Clinicians Leading Care

Libby Carter & Samantha Miller

Culture & Consumer Experience Directorate

Central Adelaide Local Health Network

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Central Adelaide Local Health Network

> Acute Care hospitals

• Royal Adelaide (650 beds) & The Queen Elizabeth

(400 beds)

> Rehabilitation hospital

• Hampstead Centre & St Margaret's

> Mental health

> Sub acute, primary health care and State wide

services

In 2012/13

• 106,433 people discharged from Hospitals

• 111,310 ED visits

• 665,552 Outpatients visits

• 13,000 staff

Central Adelaide: Directorate Structure

> Local Health Network structured into

Directorates, which provide governance

across all CALHN sites

• Medical

• Surgical

• Cancer

• Critical care

• Renal

• Mental Health

• Culture and Consumer Experience

Why a Clinicians Leading Care program?

> Issues, Challenges, opportunities

> Frontline empowerment to improve care works

> Need clinical champions who are ready to absorb

the change

> Build patient centeredness and improvement into

our DNA

Why a Clinicians Leading Care program?

> CALHN Operational Excellence Budget

Performance and Remediation Strategy 2012-13

• Identified efficient and effective management of

inpatient LOS as a component of meeting growing

demand and optimising financial performance

• Formal redesign of patient pathways, lead by

clinicians to improve quality of care could reduce

LOS .

• Clinicians required a standardised approach to the

clinical redesign process

Why a Clinicians Leading Care program?

(Cont)

> Continual Practice Improvement (CPI) Programs

where on hold SA wide

> Many CALHN staff had completed care production

and clinical redesign programs but were not actively

involved in any redesign activities

• These findings were also supported in the CLC pre

program survey

Clinicians Leading Care

> A Clinical Redesign program using care

production principles.

> Enable and Support Clinicians to

Redesign care pathways

Improved quality outcomes

Length of stay/bed days are

reduced

> Build clinical redesign capability

> 6 month intensive support program.

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CLC: Expected outcomes of the clinical teams

• An improvement in quality outcomes for

patients (as determined by the clinical teams)

• Length of stay (LOS) reduction or a reduction in

occupied bed days (OBD) within the care

pathway population

• Variation to Health Round Table (HRT) or other

benchmark to be reduced when compared to

peer hospitals within the care pathway

population

The CLC Program

> Contained program over six months

• Clear time lines, milestones and expected

quality outcomes

• Clinician contact time and minimal contained

cost

> Over the six months clinicians are

supported with:

• Workshops

Total: 3 full days (less than other programs)

Facilitated by a redesign expert

Practical and hands on with teams working on

redesign

Standardised methodology

The CLC Program

> Supported with dedicated facilitator

• 0.2 FTE support

> Supported with toolkits and access to data

> Executive support

• Clinical Directors involved in process

• Clear reporting lines to Clinical Director

> Multidisciplinary teams working across sites

Sustainability of the program

> Low cost – in house program

> Larger numbers of staff engaged

> Support from Strategic Executive

> Focus on clinical rather than process

redesign (impact on patients experiences

rather than “paper work and store rooms”)

> Celebrating success

Pilot Program: Feb to July 2013

> Four clinical teams focusing on the

following patient pathways

• Low risk chest pain (Two groups)

• Reduction of urinary tract infections (UTI) in

patients with urinary catheters

• Patients requiring laparoscopic

cholecystectomy surgery

Pilot Program (Feb to July 2013):

Summary of major accomplishments

> Capability built within the workforce

> Quality outcomes for patients

> LOS reduction for patient pathways

redesigned

> Reduced variation with peer hospitals for

redesigned patient pathways

> Executive support for two more cohorts –

total of 12 teams

Building Capability

> Staff involvement

• 36 clinicians directly involved in the four teams

• Approx. 100 staff indirectly involved through

consultation

> Pre and post program survey

• Response rate (100% pre & 80% post program)

Capability

> Overall participants described self

reported improvements in all areas:

• Knowledge

• Practical experience

• Confidence

• Attitude (value)

Do you believe

that clinical

redesign/care

production

programs such

as CLC are a

worthwhile

investment for

CALHN?

Quality Outcomes

> A reduction in the prevalence of

urinary pathogens in patients with

urinary catheters from 68% to 49%

> A reduction in the average LOS of

patients requiring emergency

laparoscopic cholecystectomy from

6.1 to 3.4 days

> Elimination in an overnight stay and

reduction in OBD for the low risk chest

pain patient

Reduced LOS and variation to peer hospitals

> LOS was reduced in all pathways

redesigned

> Variation from benchmark peer hospitals

was reduced in all cases

Facilitators

workshop

One day

Clinical Teams

Workshop 1

Two days

Clinical Teams

Workshop 3

Mid point

Final

Presentation of

process and

outcomes

CLINICIANS LEADING CARE PROGRAM

Supporting CALHN with quality outcomes through clinical redesign for the improvement of key clinical DRG areas.

Pro

ce

ss

Tim

efr

am

e

Review CLC

program,

method, content,

& toolkits

Pre capability

survey

Clinical redesign

in CALHN.

Introduction to

practical aspects

of undertaking

Care Production

& Clinical

Redesign

Care production

clinical redesign

process.

Complete

diagnostics, care

redesign

development and

implementation

using PDSA

cycles. Measure

quality outcomes,

LOS & or OBD

reductions

Clinical Teams

present process,

outcomes to date

& next steps.

Continued

Implementation

of redesigned

care pathways/

PDSA cycles,

monitoring of

quality outcomes,

LOS & or OBD

reductions

Clinical teams

present process

and outcomes.

Post capability

survey

completed.

30 Oct 201313 & 14 Nov

2013Feb 2014 May 2014

Engage

teams

- 2 weeks

Clinical Teams

Workshop 2

One day

Diagnostic Phase

– 2 weeks

Redesign &

implementation Phase

– 11 weeks

Redesign &

sustainability Phase

– 10 weeks

4 Dec

2013

Care production

clinical redesign

process.

Diagnostics, care

redesign

development.

Develop aim,

quality measures

and targets.

Designing and

implementing

care production /

clinical redesign

interventions

CLC: How it has progressed

> Pilot program in Feb – July 2013

> Evaluation & recommendations completed in Aug 2013

> Lessons Learnt

> Late Sept 2013: CLC Program supported by Strategic

Executive for another two cohorts (each with six teams)

CLC Progression (cont)

> Oct 2013: Team selection: expressions of interest

overwhelming

• Required selection process – Strategic Executive asked to

select Teams/focus areas based on;

Strategic priority?

Was there room for improvement?

Is Care Production / Clinical Redesign the answer?

Is there a team or potential team?

Does capability need building?

CLC Progression (cont)

> Nov 2013: Six enthusiastic teams

commenced

• Highly engaged working across sites on

specific areas of focus

• High attendance rates at workshops with

positive feedback

The “Bigger Picture” day

Introduction to the practical aspects of

undertaking care production and clinical

redesign

The Consumer Experience

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Thank You

Questions?