Transforming Patient Flow, Improving Patient Care

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1 Transforming Patient Flow, Improving Patient Care Transformation by Design (TbyD) Dr. Peter Nord, VP, CMO, Chief of Staff Thelma Horwitz, Director, Quality and Process Improvement Heidi Hunter, Quality Improvement Manager

2 3

3 TbyD Alignment

4 Reason for Action Increasing financial pressures on the organization Increasing acuity levels of patients in the system Over 100 ALC patients in 347 beds at Providence System pressures to reduce ER wait times and Acute Care ALC rates Lack of resources in Outpatient Clinics and Community Care Patients experience too many inefficient transitions and hand offs as they move from acute care through rehab and finally home

5 Project Timeline

6 Transformation by Design Phases today Plan Design Implement Measure Evaluate Sustain Spread Stakeholder engagement Breakthrough thinking Space, staff, process changes, engage people Scorecard Surveys Using Providence Sustainment Model One unit at a time every six months

7 Implementation Space 6 month unit renovation Staffing Staffing model to support improved patient flow Process Changes Implemented 29 process changes

8 Implementation Engagement Implementation Events TbyD Coaching Team leadership Front-line staff driven implementation, measurement and sustainment Change Supports and Change Champions

9 Evaluation and Sustainment Bi-weekly metrics walk-arounds with all involved staff Staff surveys Patient/caregiver surveys Checkpoint weekly meetings Performance boards on unit Project scorecard Sustainment model

10 The new patient journey after Transformation by Design Meet Judy Smith

11 Judy meets one of the Providence Patient Flow Coordinators

12 Throughout her stay in the A3 Specialized Stroke Services unit Judy participates in weekly bedside Huddles

13 Through staffing changes, Judy has a maximum of 13 care providers instead of 35!

14 Judy s care now flows better through Standardized team meetings Weekend Home Passes encouraged New OT and PT Practice Consultants A more organized unit Interprofessional Rehab Education Family MD linkages for all patients Referral processes and tools from inpatient to outpatient therapy

15 Her recovery is also augmented with a redesigned unit space

16 As soon Judy is ready for the next phase of her recovery outpatient rehabilitation, she participates in a Therapeutic Transfer

17 Judy s Providence Outpatient Stroke Clinic team is ready to continue her journey with an expanded team

18 48 hours after discharge, Judy is contacted by her Providence Community Health Navigator

19 Judy tells us she has had seamless transitions in her journey to recovery

20 Results using Providence s hospital staff Sustainment satisfaction Model survey 29 out of 40 (73%) designed process changes were 20% implemented increase in staff positive response from pre to post implementation 100% of the targets were met in 2011/12 Transformed unit achieved the All process highest changes score have in the been most sustained recent On average, 83% of staff agree that the staffing changes help patients 82% of staff and improve agree that the patient flow remodeled spaces support the of concept 90% of of patients rehab agree everywhere, that the environment always, one helped patient them at a time achieve and their are satisfied rehab with goals the overall design

21 Results FY 2008/09 Actual FY 2009/10 Actual FY 2010/11 Actual FY 2011/12 TARGET FY 2011/12 Actual Admissions 1,759 1,905 2,074 1,905 2,168 ALOS (Rehab & CCC) in days Discharged home 69.3% % 75.0% 78.3% Average ALC patients Admission FIM ( Rehab Beds) Discharge FIM ( Rehab Beds) Patients felt prepared to go home ER Visits by 4 months post d/c / / N/A N/A N/A Monitoring 81% N/A N/A N/A Monitoring 2.2% (related to admitting diagnosis) 4.5% (falls)

22 Lessons Learned Early and ongoing engagement of staff, patients and families key to project success Clear and transparent communication A sense of urgency created with clear vision Senior team highly engaged Change management plan a must Clear project governance structure paramount Engage the staff who do the work to develop the solutions, measure and sustain Implement a sustainment model early in the process

23 Dr. Peter Nord x 3618 Contact Thelma Horwitz x 4081 Heidi Hunter x 4424

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