A Simple Tool to Improve Patient Flow: Communication Design to Nudge Quality Improvement

A simple tool to improve patient flow:Communication design to nudge Quality Improvement

Rich Dillon, Carmen Dyck, Dr. Janet Joy, Dr. Gui Noël

Quality Forum 2016: Session D4

None of the presenters have any affiliations (financial or otherwise) with a commercial organization related to this work

1. Improving patient flow is a key priority for healthcare today

2. Timely hospital discharge is critical towards improving system flow. To address this, Richmond Hospital (RH) started the 2 x 9 initiative

3. We needed to create a new QI system to display daily discharge data

4. Many QI data reports leave staff believing that our goals are more about numbers, and less about patient care. In our display, we wanted to highlight that this work was about patient care.

Aim & Context

Our Assumptions

Nudge theory: Non-forced incentives can influence change initiatives

To transform patient flow and care, we need to break out of the typical hospital silos and find a new way to work together

It’s a new (data) world. The way you communicate and display data can change people’s behaviour, as well as how they feel about the work

Our Assumptions

Our Assumptions

Our Decision

We wanted to go beyond the typical ways of displaying data,

so we hired a designer to come up with new ideas

Design is important because it creates tools to affect the feelings, knowledge, attitudes, and behaviours of people. It can turn existing realities into better ones.

Design brings the possibility to empower people to improve health and healthcare.

Why is communication design so important?

User centred design is an approach that requires active participation in the design process of everybody involved (patients, healthcare providers, leaders).

Designing for others and caring for others both require a deep understanding of “the others.”

What is user-centred design?

Attention Memory Previous knowledgePrevious experienceExpectations

MotivationValuesCultureEmotions

Text/ContentTopicGenreWritten styleVocabularyOrganizationVisual design

Distractors

Light

Vocabulary level

Reader

Reading purposeLevel of difficultyLevel of interest

Reading environment

The patient discharge time board

Units

Date

Patient discharge times: How are we doing?

ED

DTU

2S

3S

3P

3N

4N

6N

PEU

anticipated actual

000-800 800-1000 1000-1200 1200-1800 1800-2359

Transforming

care

.......

........

........

Work toward safe and timely discharge. Patients and families will thank you for it!

# of dischargesour goal

VCH-Richmond

00:00-08:00

000-800

The biggest changes we’ve seen

We moved from a mentality of resistance and pushing, to pulling

There is a sense of ownership for patient flow at all levels – it’s transformed our teams and how we work together

Performance: Impact on our P4P numbers

Our most significant lessons learned

By reminding staff that the patient is at the heart, such displays can motivate QI in ways that accountability data do not

Providing hands on support & displaying timely data in a meaningful way can change everything

A relatively small investment ($2500) in data display can help revolutionalize how we approach our daily standard work

Where we still struggle

We need to find more ways to balance data for senior level accountability with data that also speak to unit-level staff

Using design principles to create our displays–right now, it’s often considered a ‘nice to have’ and not a ‘necessary to have’

Discussion Question

How in our health authorities can we change the way we display QI data, to engage the hearts and minds of our point of care staff?

Contact Information

Rich Dillon Richmond Hospital, Manager of Patient Flow & Care Transitions richard.dillon@vch.ca

Carmen DyckVCH Quality Improvement Advisor carmen.dyck@vch.ca

Dr Guille NoelFrascara-Noel Visual Communication Design guille@frascara-noel.net

Dr Janet JoyVCH Director of Innovation and Evaluation janet.joy@vch.ca