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Verna Yiu, MD, FRCPC VP Quality and Chief Medical Officer
Alberta Health Services Professor of Pediatrics, Faculty of Med/Dent
University of Alberta 7th Canadian Quality Congress Sept 28th, 2015
Humanizing the Patient Experience through an Improvement Lens
• Alberta Health Services: Who we are and what we do • AHS Improvement Way: creation of a large scale sustainable
improvement methodology • Going beyond traditional process improvement methodologies to
including the patient and staff experiences: EIN collaboration • The next phase………..
Humanizing the Patient Experience through an Improvement Lens
The State of Healthcare – Alberta Health Services 2008
3
Mission: To provide a patient-focused quality health system that is accessible and sustainable for all Albertans • 120,000+ Staff and Volunteers
• 7500+ physicians
• 110 Acute Care Hospitals/Facilities (~8800 beds)
• 172 Long Term Care Facilities (>14,000 beds)
Alberta Health Services
4 million Albertans served over 661,848 square kilometers
The Opportunity • Multiple Improvement Methodologies (legacy systems) • Fragmented infrastructure for Quality improvement • Frontline health care providers confused with
improvement jargon • No connection between “training”, “improvement
projects” and “improvement capacity building” • Need for front line driven improvement culture, rather
than “top-down” approach
• In 2010, AHS designed the AHS Improvement Way (AIW)
• Customized • Easy to understand, common improvement
language • Principles of Lean, Six Sigma, Change
management and other established improvement philosophies
• Integrated system of training, certification and facilitation services to improving patient care
AHS Improvement Way (AIW) is Born!
• Continuum of Services o “I want to learn about how AHS does Improvement; where do I go?” AIW Fundamentals 1-day Workshop o “I attended the AIW Fundamentals and thought it was interesting; how do I apply this to
my workplace?” AIR Core 5-day Workshop OR AIW Small Scale Project Stream o “We improved processes on my unit; how do I tackle issues that span multiple
departments?” AIW Large Scale Project Stream o “We reduced infections in our hospital; how do I spread that knowledge across AHS?” AIW Collaboratives
• Knowledge Transfer o “I want to learn how to lead improvement initiatives; how do I qualify to do that?” AIW Certification Programs (Yellow Belt and Green Belt)
The AIW Approach
The AIW Components
The AIW Journey to date Milestones • 2010-11: AIW Fundamentals Workshop Developed by team
responsible for training and certification o Team of AIW Facilitators created
• 2011-12: First batch of successful AIW initiatives (Cancer Care, Emergency Departments) o Merger of Training and Facilitation teams into one cohesive unit
• 2013: Development of AIW Yellow Belt and Green Belt Modules • 2014-15: Development of the AIW Collaborative (Falls
Collaborative)
The AIW Journey to date Results • 200,000+ patients positively impacted every year • AIW Initiatives in every health sector (Acute Care, Continuing Care,
Public Health, Addictions and Mental Health) – over 200 small and large scale improvement initiatives
• 11,000+ staff trained • 1500+ staff trained in Advanced AIW techniques • 1300+ staff certified to the AIW Yellow Belt level • 40+ AHS Staff certified to the AIW Green Belt level
The AIW Journey to date Specific Examples of Results • Within 6 months of embarking on AIW implementation, Cross
Cancer Institute saw its Radiation Oncology wait times from referral to consult drop by 40%
• The Sturgeon Community Hospital saw its Emergency Department increase capacity by over 20% without adding any new staff or equipment.
• The Endoscopy department in the University of Alberta Hospital increased capacity to see more complex cases while at the same time increasing overall capacity to perform the procedures…..
AIW Impact • In 2013, AHS conducted a comprehensive evaluation of
AIW o In Phase 1 (Qualitative) of the Evaluation (4000+ staff
surveyed) o 85% of respondents agreed that attending AIW workshops has
increased their commitment to improvement work o 82% of respondents have identified improvement opportunities o 64% of respondents have become involved with improvement
work within a team, with 50% of those leading the improvement
AIW Impact • CancerControlAlberta has made AIW one of their top
three strategic priorities (after seeing major improvements in patient outcomes)
• Addictions and Mental Health and Public Health are increasing their participation rates in AIW training, certification and AIW initiatives
• Provincial Services like Labs, Pharmacy, Capital Management and IT have embraced AIW as their improvement method of choice
The AIW Journey to date
Scanning Across the Industry
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Quality & Safety Improvement
Performance Improvement
Service Excellence
Methodologies Measures Outcomes
Methodologies Measures Outcomes
Methodologies Measures Outcomes
Key focus: Implement evidence-based guidelines
Key focus: Strip out waste
Key focus: Service recovery & nonclinical support
Inefficiency
Initiative fatigue
Fractured attention
Redundant infrastructure
Lack of enduring change
Burnout
The Traditional, Siloed Improvement Approach
Parallel initiatives duplicate efforts and limit efficiency
16
17
Human Experience =
Making a Difference
Empathy +
Communication, Relationship, Emotional
Support
Experience Mapping
= Efficiency
Quality, Safety, Efficiency
Process Improvement
+
17
The Key to the Ideal Experience
Page 17
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Alignment Intelligence Discovery Design Realization Sustainability
Set patient experience goals, develop strategy and identify resources to catalyze patient experience transformation.
Collect experience data; assess current experience, perform initial benchmarking and set measureable project goals.
Process for observing the moments of truth along the continuum of care and capturing patient, family, staff and physician voice.
A visioning exercise that brings together multi-disciplinary stakeholders to prioritize experience gaps and identify solutions.
Implementation of evidence based interventions or “Always Events” that transform the patient, family, staff and provider experience.
The spread, measurement and monitoring of interventions that optimize the experience.
Experience Design and Mapping blends LEAN/Six Sigma and ethnographic research principles to assess current experience and design new standards of care that optimize
operational efficiency and differentiate the healthcare experience.
What is Experience Design + Mapping?
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Identifying Moments of Truth along the Journey
What matters most?
With fresh eyes, step into the role of a family member with a loved one to observe the experience and identify the “Moments of Truth” across four dimensions.
Communication-Did the patients, families, staff, and physicians receive the right information at the right time?
Clinical-How did the patients, families, staff, and physicians perceive the quality of care?
Physical - Did the physical environment support the patients, families, staff, and physicians needs?
Emotional - Were the patients, families, staff, and physicians emotional needs met?
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Experience Observation
Relationship Building Quality & Safety Perceptions
Emotional Wellbeing Information
Human Experience
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Standard Design + Mapping Project Timeline
Alignment and Intelligence Design Realization and Sustainability
[Team & Goals]
[Data Analysis]
[Pulse Survey, Interviews, Planning for Onsite]
[Observation, Focus Groups, Design Session]
[Future State Map]
[Project Plans]
[Coaching & Implementation Support]
1 2 3 4 5 6 7 8 9 10 11 12 Week
Note: Multiple projects can be run in parallel
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Case Study: Enterprise Design and Mapping
Unify medical staff and administration in redesigning the patient and employee experience across a two hospital campus.
APPROACH
• 100+ Patient, Family Caregiver Interviews
• Patient & Family Perspectives and Videos
• Facilitation of 14 Service Line Meetings (300+ Clinicians)
• Developed Experience Road-map
• What immediate process improvements will enrich the patient and caregiver experience at Mission Health?
• What changes in the physical plant will improve the patient and caregiver experience at Mission Health?
• What innovations will differentiate the serve line for patients and families and make Mission Health the place where employees and medical staff choose to spend the rest of their careers?
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Map Efficiency + Empathy
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Unify medical staff and administration in redesigning the patient and employee experience across a 2 hospital campus.
“Now that I have done a lean event with experience mapping integrated, I would not do it any other way.”
- Dawn Burgard, MBB, MBA
Developed patient experience strategic plan.
Mapped 14 clinical service areas for redesign.
Trained process improvement team in experience mapping and design methodology..
Deployed technologies to create sustainable improvements.
Emergency Department Future State Experience Map
Approach
Results
36%
81% 74% 75%
93% 88% 95% 92%
0%
20%
40%
60%
80%
100%
MD Comm Quality of Care Teamwork Safety
2011 2014
Case Example – Aligning Process Improvement with xMapping
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Humanizing Healthcare Efficiency Experiential Innovation Network
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Date Created: Wednesday, July 01, 2015
77 Total Responses
Complete Responses: 69
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Q7: How often in your improvement projects do you measure a baseline and subsequent measure for each of the following? Answered: 75 Skipped: 2
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Q8: How frequently do you have patients/families present during your: Answered: 74 Skipped: 3
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Q10: Which of the following best describes your organization's adoption of structured, experience-focused improvement methodologies? Answered: 74 Skipped: 3
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Q15: How well does your organization “people-ize” the data (i.e. put a human face on quality, safety, and efficiency measures)? Example: “Last year we reduced avoidable readmission by 21%, that is 8,000 readmissions, or 21,000 nights patients spent in their own beds.” Answered: 73 Skipped: 4
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Q17: Many process improvement efforts start well but aren’t sustained. Please select the top 3 reasons why improvement initiatives stall or fail. Answered: 71 Skipped: 6
• Demand comes from the front line staff and/or operational leaders: o Success stories on AHS intranet o Support from Senior leadership o Collaboration with local quality leaders
• Fiscal Sustainability o Internal Coaches o Focus on Improvement with existing or fewer resources
(space, overtime, supplies) o Return on Investment (ROI) as foundational concept
The AIW Approach – what did we learn?
• Aligning Process Improvement with XMapping: o UAH Hospital/Medicine + Patients/Families + Process
Improvement + Engagement/Patient Experience = Experiential Process Improvement of the Over Capacity Protocol (OCP)
o Detailed interviews/focus groups/surveys with affected groups to defining the experiences (first starting with baseline survey of pts/families/staff who have experiences of the OCP)
o Strategies on designing solutions and messages will be developed based on the input
o Project team working in collaboration with Physician+nursing unit manager
AIW+Xmapping– next phase
Changing Experience Expectations
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Meet me where I am. Empathize with me.
Make it easy for me. Nurture me.
It takes a village………
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Kimberly Petty
Elizabeth Boehm Anurag Pandey
Carolyn Hoffman
Glenda Coleman-Miller
Laurie Taylor
Rhonda Vandenberg