Designing Care

Samantha LudolfDesigning Care Project Team

Department of Human Services

• What are the 3 major issues facing the delivery of patient care for your organization? How will Designing Care help to address these?

• What would the “the government of the day” need to know at the end of the 18 months to continue funding initiatives such as DC?

• What are the perceived benefits of reporting to DHS on Designing Care?

Questions

• What would you like to gain from this session?

Objectives

• Overview of Designing Care

• Overview of your Designing Care

• Next steps

Designing Care: a history

• Quality improvement Deming / Juran 1960s

• Organisational learning / systems theory

Senge 1991

• Re-engineering / process redesign Hammer 1993

• Breakthrough improvement, Institute for Healthcare Improvement 1996

Designing Care Is…….

18 month program to either indirectly or directly improving patient care through

• Learning & Networking

• Measurement

• Projects

Priorities for your projects:

• Patient flow - across the system of care linking in with the work of the Patient Management Taskforce & the Emergency Demand Project Team

• Quality management - linking in with Adverse Events, Risk Management and Clinical Governance

Designing Care: is not

• a quick fix• the latest management fad• a way of avoiding challenging implementation issues• an all-encompassing strategic approach

Designing Care: what it can do

• Tackle key issues

• Create significant improvement (up to 50%) in key measures of performance

• Create new ways of working across professional, departmental and organisational boundaries

• Learning & cultural change

Process Improvement

‘not all change is improvement but all

improvement is change”

Don Berwick, President, IHI

What is a process?

Process has inputs and outputs

Input OutputProcess

Definition - a process is a series of connected steps or actions to achieve an outcome

A

Fractured neck of femur process

B

Patient processes cross many boundaries

C D E

• 30 - 70% of work doesn’t add

value for patient

• up to 50% of process steps involve a “handoff”, leading to error, duplication or delay

• no one is accountable for the patient’s “end to end” experience

• job roles tend to be narrow and fragmented

organisational/departmental boundaries

endoscopy process

outpatient process

“In healthcare, the tendency has been to seek improvement by trying to perfect the elements of care

- to make doctors better at doctoring,

- to make nurses better at nursing,

- to give equipment more functions,

- or to replace one drug with a better one.

All of this “subject matter” or “discipline” specific” improvement helps, but modern systems theory suggests that greater leverage often lies in changing the patterns of interaction and in redesigning the overall flow of work.”

Berwick and colleagues 1998

Physicians as leaders in Improving Healthcare

Your Designing Care Project is stays in the ED, who would you

involve in the project?

Designing Care Funding for:

• Multi-disciplinary project teams

• Cross functional project teams

• Dedicated time to meet

• Commitment to change

• Ownership of the change

• Support for the change

Designing Care Project Teams

• Executive Sponsor

• Project Leader

• Project facilitator

• Multi-disciplinary team members

What are the roles?• What do you think is the role of your

Executive sponsor, Project Leader & Project Facilitator?

Sponsoring Designing Care

• provide leadership commitment (clinical/managerial)• identify direction • ensure that the project is feasible• ensure that the project area is strategically important

& worth doing• define the aims/objectives and performance

measures• remove ‘log jams’• gain ‘top team’ approval for the project outcomes• continually reiterate the importance of the project• celebrate success!

Facilitating Designing Care

• Manage (drive) the project

• Avoid advice giving

• “external” facilitator

• “mind of a beginner”

• Share of talking should 75% team, 25% facilitator

Project Leader

• Manage the project

• Lead from the discipline area

• Champion of the project with peers and team members

• Supported by “external” facilitator

What skills do you need?

- Executive sponsors

- Project facilitators

- Project teams

Tools & Learning• Project management

• Process mapping

• Measurement

• Process redesign

• Change management - cultural, people & processes

• Facilitation

• Consumer involvement

• Evidence based healthcare

Learning

• Regional learning sessions

• Internet based learning/tools

• Internet based library

• Discussion groups

• On site learning –e.g process mapping & redesign, coaching & mentoring

The toolkit

•we will have

some material

•for you to create

your own toolkit

What is the best way of learning?

“The best learning is by playing” Harold Bridges, Tavistock Institute

4 organizations are all looking at process of care for COPD

Patients.

Do you think it would beneficial to share the learning with 4

organizations?

Networking & Sharing

• Program of monthly meetings – key topics

• Quarterly project team meetings: Feb 2001

• International conference: Feb 2002

• By June 2002, the end of Designing Care, what will you have achieved?

•How will you measure your achievements?

• How will you apply process mapping and redesign methodology?

From you:

Next steps

• Feedback from the briefing session

• Final submission - Jan 01

• Approval - Feb 2001

• 60% Funding - Feb 2001

• Launch event - Feb 2001

• Baseline measures