Breaking the Rules for Better Care

June 13, 2017

Vancouver, BC

Carolyn CandielloSaranya LoehrerCheryl Woodman

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

Who We Are

Saranya Loehrer

Institute for Healthcare Improvement

Head of North America Region

Carolyn Candiello

GBMC HealthCareVice President for Quality and Patient Safety

Cheryl Woodman

Women’s College HospitalChief of Strategy and Quality

Why Break the Rules?

“Breaking the Rules for Better Care” Week

January 11 – 15 was our

inaugural “Breaking the

Rules for Better Care” Week

24 participating

organizations

375 rules submitted

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

Key Themes1. 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

From Collection to ActionRule Type Rule Category Response Example

Rules that need clarity

Regulation myths or an opportunity to tie the rationale back to the rule

Debunk organizationalmyths or hear directly from entities to clarify

HIPAA call

Rules that need redesign

Administrative prerogative or habits

User-centered design

Rule breaking mentors

HealthPartnersand visiting hours

Rules that need advocacy

Real regulation or policies

Collective voice Trans surgeryfees (OHIP changes)

Rule Breakers at Work…

BTR in Action

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.

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?

Gathering of the rules

What are the rules getting in the way of providing safe, patient-centered care?

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.

Rule“Why do I have to wake an otherwise stable patient to take vital signs between the hours of 2200-0600??”

Type: Myth:

If patients are stable, policy allows patients to sleep.

Action: Clarified through organizational newsletter

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.

Back to Melissa…

Women’s College Hospital

Toronto, Ontario

Frequency

Patient Care

Experience/ Triple Aim

Existing Momentum

Quick Win (3-6 months)

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)

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

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

WCH RULE MAKERS TURN RULE BREAKERS

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

Resources

New Rules for Radical RedesignChange 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.