Transforming Interprofessional Care and Organizational Performance through

Best Practice Implementation

June 12th 2015

Tracey DasGupta, Director of Interprofessional Practice

Beth O’Leary, Program Manager

We were asked to talk about:

How we:

• Positioned Best Practice work strategically

• Leveraged & aligned with other work

• Fit this work into existing organizational priorities

Sunnybrook Health Sciences Centre • Fully affiliated with University of Toronto

• 1,200 inpatient beds / 125 critical care beds / 26 operating rooms

• 10,000 staff and 2,000 volunteers located at Bayview and Holland

• Each year we:

– Care for 1 million patients (about 70% are from outside of Toronto)

– Teach 2,000 students (from around the world)

– Conduct in excess of $100 million in research

• One of Canada’s Top 100 Employers (two years running)

• 3.2 million square feet of buildings on 95 acres of land

• We consume 13,000 cups of coffee per day!

BPSO Reflections from the Early Days

• ‘Oh my’

• Listening to others

• Images & models that resonated with us

• Spent fair bit of time planning

Alignment & Coordination of Activities

PATIENT CARE IMPROVEMENT INITIATIVES

Improved Patient Care

↑ efficiency ↑ engagement ↑ coordination

Middle Leaders

Frontline Staff

INTERPROFESSIONAL APPROACH

5

Program /

Unit

Client

Centere

d Care

Assessme

nt &

Managem

ent of Pain

Risk

Assessme

nt &

Preventio

n of

Pressure

Ulcers

Care &

Maintenan

ce to

Reduce

Vascular

Access

Complicati

ons

End of

Life

Care

During

the

Last

Hours

& Days

Preventio

n of Falls

& Fall

Injuries in

the Older

Adult

Corpora

te Corporate

TECC

M2 CVICU

CRCU

D4 ICU

B5 ICU

C5

D5

Ross Tilley

Burn Centre

ER

Holland

MSK

3E & Special

Care

6E

7E

Client Centered Care to support roll out of each practice Local implementation to align to specific units Director Sponsor for each BPG

Green = Corporate Implementation Blue = Broad Practice Change Yellow = Focused Quality Improvement

BESTPRACTICE IMPLEMENTATION

Q22 0 1 2

Ju ly –

Se p t

Q3 Oct –

De c

Q42 0 1 3

Jan –

M ar

Q1Ap r –

Ju n e

Q2Ju ly -

Se p t

Q3Oct –

De c

Q42 0 1 4

Jan –

M ar

Q1Ap r – Ju ne

Q2Ju ly -

Se p t

Q3Oct - De c

Q42 0 1 5

Jan –

M ar

P C C

GIM HOL

P AIN P AINSURV

RESULTs

GIMB4 , C 4 ,

D2 , D4

HOL3 E, 6 E, 7 E

SK IN & WOUND TEC C C VIC U

C RC URTBC

B5 IC UD4 ICU

C OM MC 4

SC HULD3

ONCC2 , C6, D6

EOL ONCC 2 , C6, D6

VETK 1 E / K 1C

FALLS HOL3 E, 6 E, 7E

C OM MD2

SC HULD3

TEC CED

ONCC 2

ST JOHNSA3 , A4

VETK 2 E K 2 C

LTSE LTSWLFSE LGSE

LGSW LSSWLSSE

TEC CC 5

D5

VA TEC CC 5 , D5

C OM MB4

ONCC 6

SC HULD3

C IC USS

HOL3 E, 6 E, 7E

C OM MD2

Person-Centred Care Strategy Development

Stakeholder Engagement in the Development & Approval of a

Corporate Pain Policy

Corporate Implementation –Leaders / ACNRT / IP

Development of Standard Order Sets, Comfort Orders & Customized Evaluation

Corporate Implementation

Branding

We identified this was important

Wanted to reflect this not as discreet pockets of work

Rather it all fits together

Focus: Developing structures and processes to support ALL Best Practices

Clinical & PCC

Clinical & PCC

Clinical & PCC

Clinical & PCC

Professional Practice Committee Reporting Structures

Focusing on Staff as Champions

11

Champion Development / Year

100 Nursing + 25 IP Team Members

Developing a Unit Engagement Strategy And a Network Structure

Vision in 2015: To achieve a Critical Mass of > 375 staff who: Understand quality improvement

Seek best practice Use data to drive decision making Implement small tests of change

Support & sustain clinical best practice

Change Coordinator Role

KEY

13

Project Charters Standardized Communication

SBAR pic

Identify Alignments & Synergies

• With Quality & Patient Safety

• With the Office of the Patient Experience

• Operations Directors

• Accreditation – alignment of # of BPG’s

• Quality Improvement Plans

• Other – physicians, patient & family members

14

NHS Sustainability Model Source: National Health Service, UK

The Plan

• Implement 6 interprofessional best practices

• Programs to identify where there is the greatest opportunity for enhanced practice – ‘measurement units’

• Expect broad uptake across the hospital

• iLead Champions recognized as the vital link for successful implementation

• Focus on measurement

• The foundation will support all future work

THE JOURNEY

Year 1, Year 2, Year 3

PEOPLE: The iLead Champion

• Identify / Engage / Educate

PROCESS: Living Best Practice

• Data / Ongoing Education / Support

ORGANIZATION: Infrastructure

• Connecting / Networking / Profiling

Thoughts we had along the way

• Complexity theory

• Stay the course

• Stay united

• Progress not perfection

• Sense of humor is important

FAST FORWARD TO NOW

VISION

Collaborative interprofessional practice environment

that focuses on what matters and what is important to patients, where there are established processes to

ensure best practice drives what we do

and we do it well

every time…..

PEOPLE

Skilled, equipped & supported

PROCESS

Clearly defined &

understood

ORGANIZATION

Profiles & supports the

work

New Practice

Knowledge to Practice

Interprofessional Champions

Develop knowledge and skill through

participation in iLead Foundations

education

Champions come together in iLead

Connects meetings

Have Best Practice focused dialogue

Focus on data

Champions receive education & support to understand data

Champions are enabled to share

information & engage colleagues in

conversation to enhance patient care

outcomes

PROCESS Support & Sustain

an Evidence Based Culture

ORGANIZATION Connect

Champions & Integrate Best

Practices

PEOPLE Build Capacity

& Develop Leaders

iLead Champion Role

KEY

TAHSNp and Innovation Fellowship

Champion Engagement n=60

Development of iLead Champion Toolkit

Broad Engagement N= 1000

Capacity and Leadership Champion and Leadership Roles

iLead Champions learned to lead best practice implementation to improve quality of care and the patient experience 540 iLead Champions 100 interprofessional champions 4 Change Coordinators 2 RNAO Advanced Clinical Fellowships 2 TAHSNp Innovation Fellowship 1 Patient Engagement Collaborative Lead

An iLead Champion is passionate about patient care improvement and actively promotes, educates and inspires team members to

implement change and evidence based practices into every day care.

CONNECTING CHAMPIONS

MEANINGFULLY

Interprofessional Team Dialogue

Discussion in clinical areas

What is the data telling

us?

How is my unit doing relative to

other units?

How are we moving

collectively toward the

target What do we need to do to continue to improve?

iLead Champions Connect

Some Examples

Maria Teresa Salazar Marva McCalla

Swati Rathod Rebecca Liang

Will Wong Andre Feliciano Andrea Nunn

Network Events

WHY IT MATTERS

Corporate Best Practice Data Q3 2014/15 Update

iLEAD… THE CALL TO ACTION

Best Practice Dashboard

• User friendly tool for front line staff to review best practice performance data and generate local improvement plans

• Builds front line capacity of champions for quality and patient care improvement

• Enhances organizational action to enhance patient outcomes

iLead… the Call to Action

1. What is our current status?

2. How are we moving toward the target?

3. What do we need to do to continue to

improve?

Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec

Dashboard Release –

Champions receive info /

education & support

Middle Leaders create

space & support

champions to discuss &

plan next steps @ Unit /

Program levels

Successes of Unit /

Program dialogue shared

at Nursing Council & with

Best Practice Working

Groups

Champion are profiled

organizationally in regard

to enhanced outcomes

iLead Connect

iLead Connect

iLead Connect

iLead Connect

Champion B’fast

May 27th Network

Nov 25th Network

iLead Connect

iLead Connect

iLead Connect

OTHER ALIGNMENTS / SYNERGIES /

STRUCTURES

Inclusion in Quality Improvement Plans

• Person-Centred Care – 2 years – target > 93 to 95%

• Falls Risk Reduction – 2 years – focus > from 9 to > 60 patient care areas

• Quality Dying – 1 year

• Mobility / Preventing & Managing Delirium – 3 years

16-week Implementation Plan

0 20 40 60 80

100

Jan

-…

Ap

r-…

Jul-

…

Oct

-…

Jan

-…

Ap

r-…

Jul-

…

Oct

-…

Jan

-…

Overall, how would you rate the care you received at the hospital? -

Holland Centre

6E

3E

7E

Target 99%

Sunnynet Intranet Resource

Partnering with Patients and Families

Video Project Innovative interprofessional staff, student, and physician

education that supports the Person-Centred Care strategy by partnering with patients and families.

Patient and Family Forum

Create videos highlighting key messages to improve the care and the patient experience

Partner with patients and families to deliver education

Person Centred Care Processes Documentation of Care

Standardized Care Planning Tools: Questions for Team Rounds

Patient and Family Engagement Tools

Going Forward

• Other Best Practices engaging in this model – Initial 6 + Mobility, Delirium Prevention, Smoking Cessation, Diabetes, Phlebotomy,

Quality Based Procedures …

• Ongoing Quality Committee / Board reporting

• Engagement of Board Members in “Walk Abouts”

• Planning for Dashboard Releases, Connects, Network Events

• Toolkit creations

– Organization wide Person Centred Care Implementation

• Ongoing role of the Change Coordinator

• Further alignment; Best Practice, Quality, Patient Safety

THOUGHTS / QUESTIONS / WHAT DO

YOU WANT YOUR JOURNEY

TO LOOK LIKE?