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Designing Care Samantha Ludolf Designing Care Project Team Department of Human Services.

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1 Designing Care Samantha Ludolf Designing Care Project Team Department of Human Services

2 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?

3 Questions What would you like to gain from this session?

4 Objectives Overview of Designing Care Overview of your Designing Care Next steps

5 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

6 Designing Care Is……. 18 month program to either indirectly or directly improving patient care through Learning & Networking Measurement Projects

7 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

8 Designing Care: is not a quick fix the latest management fad a way of avoiding challenging implementation issues an all-encompassing strategic approach

9 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

10 Process Improvement ‘not all change is improvement but all improvement is change” Don Berwick, President, IHI

11 What is a process?

12 Process has inputs and outputs Input Output Process Definition - a process is a series of connected steps or actions to achieve an outcome

13 A Fractured neck of femur process B Patient processes cross many boundaries CD E % 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

14 “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

15 Your Designing Care Project is stays in the ED, who would you involve in the project?

16 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

17 Designing Care Project Teams Executive Sponsor Project Leader Project facilitator Multi-disciplinary team members

18 What are the roles? What do you think is the role of your Executive sponsor, Project Leader & Project Facilitator?

19 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!

20 Facilitating Designing Care Manage (drive) the project Avoid advice giving “external” facilitator “mind of a beginner” Share of talking should 75% team, 25% facilitator

21 Project Leader Manage the project Lead from the discipline area Champion of the project with peers and team members Supported by “external” facilitator

22 What skills do you need? - Executive sponsors -Project facilitators -Project teams

23 Tools & Learning Project management Process mapping Measurement Process redesign Change management - cultural, people & processes Facilitation Consumer involvement Evidence based healthcare

24 Learning Regional learning sessions Internet based learning/tools Internet based library Discussion groups On site learning –e.g process mapping & redesign, coaching & mentoring

25 The toolkit we will have some material for you to create your own toolkit

26 What is the best way of learning? “The best learning is by playing” Harold Bridges, Tavistock Institute

27 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?

28 Networking & Sharing Program of monthly meetings – key topics Quarterly project team meetings: Feb 2001 International conference: Feb 2002

29 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:

30 Next steps Feedback from the briefing session Final submission - Jan 01 Approval - Feb % Funding - Feb 2001 Launch event - Feb 2001 Baseline measures


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