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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 [email protected] +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