Flow Cost Quality: Transforming non-elective healthcare for older people Tom Downes 4 th March 2014...
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Transcript of Flow Cost Quality: Transforming non-elective healthcare for older people Tom Downes 4 th March 2014...
Flow Cost Quality: Transforming non-elective healthcare for older people
Tom Downes
4th March 2014
@sheffielddoc
“Right First Time programme is delivering real benefits to patients and the transformation journey across the health and social care system has begun…”
Older, frail patients ….part of the NHS must be custom-tuned to their needs.
Roy Lilley, The Guardian 29th May 2013
A complex system problem
2003 Toyota Corolla
Toyota Oobeya (Big Room)
How do others design complex systems?
First find a room
A place to meet
The Big Room in Action
Physiotherapist gives an account of the test of change to get a patient home on the day theywere discharged by the GSM consultant
Senior registrar
General ManagerFor Medicine
GSMMatron
ServiceImprovement
Social ServicesManager
CommunityServicesmanagerPhysiotherapist
Secretary
DischargeLiaison
Let me introduce ‘George’• 82 years old• Lives independently and wants
to continue doing so• Widowed 5 years ago• Has mild dementia• Daughter lives locally• Losing weight + poor mobility
PDSA tests of moving from ‘post take’ to ‘on take’
Implementation dates:• April 2012
• Consultant geriatricians ‘on take’ 7 days per week
• May 2012
• Frailty Unit process initially virtually
• Frailty Unit opens mid-May
Outcome measure: 34% increase in discharge within 1 day
Midnight bed occupancy dropped by over 60 beds (no similar change in previous 10 years)
Was reduction in bed usage due to reduced admissions? No
Balance measure: No increase in readmissions
The in-hospital mortality dropped by over 13%
Discharge to Assess (D2A)
The future hospital will support a system of ‘discharge to assess’ in physiotherapy and occupational therapy.
Section 5.20 Future Hospital Report, Royal College of Physicians (September
2013)
Implementation dates:• April 2012
• Consultant geriatricians ‘on take’ 7 days per week
• May 2012
• Frailty Unit process initially virtually
• Frailty Unit opens mid-May
• September 2013
• Testing of ‘discharge to assess’ from base wards
• October 2013
• Implementation of ‘discharge to assess’ begins
Time waiting per patient
D2A starts
• Modern health care is complex• Iterative testing and prototyping by front line staff• Our patients want timely quality care • Timely quality care is cheaper and safer• Measure• D2A – don’t worry that it’s obvious• Our journey has only just started
CONCLUSION