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Going with the FlowThe Danish Flow Collaborative

The Danish Flow Collaborative is running from January 2014 to December 2015.12 out of 21 Danish acute care hospitals are reducing waiting time and improving fl ow by removing bottlenecks and implementing huddles and bedmeetings using Real Time Demand Capacity Management (RTDC), Model for Improvement,queueing theory, Theory of Constraints and SPC.

Overall aim: The right patient in the right bed at the right time & a coordinatedin-patient experience without delays.

› Attendee reactions to learning sessions were very positive› All 12 hospitals attended all 4 learning sessions w/ a storyboard› All 12 teams team identifi ed bottlenecks› All 12 hospitals tested the fl ow bundle› Nine teams now have huddles and bed-meetings in all relevant units› Five teams improved processes› Two teams improved outcomes

Flow commitee (leaders responsible for fl ow)

Hospital bed-meeting(units + x-ray + EVS

+ C-suite + OP)

HuddleUnit A

HuddleUnit B

HuddleUnit C

HuddleUnit D

Overall satisfaction w/ learning sessions (percent 5, 6 and 7 (scale 1-7))

Model for Improvement

What are we trying toaccomplish?

How will we know that a change is an improvement?

Act

Study

Plan

Do

How will we know that a change is an improvement?

IHI Breakthrough Series

Louise Rabøl, MD, PhD, program director, Rie Johansen, IA, MScPH, Vibeke Rischel, RN, BA, MHSc, program director Further reading: www.sikkertpatientfl ow.dk Contact information louise.rabol@patientsikkerhed.dk +45 61338021

Collaborative results

Clinical results

› Work environment at the hospitals benefi ted from the fl ow bundle› Adapting measures to the Danish healthcare system proved harder than expected› Implementing hospital-bedmeetings went faster than expected› Implementing multidisciplinary huddles at unit level proved harder than expected› Using big data on census/crowding and wait times proved harder than expected› Team w/ a data strategy had better implementation

Lessons learned

Change Methods

Collaborative driver diagram

Collaborative aim

Implementation of the fl ow bundleat 12 Danish acute care hospitals

by December 31st 2015

A burning platform

Systematic exchange of experiences

Local adaptation of the fl ow bundle

Data for improvement

Leadership support

Empowered local project managers

Feedback on monthly reports

Team visits

Training in Model for Improvement and fl ow

The voice of the patient

Individual team-time for all teams during learning sessions

Team visits including a tour to the frontline

Individualized feedback on monthly reports

Patient feedback on experience using ‘smiley-standers’

Patient stories at all learning sessions

Learning sessions Case-based small group workshops in learning sessions

Primary drivers Secondary drivers Changes tested

Desired direction of

change

Desired direction of

change

Are Clinical results due to seasonal variation?

Desired direction of

change

77 82 83

Desired direction of change

LS1 LS2 LS3 LS4

%66

Vendsyssel HospitalPercent units expecting crowding issues (weekly average)

Weeks

Per

cent