Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability

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1 Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and Quality Outcomes at Northwest Hospital

2 Our Journey to Shared Accountability Implementation process and outcomes of the ACU model Move to culture of Shared Accountability and Outcomes Lessons Learned Next Steps

3 Our Journey to Shared Accountability Implementation process and outcomes of the ACU model Move to culture of Shared Accountability and Outcomes Lessons Learned Next Steps

4 Quest to be the Best Northwest Hospital will rank among the state s BEST in Quality and Patient Satisfaction.

5 2001 Institute of Medicine report: High Quality Healthcare in US Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care.

6 Healthcare Silos Pharmacy Inpatient Care Skilled Nursing Facilities Emergency Department Outpatient Services Office Based Provider

7 Hospital Care Silos Nursing Attending Provider Resource Teams Consultant Services Case Management Ancillary Service Teams

8 Asynchronous Care RN with Patient at 8AM

9 Asynchronous Care Provider with Patient at 12pm

10 Asynchronous Care Care Manager/SW with Patient at 2pm

11 Team Based Patient Care Nursing Attending Provider Case Management Ancillary Support Team Consultant Services Resource Team

12 Accountable Care Unit Model

13 Accountable Care Unit Model Unit level Provider and Nursing Co-leadership Unit based teams Unit level performance reporting Interdisciplinary bedside rounds

14 ACU Pilot Unit at Northwest Insert Picture of team here

15 Number of Days Benefits of ACU Pilot: Improved Communication Length of Stay (LOS) Start of Rounds 1.0 Avg 2015 March 2015 April 2015

16 Benefits of ACU Pilot: Improved Accountability D Indwelling Catheter Days Start of Rounds Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Foley Days Linear (Foley Days)

17 Benefit of ACU Pilot: Improved Patient Experience 4D Scores 80.0% 70.0% 60.0% 50.0% 50.0% 46.2% 50.0% 75.0% 61.5% 71.4% 75.0% 40.0% 30.0% 20.0% 25.0% 30.0% 10.0% 0.0% 0.0% Start of Rounds Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 4D Scores Linear (4D Scores)

18 Score Benefits of ACU Pilot: Improved Team Satisfaction 5.0 Internal Stakeholder survey pre and post ACU model initiation Goal Quality PI reps Care Management Providers

19 Score Unexpected Benefit of ACU Pilot Goal Question: 3.75 I have appropriate staffing to provide the best quality care to my patients. 1.0 Perception of Staffing Resources

20 ACU Co-Leadership Teams ED Med/ Surg OBS PCU Med/ Surg ICU/ IMC Med/ Surg

21 Structured Interdisciplinary Bedside Rounds

22 Our Journey to Shared Accountability Implementation process and outcomes of the ACU model Move to culture of Shared Accountability and Outcomes Lessons Learned Next Steps

23 Patient Safety and Quality Checklist

24 ACU Team Members Provider Partner Nurse Manager Nursing team Zoned Hospitalist Quality, Infection Prevention, Care Management Educators

25 Unit Resource Team Quality Infection Prevention Educators/CNS

26 ACU Co-Leadership Team Meetings Handoff Communication Telemetry Protocol Family Communication CLABSI C diff Challenging Patient/Families Falls CAUTI

27 ACU Co-Leadership Team Meetings Med /Surg ED Med/ Surg OBS IMC/ ICU PCU Med/ Surg

28 Benefits of Shared Accountability: Improved Hospital Acquired Infection Rates

29 Benefits of Shared Accountability: Decrease in Patient Falls

30 Benefits of Shared Accountability: Increased Event Reporting

31 System Based Patient Care Nursing Attending Provider Case Management Ancillary Support Team Consultant Services Resource Team

32 Shared Accountability Approach: MHAC

33 Shared Accountability: Readmissions and Mortality MHAC Readmissions Mortality Others

34 Our Journey to Shared Accountability Implementation process and outcomes of the ACU model Move to culture of Shared Accountability and Outcomes Lessons Learned Next Steps

35 Critical to Success: Time Investment ACU Timeline Nov 2014 March 2017

36 Critical to Success: Leadership Support Med/ Surg ED Med/ Surg OBS IMC/ ICU PCU Med/ Surg

37 Critical to Success: Development Med /Surg ED Med /Surg ICU Med /Surg OBS PCU

38 What we would have done differently had we known. Communication plan around ACU and Shared Accountability Visibility of ACU Co-Leadership in cross departmental settings Implement Ground Rules of Rounds earlier in ACU development Better incorporation of night teams into ACU structure Build the ACU framework into onboarding of all new team-members

39 Our Journey to Shared Accountability Implementation process and outcomes of the ACU model Move to culture of Shared Accountability and Outcomes Lessons Learned Next Steps

40 The Journey Continues Private Attendings and Consultants into Model Challenging Conversations with Patients and families

41 We are the Accountable Care Units of Northwest Hospital

42 We are the Accountable Care Units of Northwest Hospital

43 We are the Accountable Care Units of Northwest Hospital

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