Quality, Patient Safety, and Patient Experience
Working for success: A year in review
Table of Contents About Us ....................................................................................................................................................... 1 Department Structure................................................................................................................................... 2 Quality Improvement .................................................................................................................................... 2 Patient Safety ................................................................................................................................................ 2 Patient Experience ........................................................................................................................................ 3 Success Stories .............................................................................................................................................. 4 Spreading our Successes ............................................................................................................................... 9
Message from the Director QPS PE pleased to share with you highlights of our work during fiscal year 2014/15. The purpose of this report is to provide you with a snapshot of how we work across the organization to improve the delivery of hospital services and enhance the patient and family experience at LHSC. The three teams that make up Quality, Patient Safety, and Patient Experience worked across all levels of the organization, from front lines to executives to ensure that LHSC maintains a focus on high quality, safe care with the patient voice at the forefront of all that we do. Quality, Patient Safety and Patient Experience (QPS&PE) is committed to leading work to improve the delivery of hospital services and enhance the 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. We are guided by: LHSC’s I STEP up, Quality Framework, Patient and Family Centered Care Principles and the Patient Safety Competencies. Looking forward, we will continue to play a critical role in LHSC’s strategic priorities: access, the Clinical Services Renewal, *pull from X matrix
Contact information Quality Patient Safety Patient Experience
1
Department Structure QPS&PE consists of three teams led by a Director, and supported by an administrative assistant.
Quality Improvement The quality improvement team is made up of a team of Process Improvement Consultants that work within the five dimensions of quality (I-STEP up) to ensure LHSC is a
Patient Safety Quality, Patient Safety and Patient Experience (QPS&PE) is committed to leading work to improve the delivery of hospital services and enhance the 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.
2
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, the Patient Experience Office focused on key areas in 2014/15. Patient Relations How we address and resolve concerns received from patients, families and caregivers effectively and efficiently are a priority for LHSC. The large majority of patient concerns received last year dealt with interpersonal interactions and processes that leave our patients and their families feeling disempowered and disrespected. Through increased collaboration with patients, families, physicians, leaders and staff, the office was integral to addressing 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 to help everyone understand the processes of care and what can be improved based on the patient and family feedback we receive. Curriculum Development The curriculum developed by the office is centred on sharing patient and family stories, and has proven to be a powerful opportunity to foster healthcare provider understanding about their interpersonal interactions and the value of patient and familycentred care in our cultural transformation. Stories have been connecting us to our patients in ways that push the conversation beyond the diagnosis and treatment and get us focusing on person-centred care. Patient and Family Engagement Thirty new volunteer advisors were recruited, bringing our total number of advisors at LHSC to 109. The advisors share their health care experiences across the organization with staff, physicians and volunteers, and on project teams, focus groups, committees and councils, providing valuable information on what we do well and where we can make improvements. The office provided guidance and support of patient and family advisory councils in the Renal, Children’s, Emergency Department and Cancer programs. Patient Experience Coordinating Committee The office proudly launched the newly formed Patient Experience Coordinating Committee. This group, comprised of patients, staff, leaders and physicians, is working collaboratively to determine patient experience areas for the coming year and working together to spread a patient and family- centred care mindset. Through putting patients and families first in partnership with us, LHSC is best positioned to deliver a high quality, consistent and caring patient experience that results in the best possible outcomes.
3
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 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 new this year, and changed the culture of how LHSC approaches Accreditation, by moving to a model in which the organization is always accreditation ready. 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 1: Accreditation Results by Quality Dimensions
4
Connecting Care Collaborative Issue: As part of the Partnering in Transformation stream of Clinical Services Renewal, the Connecting Care Collaborative (C3) project’s purpose is to better support the top 20% of health care users who consume over 85% of health care resources: patients suffering from Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), and/or diabetes. 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, 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. Partnering organizations include LHSC, St. Joseph’s Health Care London (St. Joseph’s), and the South West Community Care Access Centre (CCAC). Actions taken to assess 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 Conference as well as the Institute for Healthcare Improvement’s Conference on Improving Patient Care in the Office, Practice and the Community. 5
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: Pre-Admission Clinics, Day of Surgery, and SPD & Supply Chain. Solution: To guide the review, a comprehensive [Type a quote from the document or the measurement plan was developed with stakeholders summary of an interesting point. You can and subject matter experts to identify key questions position the text box anywhere in the to answer and performance metrics. To understand document. Use the Drawing Tools tab to the current state from all perspectives, the following activities were completed: process mapping the change the formatting of the pull quote patient journey, shadowing patients and staff, time text box.] and motion studies, data analysis from SurgiNET, AEMS, FM Pro, and provider and patient focus group sessions. The project team developed recommendations under the following themes: • • • •
•
• • •
Space Utilization (UH) Metrics and Performance Improving the Patient Experience Communications (Day of Surgery Team and Patients/Families)
• •
Scheduling (Staff and Surgeries) Inventory Management Equipment & Instrument availability Standardization Better informed decision making
In total, 28 recommendations specific to Pre-Admit, 10 for Day of Surgery and 31 for SPD & Supply Chain were made. 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: • Reduced operating room delays • Reduce PACU delays to inpatient bed availability • Re-direct staff time from nonvalue added activities • Increased space utilization [Type a quote from the document or the summary of an interesting point. You can position the text box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull quote text box.]
• • •
Improved staff engagement & satisfaction Improved inventory turnover & availability Reduced cost of supplies
What makes it unique: The perioperative improvements project used simulation modeling to optimize processes associated with perioperative care. The entire project included a thorough approach to measurement and included patients through the use of patient shadowing, surveys, and focus groups as well as patient advisors sitting on the project Steering Committee. 6
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 2: MSD Incidents 2011-2014
Figure 3: Figure 3: Falls Ratio September 2012 October2014
What makes it unique: The project 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.
7
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 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: workflow and workspace redesign to reduce interruptions, and in turn decrease medication filling errors and increase patient safety and a reduction in the 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 pharmacy processes, workspace and workflow, as well as an analysis of the volume of activity in various areas of the pharmacy 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 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 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 There was positive staff feedback on the space redesign
What makes it unique: The Process Improvement team completed very thorough measurements and data collection in order to implement effective changes throughout the Plan-Do-Check-Act cycles. The measured improvements demonstrated clear, measurable changes being seen after implementation. 8
Sharing our successes Publications
“Optimization of Workflow and Medication Safety in Unit Dose Dispensing.” Canadian Society of Hospital Pharmacists Professional Practice Conference.
“Implementing an obstetric triage acuity scale: interrater reliability and patient flow analysis.” Am J Obstet Gynecol. 2013 Oct;209(4):287-93. 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 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
“A family feedback program:engaging patients and family to improve patient and family-centred care and health care delivery” at the 6th International Conference on Patient-and FamilyCentred Care Vancouver, British Columbia “Connecting Care Collaborative: Working Together to Support the System’s Top Users” at the Institute for Healthcare Improvement’s Conference on Improving Patient Care in the Office Practice and the Community Dallas, Texas “XXXXXXXXXXXXXXXXXXXXX” at the Patient Safety Education Program (PSEP) – Canada (Systems Thinking, Leadership and Teaching Skills), Toronto, Ontario
Conferences
National Patient Relations Conferences Beryl Institute conference 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 Picture of Lisa and Bev at conference
9