1. Med Rec: Beginning With the End in Mind Clara Ballantine, SIA SHN Ontario Node Ontario Node Open Line Call October 29, 2007

2. What is Med Rec?

3. Making it Manageable Two pieces of work:  The Best Possible Medication History  The Reconciliation process Two pieces of advice:  Move to designing the new process early  Don’t get stuck on the BPMH tool (form)

4. What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? Act Plan Study Do AIM Statement Measures Change Ideas for PDSA cycles Model for Improvement

5. What is “The End”? Whole Process  Admission  Transfer  Discharge Whole organization  Pilot unit  All other clinical areas Sustainability  Processes are embedded  Targets met and maintained

6. What is “The Beginning”? Project charter  Senior sponsorship  Team leadership  Pilot unit  Targets Baseline data  Maybe before first team meeting  Definitely before tests of change

7. What is “The Beginning”? Team formation  Leadership vs ownership  Membership for pilot and toward spread First team meeting  Picture, purpose, plan and place Communication

8. Pilot and Spread: What is “Spread”? “…learning which takes place in any part of an organization is actively shared and acted upon by all parts of the organization.” -NHS Modernisation Agency “Spread is the result of the process of adoption” - NHS Modernisation Agency

9. What is Sustainability? “…when new ways of working and improved outcomes become the norm.” “…means holding the gains and evolving as required, definitely not going back.

10. So, What to Do? Engage concrete, visible senior leadership support pre-charter Write a strong, clear charter and use it Consider team co leadership or an alternative to pharmacist led (becoming pharmacist owned) Consider pilot unit in terms of opportunity for learning, ease of spread, impact Decide between full three phase process in pilot unit VS first phase full organization approach Form team with spread in mind – leadership support + front line champions Design process with sustainability in mind

11. Words of Wisdom on Beginnings Beginnings are always messy - John Galsworthy, English novelist Don’t ask me to be in on the landing if I wasn’t in on the takeoff. - Lyndon B. Johnson Begin with the end in mind. - Stephen Covey, 7 Habits of Highly Effective People

12. Contact Information Clara Ballantine, BSc(PT), MEd, CPHQ SIA, Ontario Node clara.ballantine@qhn.ca Phone: (613) 736-9142