Templates and Tools. The New Normal: Redesigning Acute Care Around Complex Multimorbid Patients

Transcription

1 International Clinical Operations Board Templates and Tools The New Normal: Redesigning Acute Care Around Complex Multimorbid Patients Emory Healthcare s Signed Pledge Example and Conversation Guide 2 SIBR Rounding Structure and Attendees 8 SIBR In-Round Worksheet 9 Kaiser Permanente s Complex Disease Case Conference Charter and Agenda 10 Abington Memorial Hospital s Daily CARE Plan 12 Ottawa Hospital Research Institute s Personal Decision Guide 14 Ottawa Hospital Research Institute s Advance Care Planning Decision Aid The Advisory Board Company

2 Emory Healthcare s Signed Pledge Example Source: Emory Healthcare, Atlanta, GA, US; Advisory Board interviews and analysis The Advisory Board Company

3 Emory Healthcare s Cup of Coffee Conversations Guide Coaching or facilitating Cup of Coffee Conversations Consider before the conversation: 1. Be clear about the message. Be clear about the specific behavior the sender wants to address with the receiver. 2. Is the observed/reported behavior one that should immediately be escalated to management and/or HR? 3. Acknowledge the possibility that the behavior may be something the receiver is not aware of either the behavior itself or the impact the behavior has on others. (remember the JOHARI window) JOHARI WINDOW That part of me that I m aware of, and freely share with others That part of me that I m aware of, but try to keep hidden from others That part of me that I m not aware of, but others are aware of That part of me that I m not aware of, and others are not aware of 4. Clarify the motive for having the conversation. Is the sender offering the feedback out of a spirit of teamwork and improvement? 5. Ask if the sender is calm enough to have the conversation. Does the sender have enough emotional distance from the behavior and/or the event to deliver the message in a way that is both direct and sensitive/caring? Source: Emory Healthcare, Atlanta, GA, US; Advisory Board interviews and analysis The Advisory Board Company

4 Emory Healthcare s Cup of Coffee Conversations Guide (cont.) 6. Is the sender able to suspend any inferences drawn from the specific event/behavior, and focus on the behavior itself? LADDER OF INFERENCE CHARACTERISATION GENERALISATION INTERPRETATION DATA Conversation content: 1. Invite the receiver to a private location. Hal, can we walk over to that empty room down the hall for a few minutes? I have something I want to ask you about. versus launching into the conversation in a public place where others can hear you. 2. Invite the receiver into the conversation. Hal, I d like to talk with you about the interaction we had two days ago at the nurses station. Is that ok with you? versus Hal, you need to hear some feedback I have for you. Source: Emory Healthcare, Atlanta, GA, US; Advisory Board interviews and analysis The Advisory Board Company

5 Emory Healthcare s Cup of Coffee Conversations Guide (cont.) 3. Begin the conversation by shaping or referring to the goal the vision. Hal, I d like to talk with you about how our communication on the unit can be more consistent with the Pledge with promoting more effective teamwork here on our unit. versus Hal, I m sick and tired of the way you behave when you talk with me and other members of the care team on this unit. 4. Describe how you felt and reacted to the behavior you want to address. Hal, I felt defensive and reluctant to talk with you this morning when I didn t feel respected as part of the team. versus Hal, all of the nurses on this unit are complaining about your behavior. or Your behavior is causing a breakdown in teamwork on this unit. 5. Identify the specific behavior and circumstance you want to address rather than generalising. Hal, I felt defensive and reluctant to talk with you this morning when you raised your voice to me and cursed at me while we were both working at the nurses station. I think you wanted to ask me about whether or not the procedure had been scheduled, but when you started raising your voice and cursing, it was hard for me to listen to you, and I didn t feel respected as part of the team. versus Hal, you re always yelling at people on the unit. All of the other physicians on this unit are complaining about the way you behave. 6. If possible, contrast the negative behavior to past instances of positive behavior. Hal, I felt much more confident and respected last week when you asked me about Mrs. Smith. You weren t raising your voice, you weren't using curse words, and it felt much more collaborative. Source: Emory Healthcare, Atlanta, GA, US; Advisory Board interviews and analysis The Advisory Board Company

6 Emory Healthcare s Cup of Coffee Conversations Guide (cont.) 7. Set a tone of directness and sensitivity/caring. Don t beat around the bush, and do offer the feedback out of a spirit of caring. Direct, but insensitive/uncaring: Hal, your behavior is killing any sense of teamwork we have on this unit. Indirect but sensitive/caring: Hal, have you ever been in a situation where someone has said or done something that really bothered you, and you thought maybe they didn t even realise they had said or done anything wrong, but you felt like it was important to talk with them, but you weren t sure how to approach them Direct and sensitive/caring: Hal, I really value being on the same team as you. When you use curse words and raise your voice at me the way you did this morning, it makes me feel disrespected and even a little afraid to interact with you. I don t want to feel like that. I want to be a good team member with you. 8. Offer feedback that is descriptive rather than evaluative. Evaluative: Hal, when you were being such a jerk this morning that was a perfect example of everything that s wrong with this place. Descriptive: Hal, when you used curse words and raised your voice this morning at the nurses station, it made me feel disrespected and a little afraid of you. 9. Avoid using words and phrases that lead to defensiveness words and phrases that are: Orders/directives What you need to do is You have GOT to start Warnings/threats You better not If I see you doing that again, I ll Source: Emory Healthcare, Atlanta, GA, US; Advisory Board interviews and analysis The Advisory Board Company

7 Emory Healthcare s Cup of Coffee Conversations Guide (cont.) Preaching/Moralising: Don t you know better than to? Most people learned this in kindergarten Diagnostic/interpretive: I think your problem is I know you must be under a lot of stress Unsolicited advice: If I were you I d see someone about this Why don t you make an appointment with someone from the employee assistance programme? 10. Check to see if the receiver has heard what you and/or the sender intended to communicate. Hal, I m not sure if I m doing a good job communicating this. What did you hear me say? Source: Emory Healthcare, Atlanta, GA, US; Advisory Board interviews and analysis The Advisory Board Company

8 SIBR Rounding Structure and Attendees Round Structure 1. Introduce patient, review case Lead team into room Introduce team members Summarise active problems Provide updated investigation results Waiting for What? 2. Summarise overnight events, safety check Drips and drains (Cannula, catheter, etc.) VTE prophylaxis Falls risk Pressure injury 3. Allied health, pharmacist, discharge planner, summarise plans Update on progress of the patient State priorities for the day 4. Patient, family ask questions Invite input from patient and family 5. Outline daily plan; discharge estimate Summarise plan for the day and assign responsibility Propose plan for discharge Estimated Date of Discharge (EDD) Round Attendees Patient, family Junior doctor Consultant Bedside nurse Nurse unit manager Allied health (i.e., Occupational Therapist, Physical Therapist, Social Worker) Pharmacist Source: Orange Health Service, NSW, Australia; Clinical Excellence Commission, NSW, Australia; Advisory Board interviews and analysis The Advisory Board Company

9 SIBR In-Round Worksheet Source: Orange Health Service, NSW, Australia; Clinical Excellence Commission, NSW, Australia; Advisory Board interviews and analysis The Advisory Board Company

10 Complex Disease Case Conference Charter and Agenda Kaiser Permanente Southern California Region Purpose: The Complex Disease Case Conference committee shall be responsible for overseeing the identification of suitable members for coordination and initiation of case conferences aimed at developing a comprehensive plan of care to address the individual needs of the member. Responsibilities include: Identification of patients appropriate for case conferencing The scheduling, coordination, and implementation of individualized case conferences Review of patient medical records Development of a comprehensive plan of care that is documented via electronic medical record Promotion of the most efficient use of available resources to ensure timely, quality, coordinated care delivery in the most suitable setting Identification and referral of potential quality issues Ensure compliance with organization and regulatory requirements Provide timely information to the appropriate provider following case conference Identify lead physician for the management of the case discussed Limits of Authority: The committee may utilize any of the following to carry out its functions: Form ad hoc sub-committees Make recommendations on matters related to effective management of the patient s medical and social issues Make adjustment to the medication regimen with or without the presence of the primary physician Request information from other committees, departments, and/or individual staff members Frequency of Meetings: This committee may meet as often as necessary to carry out its business but shall meet at least monthly. Voting Rights: All members are voting members. Appointment of Members and Term of Office: Physician members will be appointed by the chief of service. There is no term limit for members of the committee. Source: Kaiser Permanente Southern California Region, Pasadena, CA; Advisory Board interviews and analysis The Advisory Board Company

11 Complex Disease Case Conference Charter and Agenda (cont.) Kaiser Permanente Southern California Region Membership Composition: Facilitator (utilization management/quality management chair, hospitalist) Hospitalist Nephrologist Cardiologist Primary care Case managers (hospital, heart failure, ESRD 1 ) Continuing care (palliative, hospice, home health) Social services Quality Pharmacy Emergency department/urgent care Ad hoc: Department administrators, pulmonologist, bioethicist, other MDs Agenda Discussion Topics Review current system data: High-risk patient reports, trended readmission rates and counts Review existing action plan and case log (e.g., number of days since last readmission) Case #1: Overview of case, GP perspective, care plan, next steps Case #2: Overview of case, GP perspective, care plan, next steps Wrap-up: Update action plan Duration 5 min 10 min 20 min 20 min 5 min 1) End-Stage Renal Disease. Source: Kaiser Permanente Southern California Region, Pasadena, CA; Advisory Board interviews and analysis The Advisory Board Company

12 Abington Memorial Hospital s Daily CARE Plan Source: Abington Memorial Hospital, Abingdon, PA, US; Advisory Board interviews and analysis The Advisory Board Company

13 Abington Memorial Hospital s Daily CARE Plan (cont.) Source: Abington Memorial Hospital, Abingdon, PA, US; Advisory Board interviews and analysis The Advisory Board Company

14 The Ottawa s Personal Decision Guide Source: The Ottawa Hospital Research Institute, Ontario, Canada; Advisory Board interviews and analysis The Advisory Board Company

15 Ottawa Personal Decision Guide (cont.) Source: The Ottawa Hospital Research Institute, Ontario, Canada; Advisory Board interviews and analysis The Advisory Board Company

16 Advance Care Planning Decision Aid, Available Through OHRI 1 1) Ottawa Hospital Research Institute. Source: The Ottawa Hospital Research Institute, Ontario, Canada; Advisory Board interviews and analysis The Advisory Board Company

17 Advance Care Planning Decision Aid, Available Through OHRI 1 (cont.) 1) Ottawa Hospital Research Institute. Source: The Ottawa Hospital Research Institute, Ontario, Canada; Advisory Board interviews and analysis The Advisory Board Company

18 Advance Care Planning Decision Aid, Available Through OHRI 1 (cont.) 1) Ottawa Hospital Research Institute. Source: The Ottawa Hospital Research Institute, Ontario, Canada; Advisory Board interviews and analysis The Advisory Board Company

19 Advance Care Planning Decision Aid, Available Through OHRI 1 (cont.) 1) Ottawa Hospital Research Institute. Source: The Ottawa Hospital Research Institute, Ontario, Canada; Advisory Board interviews and analysis The Advisory Board Company

20 Advance Care Planning Decision Aid, Available Through OHRI 1 (cont.) 1) Ottawa Hospital Research Institute. Source: The Ottawa Hospital Research Institute, Ontario, Canada; Advisory Board interviews and analysis The Advisory Board Company

21 Advance Care Planning Decision Aid, Available Through OHRI 1 (cont.) 1) Ottawa Hospital Research Institute. Source: The Ottawa Hospital Research Institute, Ontario, Canada; Advisory Board interviews and analysis The Advisory Board Company

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