Breaking the Rules for Better Care
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1 Breaking the Rules for Better Care June 13, 2017 Vancouver, BC Carolyn Candiello Saranya Loehrer Cheryl Woodman
2 Agenda Why Break the Rules? Case Examples of Breaking the Rules in Action Take Home Exercise: If You Could Break a Rule From Ideas to Action Wrap Up
3 Who We Are Cheryl Woodman Women s College Hospital Chief of Strategy and Quality Carolyn Candiello GBMC HealthCare Vice President for Quality and Patient Safety Saranya Loehrer Institute for Healthcare Improvement Head of North America Region
4 Why Break the Rules?
5 Breaking the Rules for Better Care Week January was our inaugural Breaking the Rules for Better Care Week 24 participating organizations 375 rules submitted
6 Breaking Rules?! First reaction We follow rules for safety We need rules But wait a minute Some rules just don t make sense Some get in the way of patient-centered, high quality care Some are misunderstood
7 Key Themes 1. Rules related to policies and regulation 2. Rules related to patient and family experience 3. Rules related to workflow and processes 4. Rules related to staff experience 5. Rules related to culture and mindset
8 From Collection to Action Rule Type Rule Category Response Example Rules that need clarity Regulation myths or an opportunity to tie the rationale back to the rule Debunk organizational myths or hear directly from entities to clarify HIPAA call Rules that need redesign Administrative prerogative or habits User-centered design Rule breaking mentors HealthPartners and visiting hours Rules that need advocacy Real regulation or policies Collective voice Trans surgery fees (OHIP changes)
9 Rule Breakers at Work
10 BTR in Action
11 Greater Baltimore Medical Center GBMC HealthCare, Inc. Baltimore, Maryland To every patient, every time, we will provide the care that we would want for our own loved ones.
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13 Gathering of the rules Silly Rule Data Collection date: 10/15/2016 Unit Who Silly Rule & Reason Comments/concerns *Are you a patient? If not what is your relationship to the patient? *Have you encountered any rules during your stay that you think are unnecessary? What is it? *Why do you feel this rule is unnecessary? *Do you feel like you were given a thorough explanation as to why the rule is in place? *Do you have any suggestions on how to improve the rules you were given? *Any other comments or concerns? What are the rules getting in the way of providing safe, patient-centered care?
14 Rule Transport is only available to help inpatients. Some of our outpatients have trouble getting to our location. Type: Administrative Action: Broken! Transport staff are available to help all staff, not just inpatients.
15 Rule Why do I have to wake an otherwise stable patient to take vital signs between the hours of ?? Type: Myth: If patients are stable, policy allows patients to sleep. Action: Clarified through organizational newsletter
16 Rule Pharmacy: Patients can t take home their single-use meds (inhalers, eye drops, etc.). Type: Myth/Administrative Action: Implemented new process with pharmacy to label the medications prior to discharge.
17 Back to Melissa
18 Women s College Hospital Toronto, Ontario
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20 Frequency Patient Care Experience/ Triple Aim Existing Momentum Quick Win (3-6 months)
21 The Quick Wins Access to drinking water in waiting rooms (redesign) Improved signage (redesign) Portering patients to cars (clarity) Access to affordable prescription medications in new pharmacy (advocacy) Replacing ineffective equipment that caused waste and impacted patient experience (clarity)
22 Rule related to patient and family experience Rule: Patients can t access health records and test results Type: Rule that needs clarity and redesign Action: MyHealthRecord Outcome: Over 7000 patients and counting now accessing health record and laboratory tests online
23 Rules related to workflow and processes Rule: Providers access referrals/consults with specialists based on relationships which can dictate timeliness of response. Type: Rule that needs redesign Action: Central access point and referral form for care providers with complex patients living with pain requiring specialist exam/consult
24 WCH RULE MAKERS TURN RULE BREAKERS
25 Parting Thoughts Reflect on the following: If you could break or change any rule in service of better patient care, what would it be? Write it down on a post-it note Make it happen
26 Resources
27 New Rules for Radical Redesign Change the balance of power: Co-produce health and wellbeing in partnership with patients, families, and communities. Standardize what makes sense: Standardize what is possible to reduce unnecessary variation and increase the time available for individualized care. Customize to the individual: Contextualize care to an individual s needs, values, and preferences, guided by an understanding of what matters to the person in addition to What s the matter? Promote wellbeing: Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require health care. Create joy in work: Cultivate and mobilize the pride and joy of the health care workforce. Make it easy: Continually reduce waste and all non-value-added requirements and activities for patients, families, and clinicians. Move knowledge, not people: Exploit all helpful capacities of modern digital care and continually substitute better alternatives for visits and institutional stays. Meet people where they are, literally. Collaborate and cooperate: Recognize that the health care system is embedded in a network that extends beyond traditional walls. Eliminate siloes and tear down self-protective institutional or professional boundaries that impede flow and responsiveness. Assume abundance: Use all the assets that can help to optimize the social, economic, and physical environment, especially those brought by patients, families, and communities. Return the money: Return the money from health care savings to other public and private purposes.
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