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Redesigning Acute Care for Older People: The Start of Sheffield’s Journey Tom Downes MB BS, MRCP, MBA, MPH (Harvard) Clinical Lead for Quality Improvement.

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Presentation on theme: "Redesigning Acute Care for Older People: The Start of Sheffield’s Journey Tom Downes MB BS, MRCP, MBA, MPH (Harvard) Clinical Lead for Quality Improvement."— Presentation transcript:

1 Redesigning Acute Care for Older People: The Start of Sheffield’s Journey Tom Downes MB BS, MRCP, MBA, MPH (Harvard) Clinical Lead for Quality Improvement Sheffield Teaching Hospitals The Health Foundation / IHI Quality Improvement Fellow 28 th November 2012

2 Healthcare inflation Rises in healthcare spending: where will it end? Jon Appleby, BMJ 1 st November % per year over the last 30 years Driven by technology and expectation Only 0.4% attributable to ageing Need to deliver over 20% more care in 5 years’ time Need to deliver over 50% more care in 10 years’ time UNSUSTAINABLE Rises in healthcare spending: where will it end? Jon Appleby, BMJ 1 st November 2012

3 ‘We must redesign services. Decisions about service redesign must be clinically led and clinicians must be prepared to challenge the way services - including their own service – are organised.’ Hospitals on the Edge – The time for action Royal College of Physicians, 13 th September 2012

4 Day 2127 as a consultant

5 A ‘system’ problem

6 A complex system problem

7 2003 Toyota Corolla

8 Toyota Oobeya Room How do others design complex systems?

9 First find a room

10 The Room

11 Board 1: The Business objectives: GSM weekly bed occupancy from April 07 with target lines Board Level Business objectives for GSM

12 Board 2: What do these objectives mean for our patients? A Future State diagram Of the GSM Process as it evolved Post-it note comments from stakeholders

13 Board 3: How are we doing against the GSM business and patients objectives?

14 Board 4: High Level GSM Process through the complex health and social care system & Board 5: Real time plan High Level: Current State Map of the GSM process Programme Plan time April Each row presents the tasks (yellow post-its)to be performed by each stakeholder group

15 Tests

16 Let me introduce ‘George ’ 82 years old Lives independently and wants to continue doing so Widowed 5 years ago Has mild dementia Daughter lives locally Losing weight and finding walking more difficult PDSA tests of moving from ‘post take’ to ‘on take’

17 Challenge to UK geriatric medicine traditions: Split of inpatient / outpatient care Combined immediate delivery of specialist MDT care

18

19 Batching patients for ‘Post-take ward round’ Real-time senior specialist review (7/7) Bedded medical assessment unit could be unnecessary for most geriatric medicine patients

20 Twice weekly senior clinician ward rounds Daily senior decision capability on every ward

21 MDT planning meetings Assess needs at home once acute hospital environment no longer adding value

22

23 Porter’s Value Based Design Integrated Practice Units Measure Outcome Bundled Pricing Integrate across Geography Expand Excellence Enabling IT platform VALUE What Is Value in Health Care? Michael E. Porter, Ph.D. N Engl J Med 2010; 363: December 23, 2010

24 Implementation headlines: April 2012 New discharge process from assessment units Consultant geriatricians ‘on take’ 7 days per week May 2012 Frailty Unit process initially virtually Frailty Unit opens mid-May July 2012 Ambulatory care area for work formerly considered to be outpatient

25 Outcome measure: 34% increase in discharge within 1 day

26 Outcome measure: Bed occupancy reduced by over 60 beds

27 Was reduction in bed usage due to reduced admissions? No

28 Balance measure: Would it have happened regardless?

29 Balance measure: Decrease in readmissions

30 Balance measure: Decreased mortality

31 Value Value = Outcome / Cost Return on investment = Saving – Investment / Investment = (£3,000,000 - £750,000) – 140,000 / £140,000 = 2,110,000 / 140,000 = 15

32 Resources have started to move to the community Designing and Not home

33

34 ‘Improvement in health care is 20% technical and 80% human’ Marjorie Godfrey The Dartmouth Institute

35 Conclusion Modern health care is complex Iterative testing and prototyping is required Cooperation between and health and social care is essential Our journey has only just started

36 Thank


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