Leading Staff in Redesigning Care

Why CDMR?

Health human resources shortages

Health human resources demographics

Health care needs are not always being met (outdated care delivery models)

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Evidence for Practice Changes

• Continuous 1:1 observation

• 22 inpatient units, 3 ambulatory

• 980 staff• 35,000 hours• 1.3M data points

3

The activities performed by frontline care providers are

drifting away from the intended scope of practice.

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Determining a “New Right Way”

5

Skills of providers must be matched to

patient care needs

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How We WISH it Happens….

Intervention Proven

Effective

Providers/ Patients Act on Knowledge

of Efficacy

Better Care

Gap between KNOWING and DOING

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What REALLY Happens…

Clinical Intentions

Clinical Actions

Better Care

Perceptions re: value of new action

Perceived Behavioural

Control

Understanding of Expectations

Quality Improvement

Work

Habits, skills, environment etc.

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• Closes the knowing-doing gap• Coordinated effort needed for system transformation• Builds capacity for everyone to sustain the gains• Culture of improvement• Accelerated learning• Local context

Why Use a Learning Collaborative?

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Guided By:

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Results: Measuring Improvement

• 557 distinct changes• 7-11 changes/unit• Process & outcome• Patient Experience• Team Vitality

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• ↓Falls• ↓ LOS• ↑Care plans• ↑ Hand-washing• ↓ Transfers

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Changes Implemented

• White boards• Acuity/intensity

matrix• Hourly care rounding• Huddles• Planning rounds• SBAR for handoffs• Mobility boards

Elder Friendly• Emergency Department• Medicine• Surgery• Rehabilitation• Neurosciences• Heart Health• ICU• Mental Health• Paediatrics• Community• Seniors Health

Finding A “New Right Way”:Care Delivery Model

Redesign (CDMR)