprehensive, interdisciplinary and holistic approach that also focuses on the physical, psychological, spiritual and social needs of each resident. To further enhance our Palliative Care Program, the nursing team has identified a need for an assessment tool for residents approaching end of life.

Impact of the Clinical Support Tool on the quality of palliative and end of life care at Kensington Gardens:

In April 2018, Kensington Gardens partnered with Think Research to implement the Palliative/End of Life Clinical Support Tool (CST). The tool streamlined the palliative care assessment process to help the team provide care for residents at the end of life. Moreover, the nursing team utilized the tool to help identify when a resident is approaching the end of their life.

Benefits to resident and their family: • Residents receive holistic, standardized care from the care team during end of life • Residents experience increased quality of care during their end of life • Families are reassured and feel more confident for their loved one to remain at Kensington Gardens during their last days of life instead of an acute care setting

WHAT ARE WE TRYING TO ACCOMPLISH? Kensington Gardens aims to standardize the Palliative and End of Life Care Program with the use of the CST to ensure consistent care. The tool will help the nursing team identify residents with a life-limiting illness (e.g. COPD, CHF, CVA, and Dementia) who are experiencing a decline in health status, and/or residents who are diagnosed with a life-threatening illness and may benefit from a palliative approach.

The tool will also help the nursing team work with a residents’ Power of Attorney to change goals of care as necessary.

As part of the implementation process the care team developed steps on when to use the tool. This provided an opportunity to teach nurses about other existing assessments that were incorporated into the CST. All of these tools and assessments aim to increase quality of care for residents at Kensington Gardens.

WHAT DID WE FIND? Since its implementation, the team has consistently completed the CST for palliative residents who passed away at Kensington Gardens. The chart shows the percent of residents who had a CST completed prior to the end of their life. Although opportunities for improvement exist the team is close to achieving their target of completing the CST for 100% of palliative residents.

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Benefits to the care team: • Increase in end of life knowledge and assessment skills • Improved confidence when managing end of life symptoms • Increased efficiency and support of best practices in clinical decision making • Improved documentation and care planning for residents during end of life • Improved interdisciplinary communication and support of the resident and the family during end of life Benefits to Kensington Gardens: • Clinical Support Tools assist our home in creating a culture of comfort and reassurance for residents and their families • Establish a standardized care process at end of life that is consistently reflective of best practices

WHAT IS NEXT? Ongoing use and feedback of the CST has provided Kensington Gardens with opportunities to continue to do ongoing improvements. For example:

% of Deceased Residents with CST completed 110%

• In March of 2019, an updated version of the CST was implemented, which was more streamlined and more efficient. The process also changed to focus not only on the last days of the resident’s life, but to identify opportunities to implement the tool earlier when there is a decline in resident’s health status. This helped to start the conversation regarding goals of care and palliative approaches to care.

100% 90% 80% 70% 60% 50% Apr-Jun 2018

Jul - Sept 2018

Oct - Dec 2018

Jan - Mar 2019

Apr-Jun 2019

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The care team at Kensington Gardens will continue to look at other clinical support tools to implement that will benefit the residents.

kensingtonhealth.org

6 2019-10-10 8:50 AM

INCREASING RESIDENT ENGAGEMENT: ROBOTIC PET THERAPY BACKGROUND Robotic pet therapy was implemented as a strategy to support residents who may benefit from, or participate, in structured group programming. Robotic pet therapy is an opportunity to diversify programming, and stimulate residents both mentally and emotionally. Participants in this program are residents who may prefer to be alone or are unwilling to join bigger group activities.

Not all residents partake in robotic pet therapy. However, it was observed that even with one resident in the home area participating, it brought joy to other residents and staff as well.

WHAT ARE WE TRYING TO ACCOMPLISH? With the use of robotic pet therapy, the Life Enhancement team aims to improve the quality of life and experience of isolated residents by: • Increasing emotional and social stimulation through means of physical interaction amongst residents who may not otherwise participate in scheduled programming • Alleviating loneliness amongst residents and increasing cognitive activity • Establishing relationships and increasing overall mood and engagement • Increasing verbal activity and psychological well-being In addition, the Life Enhancement team aims to monitor reactions at each time the robotic pet is presented to the resident with the goal to see an increase in anticipation towards the return of the robotic pet.

WHAT DID WE FIND? Heightened Interest

Residents were immediately responsive to the robotic pets, taking on a natural nurturing role.

Residents experienced an immediate rise in mood as well as increased social interactions with staff and the robotic pets.

Witnessing a resident with a robotic pet has caused positive curiosity and interest amongst both staff and other residents. Residents feel a vicarious joy from watching their peers engage in their time of care and glee.

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WHY IS IT IMPORTANT? Life Enhancement is dedicated to resident-centred and effective care.

• Robotic pets boost resident mood, not only emotionally but also physically and socially • The process creates a positive, fulfilling relationship between the resident and pet, as well as a positive environment for everyone around • Residents feel a sense of integrity versus despair

WHAT IS NEXT?

Resident Engagement

Kensington Gardens

Some of the Robotic Animals that are available to residents at Kensington

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The Life Enhancement team will: • Track quantitative results to see if increased level of stimulation is maintained • Expand types of robotic animals for residents who may not be susceptive to certain animals • Create a more structured program around robotic pets

kensingtonhealth.org

7 2019-10-10 8:50 AM

MEASURING THE IMPACT: CAREGIVER SUPPORT PROGRAM BACKGROUND The Second Mile Club’s Caregiver Support Program has been providing support to caregivers living in Toronto for a year and a half. Over this time, the team has learned that a multi-faceted approach including weekly peerbased support group and individual sessions can enhance the caregivers’ ability to remain in their role and support resiliency. The team wants to assess the impact of the caregiver support program on participants and is exploring assessment tools to quantify caregiver experience.

WHY IS IT IMPORTANT? The Caregiver Support Program puts our clients at the forefront.

WHAT HAVE WE ACCOMPLISHED?

“Everyone needs somebody to lean on”

To support the caregivers in the community, the Second Mile Club: • Developed a weekly Caregiver Club at Kensington that offered 62 group sessions to caregivers living in Toronto • Developed partnerships with Gilda’s Club Greater Toronto and Wellspring Toronto to facilitate their support groups • Facilitated training for professional caregivers at Kensington Health, and in the community, to enhance caregiver resiliency • Piloted a validated tool to measure caregiver burden before and after a nine week caregiver support group

Meeting other people who are going through a similar situation can do more than just decrease feelings of isolation or loneliness.

It creates community—improving the quality of life of caregivers and their loved ones..

WHAT DID WE FIND?

WHAT IS NEXT?

The Caregiver Support Program is effective in achieving its goal of reducing the adverse effects of caregiving.

Caregivers who have partaken in the program have expressed how it has reduced feelings of caregiver burden, anxiety and social isolation.

An unexpected outcome Unexpectedly, attendees have expressed that they are developing relationships outside the group and offering practical and emotional support to one another independently throughout the week.

For example: • Two participants have assisted another participant to learn simple techniques of meal preparation. The individual had no prior knowledge and is learning to cook for themselves for the first time. This camaraderie has also decreased social isolation for all participants involved.

• One participant lent a helping hand to another participant by driving the individual from the hospital home after a day surgery.

The Second Mile Club 2019 Quality Day Posters b.indd 6

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• Results will be analyzed for their accuracy in measuring participant’s experience. The data will also assist in determining the correct scale for assessing caregiver burden. Once finalized, the Caregiver Burden Scale will help measure the effectiveness of the Caregiver Support Program by measuring participant burden at different points in their program involvement.

• The team will explore and pilot other assessment tools to capture effectiveness of the program.

• The team will also explore the possibility of expanding the program by offering a second day per the week.

kensingtonhealth.org

8 2019-10-10 8:50 AM

IMPROVING RESIDENT EXPERIENCE: ENHANCING THE LAUNDRY PROCESS BACKGROUND Residents and families have expressed concern with the laundry services as some items have been misplaced or slightly damaged due to gaps in the current labelling and sorting process. In some cases, items are placed in lost and found of which only 30% are claimed.

There is an opportunity to address two issues: 1. Reduce the number of items that are lost or damaged 2. Increase the percent of claimed lost items

WHAT ARE WE TRYING TO ACCOMPLISH?

WHAT DID WE FIND?

There are two goals for this quality improvement project: • Decrease the number of items that are lost or damaged to less than 20 items/month • Increase number of claimed lost items to 80% by improving visibility and accessibility of items

During the investigation stage of this project new opportunities for improvement arose: • Gifts from family for residents are not being labeled prior to reaching the resident home area • Staff do not always check pieces of clothing for labels before dressing each resident • Knowledge of the sorting process was not common throughout the organization

To accomplish these goals the team will work to implement the following change ideas: • Develop a communication plan to increase awareness of laundry processes for staff, family and residents • Revamp policies and procedures to reflect new processes for laundry labelling and sorting • Develop education plan for staff • Implement preventative measures to avoid items being sent to lost and found • Develop an electronic catalogue system for residents and their families to easily access and claim lost items The following measures will be used to track the project’s progress: • Number of damaged clothing items • Number of improperly sorted clothing • Number of items in lost and found • Percent of staff receiving re-education • Percent of families and residents receiving new process education • Number of comments related to satisfaction of laundry service in the Resident Experience Survey

Kensington Gardens 2019 Quality Day Posters b.indd 7

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WHY IS IT IMPORTANT? Creating a more sustainable laundry process improves the resident and family experience.

The team at Kensington Gardens understands the importance of caring for residents’ belongings and appreciates the cost involved when items are lost or damaged. Every attempt is made to maintain a system to prevent loss. If an item is lost or damaged, the team works diligently to address concerns.

WHAT IS NEXT? The team will evaluate the results of the project by December 2019 and create a sustainability plan.

kensingtonhealth.org

9 2019-10-10 8:50 AM

ENHANCING THE ONLINE EXPERIENCE: REDEVELOPING OUR WEBSITE BACKGROUND In today’s digital age, a website can be considered the digital ‘face’ of an organization. Many people get their first impression of Kensington Health by browsing our website online.

Kensington Health has evolved over the last several years and we needed to create a website that reflected that evolution. This website project was an opportunity to enhance the sustainability, functionality and efficiency of the Kensington Health website. It was also an opportunity to update all information on the site so it is accurate, informative, and engaging for users.

WHAT ARE WE TRYING TO ACCOMPLISH?

WHY IS IT IMPORTANT?

The website project was designed to accomplish three major objectives:

The website project satisfies many quality dimensions.

The new website is:

• Enhance the design and usability of the website • Ensure the accuracy of information • Increase functionality for the team

• PEOPLE-CENTERED: by enhancing the user experience and providing people with the right information to common questions

The website is an essential platform for information sharing, fundraising, recruitment, and education.

Redeveloping the website allows us to make it easy to navigate for everyone and to ensure all the information about Kensington Health is accurate and easy to find.

In addition, the website was originally built on a platform that was difficult to navigate and to update.

Staying on the current Content Management System (CMS) was a risk considering the costs associated and the limited number of developers trained on the platform. The new CMS can be customized inhouse with the expertise on our IT team, meaning that the Communications team will be able to increase efficiency of their work flow with the new CMS.

The Communications team conducted research to find the most user-friendly CMS. A project plan was used as a guiding document to track the team’s progress. We met with stakeholder groups across Kensington Health, and gathered input on many of the issues and concerns with the former website.

Frequently asked questions from stakeholders were identified and implemented into the plan. Based on stakeholder group feedback, the team developed a site map, a list of all pages of a website. After researching best practices of web design, the team developed wireframes, visual guides that represent the skeletal framework of the website. Then came content creation the team wrote content for all web pages and planned photoshoots and video shoots.

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and keep content fresh

• EQUITABLE: by being accessible to all and following AODA compliance,

including accessibility options where users can adjust brightness and font size

• TIMELY: by allowing stakeholders to access information easily and quickly • EFFECTIVE: by further supporting Kensington Health by driving donations recruitment, and information sharing

WHAT IS NEXT?

WHAT DID WE FIND?

Corporate Services - Communications

• EFFICIENT: by increasing our ability to respond quickly, make changes,

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To manage the success of the website project, the Communications team will continue to track the following: • Feedback on questionnaires from user-testing groups • ualitative feedback from stakeholder groups • Google Analytics to track the performance and traffic on the site With ongoing feedback, the team looks forward to continuously enhancing the website and developing additional features that further improve the user experience.

kensingtonhealth.org

10 2019-10-10 8:50 AM

IMPROVING THE PATIENT EXPERIENCE: WAIT TIMES BACKGROUND The Kensington Vision & Research Centre (KVRC) aims to continuously improve the patient experience by decreasing the total average time that patients spend at the eye clinic without compromising the quality of care provided by the physicians.

The team will specifically focus on wait times, since long wait times on the day of their appointment are a primary driver of patient dissatisfaction.

Many factors can contribute to the interruption of clinic flow such as scheduling problems, equipment availability, and other inefficiencies. Consequently, longer wait times can lead to the increase of pain, suffering and mental anguish in patients, especially in the older adult population.

WHAT DID WE FIND? Define the problem:

Patients are spending too much time waiting at the clinic.

Why?

Because they are waiting to see a doctor or technician.

Why?

Because there is a backlog of patients.

Why?

Because some scheduled patients need more time with the physician causing an interruption to the clinical flow.

Why?

Because all appointment types are given the same time allotment in the scheduling system.

Why?

Because the scheduling protocol is not optimized to take into consideration the clinical needs of different patients.

Following this exercise, the data from one physician’s clinic was compiled and analyzed. It was discovered that patient wait times were appropriate up until two new patient consults were scheduled back-to-back. The physician spent a longer time with these two patients, whilst other patients were arriving and had to wait. The time spent at the clinic increased for every patient from that point forward. Collaborating with the administrative assistants to investigate solutions, such as booking appointments according to patient needs or making real time scheduling changes, may benefit the clinic’s flow by adjusting the schedule based on the day to day needs.

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WHAT ARE WE TRYING TO ACCOMPLISH?

WHY IS IT IMPORTANT?

By developing an efficient and optimized scheduling system, that intuitively considers the needs of each patient and each physician’s protocol, the team at KVRC aims to reduce the average time patients spend at the clinic to less than 90 minutes by the end of 2019.

Timely delivery of care:

The following data will be collected to track patient flow and wait times:

Long wait times have a significant impact on both the patients and staff. Reducing patient wait times and total time spent at the clinic will lead to a positive patient experience, improved quality of care, and finally the avoidance of wasting resources.

• Patient arrival time • Time needed for the patient to be ready for the physician (both from their arrival time and their scheduled time)

• Time needed to see the physician after completing their diagnostic tests and work up

• Wait time to see the physician from their schedule time • Time the physician spends with each patient • Total amount of time a patient spends at the clinic After having compiled and analyzed the data, we will apply a new scheduling structure with the goal of reducing patient wait times at our clinic. Following the implementation of this new scheduling system, the same data will be collected and analyzed again to determine whether it was effective.

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WHAT IS NEXT? This project is currently in its planning stages. The potential solutions will be piloted with one physician’s clinic. The results will be analyzed and solutions adjusted as necessary. Once finalized, this project will be trialed with other physicians’ clinics at KVRC and adapted accordingly. Changes will be implemented differently for every clinic.

In order to sustain this change, the data will be revisited every year to ensure that adjustments are made if needed.

kensingtonhealth.org

11 2019-10-10 8:50 AM

IMPROVING THE PATIENT EXPERIENCE: ENHANCING THE REFERRAL AND BOOKING PROCESS BACKGROUND The Kensington Screening Clinic (KSC) acknowledges that timely access to gastroenterology care or endoscopic procedures is contingent upon a referral and triage system that supports effective prioritization, comprehensive patient health information and active communication between patients and the clinic.

An internal review revealed that the clinic was approximately six months behind in the patient referral process as a result of an overly complicated administrative process. Moreover, patients requiring urgent assessments were not being scheduled within the Canadian Association of Gastroenterology (CAG) wait time guidelines.

The inefficiency with wait times has the potential for delayed diagnosis of significant or catastrophic conditions. Secondary concerns include: patient dissatisfaction and staff strain leading to decreased job satisfaction.

WHAT ARE WE TRYING TO ACCOMPLISH? KSC identified an opportunity for improvement by developing a standardized process of managing referrals that improved clinic workflow and remained consistent with the CAG wait time guidelines.

To accomplish this goal the KSC team implemented the following change ideas: • Develop a process for immediate triage of referrals including an urgency classification to determine priority of booking • Develop and implement proper training for nursing staff completing triage • Generate monthly reports that display consistent management of referrals • Implement a key performance indicator for triage of referrals on an ongoing basis

WHY IS IT IMPORTANT? Reducing wait times will improve the patient care experience.

The following measures will be used to track the project’s progress: • Number of urgent patients triaged within 24 hours of referral receipt • Amount of time between initial physician referral to first contact by KSC

The team at Kensington Screening Clinic understands the importance of timely appointments for its patients to receive gastroenterology care or endoscopic procedures.

Long wait times can have effects on symptom management and delays in diagnosis. Ensuring implementation of a standardized process for referrals and bookings will eliminate barriers to quality of care.

WHAT DID WE FIND?

WHAT IS NEXT?

After implementing a streamlined referral and booking process that included trained Registered Nursing staff that acknowledges each referral within 24 hours of receipt, the following results were made: • 0% of referrals were lost • 100% of referrals were triaged by RN staff within 24 business hours • 83% of urgent referrals were contacted within the CAG recommended timelines (35% increase) • 60% of non-urgent patients were contacted within the CAG recommended timelines (23% increase)

The new process will be evaluated every six months or as required. The quantified results from the reports will be analyzed and the process will be adjusted as necessary. The KSC team will work to finalize the development of a Standard Operating Procedure and conduct comprehensive training for all administrative staff.

The new process was trialed during the summer months when the clinic had additional staff to assist with the backlog of referrals.

In the fall, the clinic will trial the streamlined process with normal staffing levels. Adjustments will be made accordingly.

Kensington Screening Clinic 2019 Quality Day Posters b.indd 10

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kensingtonhealth.org

12 2019-10-10 8:50 AM