IMPROVING FLOW IN the NW HSDA TO PROVIDE

“CARE IN THE RIGHT PLACE”

Penny Anguish, NW COO On behalf of the NW CitRP Steering Group

Quality Forum – Vancouver February 26, 2014

Northwest Health Service Delivery Area

Participating Communities… Hazelton Prince Rupert

Kitimat

Terrace Smithers

The (Burning) Quality Issue

Admitted patients in the Emergency Department….

Inpatient congestion the norm in our rural community hospitals….

Many patients waiting for an alternate level of care (ALC)….

~20 - 25% of the acute beds had people waiting for residential care, usually for > 9 months….

Far too many “awful shifts”…..

The Quality Initiative: “Care in the Right Place”

Overarching Goal o Smooth and timely transitions of patients

to the right level of care to optimize use of acute care and community resources

Planned Outcomes o Reduced acute care occupancy rates o Reduced ALC and ALC to residential care

placement in particular

Key Interventions

Typical “FLOW” strategies o Unit white boards o Daily FLOW huddles o Interprofessional care planning o Optimizing use of community resources o Daily management with a focus on

timely results for the people that need to act

But change leadership at all levels mattered most…..

Steering Group and Local Team Accountability

NW Senior Leadership Team

NW CitRP Steering Group

Prince Rupert Improvement

Team

Kitimat Improvement

Team

Terrace Improvement

Team

Hazleton Improvement

Team

Smithers Improvement

Team

NW

QI Lead

NH Executive

Execution Strategies

Project charter (2 page summary) o Developed collaboratively o Provided clear goals for teams

Steering Group Action plan o Pulled goals from charter o Basis for development of local plans

Reporting results o Daily and monthly reporting o Increased accountability o Communicated success

What Worked / What Changed

One team’s story: Prince Rupert

<Insert video link>

Results

Results

(450)

(350)

(250)

(150)

(50)

50

150

250

350

450

P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13 P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11

FY2012/13 FY2013/14

ALC

Patie

nt D

ays

NW Acute Facilities ALC Patient Days (QC & Haida Gwaii Excluded) Variance from Prior Year Period

ALC Days Variance Prior Year Baseline

Pd 9 Care in the Right Place Starts

Results

Results

Oct 2012 Nov 2012 Dec 2012 Jan 2013 Feb 2013 Mar 2013 Apr 2013 May 2013 Jun 2013 Jul 2013 Aug 2013 Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014

628.88 628.88 628.88 628.88 628.88 628.88 420.54 420.54 420.54 420.54 420.54 420.54 420.54 420.54 420.54 420.54

334.79 334.79 334.79 334.79 334.79 334.79 126.46 126.46 126.46 126.46 126.46 126.46 126.46 126.46 126.46 126.46

481.83 481.83 481.83 481.83 481.83 481.83 273.50 273.50 273.50 273.50 273.50 273.50 273.50 273.50 273.50 273.50

571.00 505.00 486.00 531.00 423.00 375.00 338.00 387.00 321.00 291.00 213.00 254.00 283.00 229.00 215.00 204.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

100

200

300

400

500

600

700

Special Cause FlagIn

div

idual V

alu

e

Calendar Month

NW HSDA - ALC Placement Patient DaysBase for LimitsAverage MR

A. 1 Beyond Control LimitB. 9 On One Side of Average

D. 14 Alternating Up & DownE. 2 of 3 Beyond 2 Sigma

G . 15 Within 1 SigmaH . 8 Outs ide 1 SigmaX. Excluded or Miss ing Data

Last Center Value 273.5Last Data Value 204Sigma for Limits 49.01

Care in Right Place Starts

Residential Care Waitlists: New Referrals

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Key Learnings

There is untapped capacity in the system if you are looking for it

Initial assistance (FLOW Coordinators and QI Lead) key in LITs getting started

Rich communication to physicians mitigated early resistance from this group, sharing results fosters physician engagement

Engaging staff through LITs using QI process/strategies is a must

Daily management is key to sustainability

Next Steps

Solidifying daily management accountability to point of care managers (acute and community)

Acting on data analysis of Emergency Department activity (high user care coordination and CTAS 3 admission avoidance)

Shifting acute care to a rehabilitative approach (our care of the frail elderly)

Further optimization of community resources/residential care avoidance strategies