1. 20,000 Days Campaign Storyboard Learning Session 3, 11-12 March 2013
VHIU Link Team
Professor Harry Rea (Clinical Lead )
Ta-Mera Rolland (Operations Manager)
Nurses
Pharmacists
Physiotherapists
Occupational therapists
Social Workers
Locality Coordinator
Administration
20,000 project support team
Links with:
Cultural Support
Mental Health
Other Specialist teams

2. Aim
To increase the number of patients enrolled into the Very High Intensive User programme (VHIU) from 120 cases to 600* cases by July 2013.
This will result in a reduction in unplanned presentation and admission to Middlemore Hospital.
*Goal of 600 includes:
GP Referrals: 200 cases
5 Flag referrals: 400 cases

3. Driver Diagram
- Include Collaborative Driver Diagram

4. 5 Flag Process Change Packages
Secondary Drivers
(Theory of change)
Change Ideas Tested
Describe Process
Screening and Triage .
Process has been standardise to ensure consistent assessment and review of all patients
Risk Assessment Guide (RAG)
Improved the existing RAG form to include information relating to language and health literacy to enable more comprehensive and thorough assessment.
Streamline Data Collection
Improved the existing data sets enable process measures that facilitate the monitoring and assessment of the change ideas.

5. 5 Flag Process Change Packages
Secondary Drivers
(Theory of change)
Change Ideas Tested
Describe Process
Patient Quality of Life Assessment
To demonstrate VHIU’s benefit to the patient.
Standardise Information to GP’s
To enable and ensure that GP’s receive clear and consistent information about what VHIU does and how they work with practices.

6. GP Process Change Packages
Secondary Drivers
(Theory of change)
Change Ideas Tested
Describe Process
GP referral, use of triage tool.
To enable GP to review their patients to identify those most likely to benefit from the VHIU programme.
Partnering with GP Practices
Working with Franklin, Otara & Mangere Practices, sharing expertise and information, sharing home and follow up visits. Developing a joint care plan.

7. Most Successful PDSA Cycles?
- Include PDSA Tree diagram

8. Most Successful PDSA Cycles?
Pt identification by
GP using PARR
(with High score)
GP Heart sink
Patients (list)
Pt identification by GP using PARR (Any score)
Test of 5 flag+PARR+
Heart sink pts
GP identification/
Referral
5 flag generation
for GP
PARR & 5
Flag comparison
Trigger tool
Our prediction before the PDSA:
GP’s can correctly identify the appropriate VHIU patients using the PARR tool.
PDSA data revealed that on its own the PARR tool did not correctly identify patients for the VHIU team
This PDSA led to the embedding of the trigger tool as part of patient identification

9. Measures Summary Outcome measures
Patients enrolled from 5 flags, Primary care & Secondary care
Reduction in unplanned presentations & admissions
Bed days saved
Patient outcome measure (pre and post VHIU programme)
Process Measures
Number of patients completing the VHIU Programme
Number of times patients complete the VHIU Programme
Time between presentations at EC & time to next unplanned presentation.
Balancing Measures
Numbers of re- presenting patients to the programme

10. VHIU Dashboard
- Include Collaborative Dashboard

11. Changes to Support Implementation
Implementation Areas
Changes to Support Implementation
PDSA cycles
Standardisation
Screening and Triage Process
Documentation
Process Map
Training
Developing training materials to support new staff.
Job Descriptions
Measurement
Develop regular reports for outcome and process measures
Resourcing
Review of Job Descriptions for new Staff recruited
Adapted from “The Improvement Guide. A Practical Approach to Enhancing Organizational Performance” Gerald Langley et al., 2009, p180.

12. Highlights and Lowlights
The collaborative support from 20,000 days bringing focus and drive that has provided a catalyst for change and increased momentum
The mutual respect within the VHIU team of our interdisciplinary skill set
Recognition of the importance of a Model of Care which includes home visit and an holistic approach
Lowlights
Confusion due to multiple agendas within Primary and Secondary care
Resistance and misunderstanding about integrated care
Difficulty in breaking down silos of care

13. Achievements to date Do you have a change package, measurement plan?
Multiple PDSA have resulted in standardised data capturing and reporting which includes monthly VHIU dashboard.
What has changed and what difference have the changes made?
The data has allowed us to focus on areas that make a difference and abandon those that don’t.
Triage process improved to identify the patient acuity enabling the timely intervention
Referral Process leading to identification of patients from across the health sector
Patient identification: Increase the appropriateness of referrals received
Improvements for patient and family experiences
Right service by the right professional to the right patient and at right time