5 countries’ experience toward deployment in your system
TRANSCRIPT
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5 countries’ experience toward deployment in your system
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Introductions
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What matters to you today?
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Intelligent Kindness: reforming the culture of healthcare (Ballat and Campling 2011)
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…How it all started
In the beginning….
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The Power of Attentiveness:
How It All Started
Sources: N Engl J Med 2012; 366:780-781
P6
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Flipping the Question
Not only “What’s the matter?”
but also “What matters to you?”
P7
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A Norwegian farmer & his hut…
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Kindness bundle
Opening and closing interactions with patients in a
structured way
Warm personal introduction
“What would you like me to call you?”
Shared decision making
“What matters to you?”
“What about today? What would make today a good day?”
Warm close-out
“Is there anything we can do to make you more comfortable?”
Source: Galina Gheihman, MD and Cynthia Cooper, MD
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Today’s CareP12
Digital Care
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Why what matters reallymatters….
P13
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Spreading WMTY
Locally
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What matters to you? – A local story from
the Royal Free London
James Mountford, Director of Quality, Royal Free London NHS FT
@mountfordjames
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The Royal Free London Hospitals:
Royal Free and Barnet…
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Improvement requires combining the two…and Chase Farm Hospital
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Jan 2017: WMTY started at the Royal Free…(thank you Jen!)
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7 June 2017, our first “WMTY-day”: focus on WMT-patients
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A tool to have a better conversation
With thanks to Karen Turner
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For it to be over58 year old man with lung
cancer
I want to get home and get out of here
82 year old lady with end stage liver disease
I want the pain to stop
62 year old man with prostate cancer and bone mets
I want to go outside
80 year old lady in respiratory failure
I want to feel safe….
67 year old lady with metastatic breast
cancer
To be healthy, walk and do things for
myself96 year old lady with cholangiocarcinoma
I want my legs to work again
77 year old lady with advanced metastatic breast cancer and
COPD
I want to see the people I love
today67 year old lady with
Glioblastoma
I want to be with my children a bit longer
52 year old lady with metastatic anal cancer
I’m worried that I’m bed
blocking…88 year lady with ca
pancreas
“ I know I’m dying. When I die, I don’t want you to tell my wife over
the phone. Please let her know face to face”
68 year old man with liver cancer
What matters today is you’re giving me some time to talk
58 year old lady with metastatic breast cancer
With thanks to Karen Turner
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Quickly actionable (for free, often)
“My syringe driver keeps
getting caught. It’s in my
right arm and I’m right
handed”
Move access to left arm
“I don’t want my wife to
hear I’ve died over the
phone”
Arrange family meeting
to cover this and work
out a solution
“I want to go outside–
can I go in the garden?”
Make arrangements for
the patient to go outside
in their bed
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Its important patients are listened to
Patients are relieved when their concerns are validated.
I learnt about my patients concerns and worries
Small things can make a big difference
More time is needed to talk to patients
Patients want to look and feel presentable
It enhanced my interaction by removing boundaries
Asking WMTY helped me get to know the patient better
I learnt patient was on the wrong management
Patients want to be involved in their own care
Asking WMTY is patient centred
Asking WMTY gave patient confidence to ask about other issues, not just physical/therapy related
As therapists, we should not go into see a patient with our own assumptions about WMTY
I will ask more open ended questions
I will remember to smile
I learnt information that I would not have known
I will ask WMTY again
“What matters to you?”
What did our Therapists say?
With thanks to Karen Turner`
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Number of WMTY conversations
0
5
10
15
20
25
30
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39
Nu
mb
er
of
In-P
ati
en
ts
Week Number
Number of Patients who have WMTY conversations discussed in weekly MDT
With thanks to Karen Turner
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What has been the impact?
Team Meetings now have the patient at the centre
The MDT is for the first time, truly patient focused"
Palliative Care Consultant
Focus of resources
“I don’t mind which nursing home I’m discharged to, just want it to be the closest one to my sister”.
In-patient
Improved Care
"In the past, I'd too often assumed what matters, now I know and our care is better"
Band 5 Physiotherapist
More meaningful relationships and job satisfaction
Asking WMTY has helped me connect with patients on a deeper level.
CNS Palliative Care
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Reduce nursing
turnover to 25% in
ICU units by Dec
2018 focus on
WMTY & raise JiW
AIM
Recognition
and rewards
Choice and
Autonomy
Camaraderie
and teamwork
DRIVERS CHANGE IDEAS
Employee of the month
ICU newsletter
Self Roster and Increase
Choice Shifts
Project to look at
handover, breaks
Improving
Communication
Coffee Catch Up
Shout out Board
Band 7 Training
What if we applied this to staff, to improve things for them?
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ICU Nurse Retention
Aim: To reduce ICU nursing turnover to 25% by 31 Dec 2018
What matters to ICU staff?
• “More choice and flexibility
with shift choices”
• “Having prompt access to
professional courses”
• “Having more access to
senior staff”
• “More positive and
constructive feedback”
What ICU staff have done
• Set Up electronic rotas with
increased number of shift
choices
• Every band 5 nurse has an
appropriate course booked as
part of induction
• Weekly Coffee Catch-ups with
matrons set up for all staff
• Employee of the month, ‘Shout
Out Boards’, monthly
newsletters
With thanks to Jasmina Davies
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“Completing the rota is so much easier as staff have written in what they wish to work. Most of the time they are allocated the shifts they wanted”
“Bank nurses can pick up extra shifts any time, anywhere”
“If you have a spare 5 minute you can request your shifts, my friends cant believe I write my own rota!!”
“It helps my work life balance, I can choose my days and in particular my nights”
“Its great, you can choose your shifts when grabbing a coffee”
“Its so simple to use, I often log on when I’m at the tube with Wi-Fi”
“My work life balance has really improved with the self rostering online, I can write mu shifts when I’m at home…”
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ICU Nurse retention: Results
With thanks to Jasmina Davies
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6 June 2018, our second year: focus on WMTY for staff
‘What matters to you?’ day on 6th June aims to
encourage and support more meaningful conversations.
Through these conversations we hope to improve staff
enjoyment in the workplace.
We want to ask our colleagues three questions:
What makes for a good day for you?
What makes you proud to work here?
When we are at our best, what does that look like?
If you would like to get involved and run a ‘What
matters you? Day event or activity for your colleagues
please contact Natalie Ware at [email protected]
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Capability model
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Title
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Capability model
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Capability model
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Capability model
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Capability model
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The big themes we heard across all our sites
• Providing great patient care
• Teamwork
• Being appreciated & valued
• “Fairness”
• Happy & friendly staff/ colleagues (who smile!)
• Honest, open communication
• Predictability
• A good work environment (& somewhere to rest)
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Capability model
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And next a trust-wide effort on Joy in Work
That staff work in a physically comfortable and safe environment
To work in a high performing team
To have strong and capable leaders
To make an effective use of time available
To work in a safe environment
To be comfortable at work with access to
basic needs
To have a sense of team belonging
Feel valued
Positivity in the workplace
Effective team communication
Visibly lead values
To have clear expectations
Reduce buraucracy
Reduce waste
That 80% of staff in the collaborative have a good day at work 90% of the
time by 31/12/19
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WMTY now core to our improvement training
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TitleAlso useful to ask when
developing services
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Reflections and lessons learned
• WMTY: a powerful driver of improvement, and culture change
• For patients
• You can't guess what matters to patients
• What matters can change; ask more than once
• Invigorating for staff
• Not only for patients
• For staff too
• Can be threaded through all aspects of work/learning
• Can help service development
• Involve everyone, celebrate, and …
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…Have courage (just try it!)
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20 minutes please
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Spreading WMTY Regionally
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#JOYMHVC #IHIFORUM @DrDamara1 @schaffer09
WMTY: Impacting Patient Experience and Joy in Work
Damara Gutnick, MD, FACP
Joan Chaya, MA
Glasgow
Session xx
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Who are we?
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Damara Gutnick, MD, FACPMedical Director
Montefiore Hudson Valley Collaborative
Joan Chaya, MASenior Director Workforce Development
Montefiore Hudson Valley Collaborative
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Disclosures
Damara Gutnick, Joan Chaya, have no relevant financial or
nonfinancial relationship(s) within the services described,
reviewed, evaluated, or compared in this presentation.
The only thing we have to disclose is our passion for this
topic!
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Session Objectives
1) Demonstrate how MHVC spread WMTY
regionally to improve the patient experience in
multiple care settings
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What is the MHVC?The Montefiore Hudson Valley Collaborative
One of 25 Performing Provider
Systems (PPS) in NYS
195K Attributed Medicaid lives
A diverse network of providers created
to achieve DSRIP goals!
Hospitals, BH & SU Providers, FQHCs, Primary Care, Health Homes, Care
Management, LGUs, CBOs
Spans 7 Hudson Valley counties
Westchester, Rockland, Orange,
Putnam, Ulster, Dutchess, Sullivan
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What is DSRIP?
Medicaid Redesign Waiver ($8.4 Billion)
Funds earned based on ~ 60 Pay for Performance
measures for attributed lives
Delivery System Reform Incentive Payment (DSRIP)
program - Five Years
25 Performing Provider Systems (PPS) in NYS
Goal: Shift the Payment System
“Fee for Service” “Pay for Performance”
Bridge to Future State: VBP Contracts with MCOs
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Social Determinants of Healthcare Costs
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A Personal Story: Jennifer
What Matters to You?
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What Matters May Include. . .
Social Determinants of Health (SDH)
What Matters to You?
I am being evicted.
My kids are hungry
I can’t get to appointments
My son uses drugs
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Our WMTY Journey
Introduced at Regional Meetings March 2017
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Leaders Demonstrating Commitment to Patient
Centered Care
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Creating a “movement”. . . .
HDSWWakefield
Nyack
St. Luke’s-Cornwall
MMV
RSS
Access
HRH
Cornerstone
Rockland ParamedicsHVCC
Cluster-Yonkers Public Library
MHA-O
Orange County LGU
Independent Living, Inc.
MHA-R
Crystal Run
MiSN
CabriniMMG
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Integrating WMTY with Multiple MHVC Partners
Strategies
o Word of Mouth
o Structured role out
Broad Application Across the Continuum of Care
o Community Based Organizations
o Behavioral Health - Living Room and Club House
o Readmission Reduction (Hospitals)
o Skilled Nursing Facility
WMTY Adaption
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YESYes
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YES
Motivational Interviewing Spirit & Skills
MI SPIRITCompassionAcceptancePartnershipEvocation
OARS• Open Ended
Questions• Affirmations• Reflections• Summaries
Yes
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YES
Motivational Interviewing Spirit & Skills
MI SPIRITCompassionAcceptancePartnershipEvocation
OARS• Open Ended
Questions• Affirmations• Reflections• Summaries
DOingWhat Matters!=
Yes
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WMTY Implementation
Stories of Impact
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Cabrini Skilled Nursing Facility
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Skilled Nursing Facility:
Listening & Doing What Matters at Cabrini
What mattered was. . . maintaining the tradition of celebrating their anniversary like they had for the previous 54 years.
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2017 Q1 2018 Q2 2018 Q3 2018
Question 1: Does our service live up to your expectations?
94% 100% 100% 99%
Question 2: Would you recommend Cabrini of Westchester to a friend or family member?
95% 100% 100% 99%
WMTY Impact at Cabrini
Skilled Nursing Facility
99%
80%
85%
90%
95%
100%
105%
Q3 2017 Q4 2017 Q1 2018 Q2 2018 Q3 2018
Patient Experience Measures
Question 1 Question 2
WMTYTraining
100%WMTY
Implementation
Ask family WMTY?
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Arms Acres: Addiction Treatment Program
What Matters?
The client’s wig mattered most!
Ah Ha: Staff learned that only once her concern was addressed, was she ready and able to fully engage in treatment
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Hospital Leadership Executive Rounds:
Changing Group Dynamics at St. Luke’s
“Asking my leadership team ”What matters to you?” changed the dynamics of our executive leadership meeting. . . .less focus on barriers, more on prioritized solutioning”
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Impacting PX MetricsWMTY Implementation: Med/Surg Oncology Unit
CAHPS- Hosp Staff took preference into account
CAHPS- Nurses listen carefully to you
CAHPS- Hosp Staff addressed emotional needs
WMTYLaunch
CAHPS- Doctors Treat with courtesy/respect
WMTY Training
WMTY Training – September / October 2018
WMTY Training
WMTYLaunch
WMTYLaunch
WMTYLaunch
WMTY Training WMTY
Training
WMTY Formal Launch on Med/Surg Oncology Unit –Jan 1, 2019
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Building Momentum:
Sizzle Reels: Stories of Impact
https://vimeo.com/251849220
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Special Interest Groups
121
Montefiore LGBTQ Alliancehttps://vimeo.com/259941956
Tool to guide student peer
conversations about CODA(Co-occurring Disorders)
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For Providers
“What do YOU think matters to the people
you care for?”
For Patients/Family
“What matters MOST for you related to your
healthcare or your loved one’s healthcare?”
“What do you think matters most to the
people you care for?”
PLEASE SCAN THE BARCODE & ANSWER THE QUESTION
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http://montefiorehvc.org/
Scotland & British Columbia
MHVC WMTY ToolkitOnline access to videos, stories, a training module & curated WMTY
implementation resources
Institute of Healthcare Improvement
Implementation Toolkits & Stories of Impact
WMTY Toolkit & Resources
http://montefiorehvc.org/
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Spreading WMTY and Making Connections
theharrisproject.org
WHAT’S IMPORTANT TO ME
What are the things that are important to you at the moment?
When you have a good day, what are the things that make it good?
Are there particular struggles/challenges/problems that you are facing?
What are your strengths? How do you use those strengths to face challenges?
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Are you willing to make a commitment?P84
TWEET Your Commitment Photo
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Spreading WMTY Nationally
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• Hosted by Danish
society for Patient
Safety PS! a NGO,
not for profit
organisation
• Founded by the
Tryg Foundation
2016-2018
WMTY in Denmark
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Recognisable (costomized ) logo
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Support from stakeholders
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Campaign material free of charge
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• Aalborg Universitetshospital
• Holbæk Kommune• Hospitalsenheden Vest• Regionspsykiatrien Midt
• Regionshospital Nordjylland• Regionshospitalet Randers• Omsorgscenter Solgården
• Regionshospitalet Holstebro• Odense Rygklinik • Roskilde kommune
• Syddjurs Kommune• Køge Universitetshospital• Frederikssund Kommune
• Næstved Sygehus• Ikast-Brande Kommune• Slagelse Sygehus
• OUH Svendborg Sygehus• Kiropraktoren Hammel• Regionshospitalet Horsens• Aabenraa Sygehus
• Odense Universitetshospital • Sygehus Sønderjylland • Aarhus Universitetshospital
• Favrskov Kommune• Sygehus Lillebælt• Amager Hospital
Hvad er vigtigt for dig?–dagen 2018
• Frederiksberg Hospital
• Regionshospitalet Viborg
• Sønderborg Sygehus
• Sjællands Universitetshospital,
Roskilde
• Sportsværkstedet Kolding
• Hospitalsenheden Midt
• Nord-KAP
• Hvidovre Hospital
• Hedensted Kommune
• Rehabiliteringscenter Grøndal
• Københavns Kommune
• Rigshospitalet/Glostrup
• Aabybro Kiropraktisk Klinik
• Vejgaard Kiropraktisk Klinik
• Sydvestjysk Sygehus
• Regionshospitalet Skive
• Kolding Kommune
• Hillerød Hospital
• Rigshospitalet
• Holbæk Sygehus
• Sjællands Universitetshospital
• AUH Skejby
• Næstved Sygehus
• Og mange flere!
1.018 Campaign
material 39.183
Employees in HC
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Experience shared
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WMTY – every day at Skovcentret
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WMTY – every day at Skovcentret
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Value Based Care - WMTY as a principle Capital Region
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Next step in Denmark
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Spreading WMTY Globally
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Why the movement has spread…
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Connecting heart, head & hands
Heart
• Building human will
through the power of
story telling
• Connecting with values
• Awakening the emotional being
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Connecting heart, head & hands
Head
Strategising:
• Impact on outcomes andperformance
• Identify key networks
• Identify key hierarchies
• Aligning with strategic
and political imperatives
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Connecting heart, head & hands
Hands
• How things could be,
how things should be…
• Generating will to
action…
• What I can do now…
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Heart… Head… Hands…
Focus on the essence
Keep rules of participation ambiguousand open to interpretation
Harness the power of the network and the hierarchy
Strategic use of story-telling
Follow the energy. Enthusiastically welcome all-comers - the people who come are the right people!
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NIPH -
Embedding WMTY Systematically
Years to life – or life to years?
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Years to life –or life to years?
Living age
Health
Level of care
ab
Spijker J, MacInnes J. Population ageing: the timebomb that isn’t? BMJ 2013 2013-11-12 23:30:47;347
NTNU
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Every system is perfectly designed to give exactly the results it gives.
Paul Batalden
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Pathway today Pathway tomorrow
Mind-shift
Structure(org.)Proscesses
Structure(org.)Proscesses
attitudesvalues
”What’s the matter?” ”What matters to you?”
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Rosstad T, Garasen H, Steinsbekk A, Sletvold O, Grimsmo A. Development of a patient-centred care pathway across healthcare providers: a qualitative study. BMC Health Serv Res. 2013;13:121
Røsstad T, Garåsen H, Steinsbekk A, Håland E, Kristoffersen L, GrimsmoA. Implementing a care pathway for elderly patients, a comparative qualitative process evaluation in primary care. BMC Health Services Research. 2015;15:86
Røsstad T, Salvesen Ø, Steinsbekk A, Grimsmo A, Sletvold O, Garåsen H. Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial. BMC Health Services Research. 2017;17(1):275
Grimsmo A, Løhre A, Røsstad T, Gjerde I, Heiberg I, Steinsbekk A. Helhetlige pasientforløp – gjennomføring i primærhelsetjenesten. Tidsskrift for omsorgsforskning. 2016;2(2):78-87
Building on a successful pilot
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• Model framing good practice• Each collaborativ built on local
ownership and QI-culture• Improvementteams from
municipalities and hospital• Preparation before start• 4 times 2-days sessions in 18
months• Coaching between sessions
8 Regional collaboratives
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NIPH -
Home:User / relatives
Hospital
Service office
GP
Homecare
Patient Trajectory for Home-dwelling elders" (PATH)
Visit GP and medication
review
Visit by homecare -
nurse
Daily obeservation and services
Evaluation after4 weeks
Emergency room
Fysio-/occ.therapi
Nursing
inst.elderlyDischarge
shortstay or rehabilitation
Coordinationunite
Start
policlinic
Meeting withhomecare
2
3
4
5
6
Discharge from specialist-healthcare
1
0
HPH0: checklisy
HPH1: checklist
HPH2: checklist
HPH3: chacklist
HPH4: chacklist
HPH5: checklist
checklist (Trondheim)
HPH0 –admittion from hospital
HPH1-prepare homecoming
HPH2-Structured follow up by a nurse
within 3 days after admittion.
HPH3- prepare consultation at GP
HPH5- Four-weeks conversastion and review with user
Dai ly services – l ist of tasks
HPH4- when helathissues/drop offunctioning level. (Contact ER)
HPH6- Information to hospital whenadmission
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Flow chart for pathway for elderly/LTC
Indicators for pathways for elderly/LTC
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NIPH -
• Prepare transitions
• What matters to you-visit within three days
• Considered by GP within two weeks
• Follow up/evaluation within five weeks
• Early sign of changed condition, what then
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NIPH -
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NIPH -
Endring fra 1. til 2. samtale
Opplevd nytte
EpiData Analysis Graph
Mean: 3.50 LCL: -3.06 UCL: 10.06
Pasienter i rekkefølge 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Op
ple
vd
nytte
10
9
8
7
6
5
4
3
2
1
0
-1
-2
-3
The
goal
for
the
Pati
ent
Exp
erie
nce
dIm
pro
vem
ent
The real Patien
tExp
erienced
Imp
rovem
ent
Exp
erie
nce
dim
pro
vem
ent
Patient Experienced Improvement«What Matters to You?»
Patients in chronological order
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What matters when it’s getting really close to me?What matters to Ellen Vege?
Mom has 7 children, many grandchildren, and grand-grandchildren.
o To mention the name of her children will comfort her: Ulf, Aashild, Kristin,
Gunnar, Erik, Anders og Ingunn. Name everyone of them and say they love her
deeply.
Mom has a Christian believe. You may read for her in the holy Bible. It is a mark
at Psalm 23. that would be good for her.
You may read the Lords Prayer if you remember from Sunday shool she also have
a book with a collection of her own poems beside her bed.
Holding her hand will do her good and give her strength. To touch her hair and
cheek will also be good.
To use lip balm and to wet her lips and mouth will comfort her.
Remember to use the hearing aid and make sure batteries are fresh
Mom has always loved music. She was a piano teacher and played the piano
recently Use the loudspeaker to play some piano concert at Spotify
o She loved piano concerts of Edward Grieg
o Amazing grace was a hymn she always came back to and loved.
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Discover and Focus on What Each Person Has the
Freedom and Resources to Do Now
15% Solutions
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4. Alone identify your top three actions to take
away from the process (1 min)
15% SolutionsWhere do you have discretion and freedom
to act?
What can you do without more resources or
authority?
1. Alone, create a list (4 mins)
2. Share in small groups of 3 or 4 (2 mins each)
3. Questions & clarifications general group
discuss (8 mins)
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Sharing our learning & ideas
Crowdsourcing 25/10
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After our discussions today…
1.What’s your next step –what are you going to do?
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After our discussions today…
1. What’s your next step – what will you do?
• Write on a post-it note
• When the music starts move around the room passing your post-its to each other
• When the music stops look at the post-it in your hand and give it a score from 1 (low) to 5 (high)
• When the music starts again… repeat the process.