BOPCCC Progress Report 30 June 2018

Appendix 1:

Progress report for BOPCCC to 30 June 2018

What are we aiming to achieve?

As one of three implementation priorities of the BOP Integrated Community Nursing Model of Care1 and Implementation Plan2, the BOP Community Care Co-ordination service has been established as a demonstration site for 12 months commencing 1 March 2018.

The aim is for 100% of referrals for community nursing services to be managed by the service, operating 7 days a week in order to: 1. Improve access to community nursing care; and 2. Be a place for referrers, patients, families and whanau to access care information.

The scope of the demonstration site includes: •

Referral management including screening, triaging and prioritising;

•

Determining the right care setting (home/clinic);

•

Allocation of referrals to appropriate service providers; and

•

Provision of relevant information to key stakeholders (includes establishing and maintaining an 0800 number and service directory).

It is a demonstration of a wider strategic approach to care co-ordination as set out in the BOP Strategic Health Services Plan 2017-2027.

1http://www.bopdhb.govt.nz/media/58212/an-integrated-model-of-care-for-community-nursing.pdf 2

http://www.bopdhb.govt.nz/media/60397/icn-service-description-and-implementationv2.pdf

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The governance group, the Bay of Plenty Alliance Leadership Team (BOPALT) agreed to apply the Institute for Healthcare Improvement Model for Improvement as the change/improvement methodology.

What changes can we make that will result in an improvement?

The following changes are being tested to see if they will result in an improvement. Changes have been designed using knowledge of the system and IHI Change Concepts for Improvement.

1. A single place for referrers and patients to access community nursing services; 2. Introduce triage and prioritisation functions 3. Decision algorithms to determine best care setting (home/clinic; nursing provider/general practice) [Improve workflow; error proofing] 4. Provision of routine care in general practice setting; 5. Documented standard care pathways and exceptions; 6. Improving quality of referral information + converting manual processes to electronic; 7. Extended operating hours, 6 days a week [producer/customer interface; improve workflow 8. Provision of on-line provider directory and customer contact number 9. Identify patients that would benefit from co-ordinated care approach

How will we know a change is an improvement?

An initial suite of measures and reporting dashboard has been developed Measure Type

Measure

Model for Improvement change concept

All measures collected by ethnicity Outcome

#/% of referrals managed by CCC since 1 March 2018 as a percentage of total referrals in scope of project

Improve workflow Manage variation Eliminate waste

Process

Scores for ‘communication’ and ‘co-ordination on the Inpatient Patient Experience of Care survey % of referrals by prioritisation category

Enhance provider/patient relationship

% of referrals by care setting (home/clinic)

Change work environment

Improve workflow

Improve workflow Time from date of receipt of referral by CCC to first encounter with patient broken down by prioritisation category

Manage time

# of contact calls to 0800 number by patients/referrers

Enhance provider/patient experience

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# of hits on Health Point for BOPCCC

Enhance provider/patient experience

% of total referrals managed in primary care

Optimise healthcare resources Enhance provider/patient experience Focus on products or services

% of District Nursing activity classed as ‘routine’

Optimise healthcare resources Focus on products or services

# of inappropriate referrals

Managing variation Error proofing

Balancing

# of provider declines and reason for decline

Focus on products or services

% of patients referred to CCC who were readmitted within 28 days

Focus on products or services Manage time

At its meeting on 12 July 2017 the Alliance agreed to: 1.

‘Support the establishment of a demonstration site within Support Net as the single place for accessing information and community nursing services. The demonstration will take place over a 12 month period and;

2.

The outcomes of the demonstration will be evaluated and will inform BOPALT in establishing a common position on the broader aspects of system-wide Community Care Co-ordination and the best options in the long term, noting the intention to expand the concept of centralised coordination to include other services.’

The approach was agreed to on the basis that it ‘allows for testing in a safe, controlled environment’. The aim was also for this option to lead to the kind of change that transcends current practice. To mitigate the risk of the status quo being maintained it was proposed and agreed that Alliance partners have input into the demonstration and develop and jointly agree time frames and evaluation measures.

BOPCCC Project Team A project team has been appointed to manage the initial implementation phase. The team is a subset of a larger, collaborative network of clinicians, administrators and stakeholders who were engaged in planning and developing the Integrated Community Nursing (ICN) Model of Care and subsequent detailed implementation plans during 2016.

The initial team, whilst not representative of the BOPALT membership, is intended to be nimble and were selected for their in-depth knowledge of the ICN project, ability to direct resources and

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effort to establishing an entirely new service within a tight time frame and respond quickly to problems and risks as they arise.

The current team has 7 core members: • • • • • •

Project Co-leads: Mike Agnew (Senior Portfolio Manager) and Sarah Davey (Service Development Manager) Sarah Nash (Project Co-ordinator) Anushiya Ponniah (Expert Advisor) Asmitha Patchay (Operations manager + clinical expertise).

Don Sorrenson (Support Net Manager + operational leadership) Charille-Ann Schoeman (Business Development and Analyst)

Additional clinical and operational expertise is sought from the District Nursing leader and Primary Healthcare Nurse Leader.

Initial Implementation phase The service has now been running for four months. BOPCCC service delivery team have been recruited for their alignment to the CARE Values of the DHB and the vision of the project and their knowledge and experience in community health care and improving Maori Health. The team consists of 2 FTE admin support, 2 FTE Triage Nurses and an Operations Manager. In accordance with quality improvement methods, a sequential approach to implementation has been adopted, with management of District Nursing referrals and In-home Falls prevention being included the initial phase. A huge amount of work has been undertaken in the first four months to manage the impact of change and undertake process improvement as well as the service managing more than 3600 referrals in that time.

A suite of measures has been established and a ‘data for improvement’ dashboard style of reporting is under development. Data to the end of June 2018 is now available for analysis.

The implementation is now entering a more steady state ‘business-as-usual’ phase after the initial months of intensive change management. The project has reached an appropriate phase to refresh the approach and evaluate outcomes to date.

It is recommended that the project team is strengthened to include additional members.

Nominations are sought from BOPALT for additional members, particularly in the areas of Maori Health equity, primary and secondary care nursing, consumer/patient experience.

Key deliverables of the refreshed project team are to: a. b. c. d. e. f.

Review the project plan Review and enhance the performance measures Develop a template for reporting that aligns with the IHI Model for Improvement Review data and assess the effectiveness of the initiative to date Provide advice and leadership to support improvement initiatives Assess the feasibility of ideas for expansion of the current suite of services managed by the BOPCCC team.

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g. Form recommendations for BOPALT to inform a decision about the whether the demonstration will continue and if so, what changes may be needed for greater impact.

Recommendations to be submitted to the BOPALT meeting on 24 October 2018 to allow time for changes to be implemented prior to the end of the demonstration site on 3 March 2019.

Results Table 1: Total Referrals received Total referrals received to 30 June 2018: 3687

Notes: Total includes District/Community Nursing, In Home falls, ACC and Short Term Support.

ACC and Short Term Support referrals are out of scope and sent directly to District Nursing as per existing arrangements.

The median shown above is 35 referrals per day.

There are signals of weekend activity presenting a different pattern; however the overall variation presented is common cause with no significant variation points.

Table 2: Community Nursing Referrals sent by group Community Provider incl. GP Regional Maori Health Services Other (HITH; Body-in-Motion) District Nursing (incl. continence DN)

206 21 3 2154 2,384

9% 1% 0% 90%

Notes: Referrals to community providers includes routine wound care referrals to participating general practices. Up to 30 June there were a total of 18 practices participating in the routine wound care trial. A further 6 have enrolled since 1 July 2018 (20 located in the Western BOP and 4 located in the Eastern BOP). BOPCCC is reporting providers decline referrals due to a

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number of reasons. When a provider declines, the default provider is the District Nursing Service. We are collecting further data on the number of declines and the reasons.

Table 3: Community Nursing Referrals sent Maori/Non-Maori Maori Non-Maori

514 1870 2384

22% 78%

Table 4: Referral Sources

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Table 5: Referrals by prioritisation category Priority GRADE 1 GRADE 2 GRADE 3 GRADE 4

%

% 137 1,211

6.36% 56.19%

640 167

29.70% 7.75%

Notes: The spread of referrals within each prioritisation category is different to predictions, notably the percentage prioritised as Grade 2. This is being investigated, particularly the application of the priorisation process.

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