Table of Contents
About Us The Quality, Patient Safety and Patient Experience (QPS&PE) ttteam is committed to leading work to improve the delivery of hospital services and enhance patient and family experience at LHSC. QPS&PE promotes this work by using the principles of continuous quality improvement, along with various Quality Improvement, Patient Safety, and Patient Experience best practices. Our team is passionate and driven to create and sustain changes that will positively impact patients, families and staff.
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We are guided by: LHSC’s I STEP up, Quality Framework, Patient and Family Centered Care Principles and the Patient Safety Competencies.
Department Structure QPS&PE includes the Director and an Administrative Assistant that all threethe Within teams. Quality team, The Patient Safety team has there are seven Process two patient safety Improvement Consultants. specialists, and one RN auditor.
support The Office of Patient Experience has one senior patient experience specialist, three patient experience specialists, and a team associate.
South Street Annex • University Hospital • Victoria Hospital and Children’s Hospital
Patient Experience Patients and their families are at the core of everything we do. In support of our commitment to patient and family centred care, we have created the Office of The Patient Experience. The Office of The Patient Experience exists to enhance the patient and family experience throughout LHSC. We want to help understand from patients and families what we are doing well and where we can make improvements. The office receives concerns from patients, families and caregivers and collaborates with patients, families, physicians, leaders and staff to help them address these concerns in a supportive and respectful environment. We are committed to engaging with a wide range of stakeholders such as our employees, volunteers, board of directors and the greater community. By putting patients and families first in partnership with us, we are best positioned to deliver a high quality, consistent and caring patient experience that results in the best possible outcomes. The Office of The Patient Experience recruits and supports Patient and Family Advisors to work in partnership with the hospital to create an authentic patient/ family centred care environment and experience, which will assist in influencing hospital decisions.
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Success Stories The following five stories are some highlights of our work with a number of teams within the hospital and with its partners in the community.
2014 Accreditation Performance Issue: In preparation for Accreditation 2014, a new method was developed to shift the culture of accreditation at LHSC, with an increased focus on accreditation work, which was occurring across all departments at LHSC. The Accreditation Lead Network (ALN) was formed to support the work of all accreditation teams. Solution: The ALN, comprised of Accreditation Team Leaders from different clinical and corporate service areas and representatives from Emergency Management and Professional Practice, met monthly beginning in June 2013 to prepare for the onsite survey. Led by the Accreditation Coordinator in QPS&PE, and supported by the Accreditation Working Group, these individuals learned about the accreditation process, shared tools and experience and supported one another through the preparations. Meetings provided education opportunities, including full day training on tracer methodology, allowing the team leads to develop their knowledge and skills in assessing compliance with the Accreditation Standards. As a result, teams felt more prepared for the onsite survey and experienced less stress when the surveyors engaged with them. Results & Benefits Realization:During the onsite survey November 3 - 7, 2014, 2,950 Criteria were assessed (24 were deemed not applicable; 2893 were met and 33 were unmet), resulting in a score of 98.9%. What Makes it Unique: The creation of the ALN was brand new this year, and changed the culture of how LHSC approaches Accreditation. The Accreditation process occurs every three years, and the permanent establishment of the ALN ensures success in patient safety now and for all future Accreditation surveys.
Figure : Accreditation Results by Quality Dimensions
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Connecting Care Collaborative Issue: Partnering in Transformation stream of the Clinical Services Renewal, the Connecting Care Collaborative (C3) project ‘s purpose to better support the top 20% of health care users consume over 85% of health care resources, with patients suffering from Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), and/or diabetes encompassing a significant proportion of the top users. Better supporting these “top users” required a systems approach and partnering across the continuum of care. Solution: Patients and families, physicians, leaders, staff (nursing and allied health) were brought together from primary care, acute care, specialized outpatient clinics and rehabilitation programs, as well as community care. Partnering organizations include London Health Sciences Centre (LHSC), St. Joseph’s Health Care London (St. Joseph’s), and the South West Community Care Access Centre (CCAC). These groups worked together to break down the silos among different parts of the continuum to develop a health care system that centres around patient needs across all types of care.
The following actions have been taken in order to assess the current state: 1. Process mapping and waste/gap analysis with each “component” of the care continuum 2. Experience Based Design Patient & Family Interviews 36 interviews were conducted, results were themed and mapped onto process maps 3. Collaborative Gap Analysis with stakeholders across the continuum; five sessions including providers and patient advisors and patient videos 4. Collaborative Solution Generation with all stakeholders across the continuum 5. Solutions (large & small projects) identified Results& Benefits Realization: • INSPIRED COPD Outreach program implemented – ongoing Plan, Do, Study, Act (PDSA) Cycles • Coordinated Care Plan being piloted for 36 patients – ongoing PDSA Cycles • Navigator Role for COPD hired – ongoing PDSA cycles as patients are recruited • Education materials across continuum identified • Ongoing data collection on all initiatives, adjustments as necessary to achieve project objectives • Unified Risk Stratification and Patient Registry What Makes it Unique: From the early stages of C3, the project focused on including the patient voice, and understanding the experiences of family members and patients dealing with chronic disease. This approach allowed for all stakeholders to participate in gap analysis and solution generation, resulting in mutually agreed-upon solutions within a short timeframe. The incorporation of Experience Based Design has been recognized nationally at the Canadian College of Health Leaders National Health Leadership
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Conference as well as the Institute for Healthcare Improvement’s Conference on Improving Patient Care in the Office, Practice and the Community.
South Street Annex • University Hospital • Victoria Hospital and Children’s Hospital
Perioperative Improvements Issue: As part of the Clinical Service Renewal Internal Improvement work stream, the perioperative project was launched with the objective of identifying opportunities for improvement across the five dimensions of quality (Integrated, Safe, Timely, Effective and Patient & Family Centered). The project was organized into three main areas: 1. Pre-Admission Clinics, 2. Day of Surgery, and 3.) SPD & Supply Chain. Solution: To guide the review, a comprehensive measurement plan was developed with stakeholders and subject matter experts to identify the key questions to answer and performance metrics. To understand the current state from all perspectives, the following activities were done: 1. Process mapping the patient journey, 2. Shadowing patients & staff, 3. Time and motion studies, 4. Data analysis from SurgiNET, AEMS, FM Pro, and 5. Provider & Patient Focus group sessions. The project team has developed recommendations under the following themes: • • • • •
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Space Utilization (UH) Metrics and Performance Improving the Patient Experience Communications (Day of Surgery Team and Patients/Families) Scheduling (Staff and Surgeries)
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Inventory Management Equipment & Instrument availability Improve standardization & reduce variability Better informed decision making
In total there are 28 recommendations for Pre-Admit, 10 for Day of Surgery & 31 for SPD & Supply Chain. Recommendations are in various stages with some having been fully implemented, others are in final stages of implementation planning and the remaining are in the planning stage.
Results & Benefits Realization: Expected benefits: • • • • •
Reduce Operating room delays Reduce PACU delays to inpatient bed availability Re-direct staff time from nonvalue added activities Increased space utilization
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Improved staff engagement & satisfaction Improved inventory turnover & availability Reduced cost of supplies
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What Makes it Unique: The perioperative improvements project has used simulation modeling to optimize processes associated with perioperative care. The entire project has included a thorough approach to measurement and has also included patients through the use of patient shadowing, surveys, and focus groups as well as patient advisors sitting on the project Steering Committee.
South Street Annex • University Hospital • Victoria Hospital and Children’s Hospital
South Street Annex • University Hospital • Victoria Hospital and Children’s Hospital
Clinical Neurological Sciences (CNS) Patient Falls and Staff Muskuloskeletal Disorder (MSD) Improvement Initiative Issue: At LHSC, safety is everyone’s responsibility and the safety of both patients and staff is of paramount importance; we cannot have one without the other. A Patient Safety Specialist, Ergonomist, and Process Improvement Consultant recognized this as an opportunity to collaborate when they saw there was a high incidence and often a correlation between patient falls and staff MSDs. Solution: The project aims is to increase awareness amongst staff regarding the relationship between safe practice and high quality patient outcomes by decreasing the number of patient falls and staff MSDs, thereby improving the overall experience and safety for both patients and staff. In order to accurately assess the current state of falls and MSDs in CNS, a comprehensive root cause analysis was conducted by an interprofessional panel. The team identified areas for improvement which guided the development of future risk reduction strategies. Collectively, the falls and MSD initiatives highlight that staff and patient safety is everyone’s responsibility. This two-part initiative aligns with the Quality Framework I STEP up focusing on the elements of safety and effectiveness. Results & Benefits Realization: The following graph and chart depict the improvements made since the CNS Patient Falls Improvement Initiative began in 2012.
Figure : Figure 3: Falls Ratio September 2012 - October2014
What Makes it Unique: This project has been unique in the Figure : MSD Incidents 2011-2014 way that it has brought both occupational health and patient safety together to improve both MSD injuries in staff and falls for patients. This project has shown that quality improvement has benefits for not just patients – but employees too.
South Street Annex • University Hospital • Victoria Hospital and Children’s Hospital
South Street Annex • University Hospital • Victoria Hospital and Children’s Hospital
University Hospital Pharmacy: Optimization of workflow and medication safety in unit dose dispensing Issue: A need was identified to increase patient safety and efficiency in the inpatient unit dose area of the University Hospital. The pharmacy desired changes before the transition of pharmacy services to 24/7 and computerized provider order entry implementation (HUGO). Solution: After the Process Improvement Consultants met with pharmacy management and did a thorough analysis of the current state in the pharmacy, it was decided to focus in on two areas for improvement. 1) Redesigning the workflow and workspace to reduce interruptions, this in turn would decrease medication filling errors and increase patient safety. 2) Reducing time to fill medication carts to increase efficiency and effectiveness. In partnership with the pharmacy staff, the Process Improvement Consultants completed a thorough analysis (using a LEAN quality improvement approach) of the processes, workspace and workflow was completed. The volume of activity in various areas of the pharmacy was analyzed to determine optimal staffing levels. This resulted in the schedule being revised to align shifts with peak activity. Next, a 5S was completed to sort, set in order, shine, standardize and sustain the proposed future state of space in the pharmacy’s unit dose area. Throughout the quality improvement project, “Plan-Do-Check-Act” cycles were completed in order to refine processes and ensure the best approach was being taken to manage changes. Results & Benefits Realization: Since completions of the improvements, a number of benefits have been realized by the pharmacy, including: • • • • • •
One month after implementation, the number of interruptions during medication cart filling had decreased by 43%. Independent double checking of medication carts increased by 10% (this value has continued to improve since implementation). 95% of medication carts were filled within the new target time. There was positive staff feedback on the space redesign. Fewer adverse errors were reported and a decreased amount of time was noted in filling the medication carts. There was no change in the number of steps required to fill each medication cart.
What Makes it Unique: The Process Improvement team did very thorough measurements and data collection in order to implement effective changes throughout the Plan-Do-Check-Act cycles. The measured improvements showed with clear, measurable changes being seen after implementation.
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Spreading our Successes Publications •
“Optimization of Workflow and Medication Safety in Unit Dose Dispensing.” Canadian Society of Hospital Pharmacists Professional Practice Conference.
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“Implementing an obstetric triage acuity scale: interrater reliability and patient flow analysis.” Am J Obstet Gynecol. 2013 Oct;209(4):287-93.
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Best Practice Guidelines from Accreditation Canada
Grants •
Canadian Foundation for Health Improvement (CFHI) INSPIRED program, a pan-Canadian learning collaborative to enhance care provided to COPD patients, a pan-Canadian learning collaborative to enhance care provided to COPD patients
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Associated Medical Services (AMS) Phoenix Grant, which aims to instill and sustain compassion, empathy and professional values in the environments in which health professionals learn and work.
Presentations •
6th International Conference on Patient-and Family-Centred Care Vancouver, British Columbia
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Institute for Healthcare Improvement’s Conference on Improving Patient Care in the Office Practice and the Community • Patient Safety Education Program (PSEP) – Canada (Systems Thinking, Leadership and Teaching Skills)
Conferences •
National Patient Relations Conferences
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Beryl Institute conference •
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Patient Safety Trainer hosted by Canadian Patient Safety Institute (CPSI)
• Master Facilitator with the Patient Safety Education Program (PSEP) – Canada Improving and Driving Excellence Across Sectors (IDEAs) Advanced Learning Program
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