patient & clinical engagement...• 18 individual storyboards visualised using essomenic...
TRANSCRIPT
DXC Proprietary and Confidential
September 7, 2017
Clinical Efficiency and
Patient Engagement in a
Digital World
Dr Joanne Curry
September 7, 2017 2DXC Proprietary and Confidential
Use patient journey model/s to communicate and engage all
stakeholders – patients, managers, clinicians and IT
Common
Language
Meaningful Use
of ITDrive IT software, integration and support needs from an
informed workflow position
Improve business
knowledgeDemonstrate software with use cases which resonate
including required business rules, alerts, triggers
NEW MODELS OF CARE REQUIRE NEW APPROACHES
It’s not just about IT we MUST!
Understand operational needs from a patient-centric perspective along with related clinical and administrative information flow requirements
HOW? Patient Journey Modelling
September 7, 2017 3DXC Proprietary and Confidential
FIONA STANLEY HOSPITAL - WA
“[It] goes right back to the meaningful engagement of clinicians, whether they be doctors or
nurses, right back at the beginning. With a modern hospital, you start with planning your
workflow and then you design your IT around that, and then you put the bricks and mortar
around that to keep the cables and the servers dry.
Whereas we had it the other way around: we had the building designed, it needed to look
good, and then IT put in some whizzbang things, and a huge amount of time was wasted by
planning workflow and so forth by people who were not necessarily experienced in it.”
(Dr Ian Jenkins - intensive care specialist Fiona Stanley Hospital –
Pulse IT August 2015)
September 7, 2017 4DXC Proprietary and Confidential
RELATIONSHIP OF CORE CONCEPTS
QUALITY IMPROVEMENT
* Flow teams
* Systems approach
CLINICAL MEDICINE
* Evidence-based guidelines
* Patient safety initiatives
INFORMATION
TECHNOLOGY
* Metric-based management
* Real-time data
Adapted from
(Jensen et al., 2006)
Patient
Journey
Modelling
September 7, 2017 5DXC Proprietary and Confidential
WHY VISUALISE THE PATIENT JOURNEY?
• 90% of information transmitted to
the brain is visual
• The brain processes visuals
60,000x faster than text
• A graphical storyboarding
approach is highly successful in
designing patient journeys that
have strong staff and patient
engagement
September 7, 2017 6DXC Proprietary and Confidential
LEAN THINKING
September 7, 2017 7DXC Proprietary and Confidential
Clie
nt
Phone call
received
Inta
ke
offic
er
Phone call to
intake line
DA
Treatment
Ceased
Dru
g a
nd
Alc
oh
ol
Schedule
Appointment
Ad
min
istr
ato
rT
rea
tme
nt P
rovid
er
Appointment
time
Contact information of
Service
Client attends?
YesNo
Re
ferr
ing
Clin
icia
n
Manage Non
Attendance
Intake
Form /
database
End to End Process (big picture): Version A - Registration completed during intake
Outlook /
CHIME /
Paper
Client
Registration
Log
Conduct
Comp
Assessment DA treatment required
No
Provide
Ambulatory
Treatment
Provide OTP
Provide
Residential
Treatment
Client Did
Not AttendDA Treatment
Not Required
Perform
Intake
Complete
Client
RegistrationService has
capacity?
No Place client
on waiting list
Yes
Prioritise
client waiting
list
CHIME/
ICIS/
Excel
Treatment
Plan
Appointment
details
Service has
Waiting list?
No
Yes Prioritisation methods:
* discussion at intake meeting
* first in first served
* client clinician matching
* local business rules
Client
Advised
to call back
another time
MDS
collection
MDS
collection
MDS
collection
MDS
collection
Commence
Treatment
Planning
Cease DA
Treatment
Self
Presentation
Occurs
(walk ins)
Client
Referred
to another
service
Comp
Assessment
Required
CHIME/
Cerner
IPM
yes
CL Request
Received
Referral Required
Treatment
Provide
Consultation
and Liaison
Assessment
form
MDS
collection
Direct Referral
Received
Additional
DA treatment
required?
yes
DA Treatment
Not Required
no
SWIM LANE DIAGRAMS
September 7, 2017 8DXC Proprietary and Confidential
ESSOMENIC METHODOLOGY
September 7, 2017 9DXC Proprietary and Confidential
ESSOMENIC ARCHITECTURE
Patient
MDTAdminDoctor Midwife NUM
1.
COMPLETE
CLERICAL
BOOKING
Valid Medicare
Card?
Medical Record Patient
Administration
System
Patient Admission
PolicyInterpreter
required?
tpt:10min
$hr2:$5.00
$pr3:$5.00
1-5
days
This layer shows when, where and how many times a patient attends the service or is moved as part of their journey.
The staff roles dimension shows what role a staff member plays and when and how that role is involved with the patient.
Names, describes and relates the processes involved in the patient journey.
Shows the creation and flow of paperwork and information to automated and manual systems as required by the processes.
Identifies the patient needs, policies and/or Clinical guidelines that must be adhered to during the enactment of the process.
Details the measurements that are used to determine the effectiveness of the patient journey.
PATIENT INTERACTION
STAFF ROLES
PROCESSES
INFORMATION CREATION/
UPDATE (medium)
PATIENT NEEDS/
CLINICAL GUIDELINES/
POLICIES
METRICS
September 7, 2017 10DXC Proprietary and Confidential
MODELLING DIFFERENT STATES
Modelling may take 3 forms:
Current state – the ‘as-is’ version of how things work priorto the introduction of the new software
Future State – the ‘to-be’ version of how things will work following implementation of the new software, taking into account current constraints. This state should look to incorporate opportunities for service transformation and/or innovations provided by the new technology
Blue Sky State – this is a view of how things could work if the goal is to maximise best-practice service delivery, irrespective of current constraints or the project is being conducted for a Greenfield site
September 7, 2017 11DXC Proprietary and Confidential
Metropolitan Maternity Care
Ryde Hospital -
Client: Ryde Midwifery
Group Practice
Midwife led maternity
service
Provide services for
Before, During and After
birth
No specialists on shift
Low risk service
September 7, 2017 12DXC Proprietary and Confidential
PERSON
INTERACTION
STAFF ROLES
PROCESSES
INFORMATION
CREATION/
UPDATE
(medium)
PERSON
NEEDS/
CLINICAL
GUIDELINES/
POLICIES
METRICS
31mins
7-10 days
CURRENT STATE - SUITABILITY ASSESSMENT PROCESS
September 7, 2017 13DXC Proprietary and Confidential
MODEL ANALYSIS
*1 Woman required to attend the service multiple times before risk
is assessed
*2 Multiple paper-based forms required and wording not
appropriate for midwife-led service
*3 Discontinuity of care exists-introduces potential for adverse
events and increased cost of service
*4 Multiple delays exist for the patient
*5 If woman assessed as too high risk must start booking process
again at new hospital
*6 Compliance to domestic violence screening policy below 50%
September 7, 2017 14DXC Proprietary and Confidential
RESULTS
• Short and medium term action plans
• New clerical booking form & change to admission policy
• Rationalisation of information collection and storage
• New Assessment Questionnaire developed, including on-
line version
• Earlier involvement of midwife
• New performance metrics set by midwives
September 7, 2017 15DXC Proprietary and Confidential
FUTURE STATE – SAVES TIME AND MONEYPERSON
INTERACTION
STAFF ROLES
PROCESSES
INFORMATION
CREATION/
UPDATE
(medium)
PERSON
NEEDS/
CLINICAL
GUIDELINES/
POLICIES
METRICS
26mins
.5-1.5 days
September 7, 2017 16DXC Proprietary and Confidential
QUANTITATIVE ANALYSIS
Item Pre-improvement
metric (ie:baseline)
Post-Improvement
metric
% improvement
Total elapsed
journey time
16 days 8 days 50%
Total patient time 115 minutes 72 minutes 37.4%
Human resource
costs
$65-60 $30-34 53.75%
Physical resource
costs
$43-10 $29-16 32.3%
• These figures are per patient and are multiplied by the average number of patients per year to obtain a projected fiscal year saving.
• Provides evidence for accreditation and +/- funding compliance
*MBS time limit=80mins, MBS reimbursement amount=$85.00
September 7, 2017 17DXC Proprietary and Confidential
PATIENT/CONSUMER INVOLVEMENT (Dementia)
• Five face-to-face workshops, each over 2 consecutive days
(Brisbane, Sydney, Kiama, Adelaide)
• 24 consumers and carers, snowball sampling.
• 18 individual storyboards visualised using Essomenic Transformational Change
Methodology
• Used consumer and carer experiences and views to develop an “ideal future state”
model
• Presented to management for decision on implementation approaach
Day 1:Collecting stories &
improvement suggestions
Model stories over night
Day 2:Validate personal models
Day 2: Develop/enhance
ideal state
DXC Proprietary and Confidential September 7, 2017
CURRENT STATE MODEL (derived from client documentation & Hospital visit)
CONDUCT REGISTRATION
CustomerSupportOfficer
iPM
ADD TO WAITLISTADD THEATRE
BOOKING
iPM
TurboCoder
Excel (freq used ICD-10
codes
iPM
NHI
CONFIRM COPAY DETAILS
SX PORTAL
iPM
Outlook Appt (fee & Pt name) Ascot
Booking Form
Referral
PATIENT INTERACTION
STAFF ROLES
PROCESSES
INFORMATION CREATION/UPDATE
(medium)
PATIENT NEEDS/CLINICAL
GUIDELINES/POLICIES
METRICS
Pt agrees to proceed to
surgery?
PROVIDE PT WITH MA BOOKLET
Registration form
Health questionnaire
Consent form
Anaesthesia Questionnaire
Prelim price estimate
REQUEST BOOKING
Surgeon
Patient
Surgeon’sSecretary
UPDATE BOOKINGS DIARY LIST
Bookings Diary List
Booking Form
yesVALIDATE
BOOKING FORM/REFERRAL
Booking Form
May be in word, excel, pdf or other format
CustomerSupportOfficer
Surgeon’sSecretary
Referral
FORWARD BOOKING
DOCUMENTATION
Booking Form
FAX
Patient
Surgeon
CONDUCT SURGICAL CONSULT
PMS
September 7, 2017 19DXC Proprietary and Confidential
CONTACT Customer Support
Officer
Patient
CustomerSupport
PT PORTAL
LORENZO
CONFIRM COPAY DETAILS
SX PORTAL
Communication option in Pt
Portal may incl: Phone, email, chat session
CONDUCT MEDICATION
RECONCILLIATION
Pharmacy
Patient
O4I: request current meds list as part of pt portal info.
This is mostly just a confirmation – saves
pharmacy time
REVIEW MEDICATION LIST
Pre-admissionNurse
REVIEW CLINICAL DOCUMENTS FROM OTHER PROVIDERS
TESTSAFE
LORENZO
LORENZOLORENZO
LORENZO
TestSafe Launched in
context
COMPLETE PRE-ADMISSION Ax
REVIEW HEALTH Hx & PRE-ADMISSION
Ax
Nurse
COMPLETE NURSING
ADMISSION Ax
Shortened task due to electronic
data transfers
CONDUCT PRE-OP SURGEON VISIT
Patient
Surgeon
Incl obtaining consent (already done in pt portal), adding brief note
to pt file
CONDUCT PRE-OP ANAESTHETIST
VISIT
Patient
Anaesthetist
Review Hx & blood results
LORENZO
FUTURE STATE CONTINUED……
September 7, 2017 20DXC Proprietary and Confidential
September 7, 2017 21DXC Proprietary and Confidential
DATA ANALYTICS
• Currently data used for analytics by IHPA do not adequately cater
for Day Hospital reporting
• A more thorough understanding of the Patient Journey:
– can help to identify what data should be captured and used in
analytics to better represent Day Hospital operations
–Design work practices required to capture the identified data at
the ‘coal-face’
September 7, 2017 22DXC Proprietary and Confidential
ACCREDITATION
• Patient Journey Models provide evidence of quality assurance and
transformation activities
• Currently state shows where we are/were
• Future state shows how we have improved or plan to improve
September 7, 2017 23DXC Proprietary and Confidential
ESSOMENIC TRANSFORMATIONAL
CHANGE METHODOLOGY
Represents the patient perspective and
provides a common language for all
stakeholders, in a single visual output
Provides
input to…
Post Implementation Reviews
Justify service transformation & change
management planning
Workflow to software gap analysis
Engage users in new IT system implementations
User training and education
Identify requirements for tender requests
Budget compliance analysis
Human resource business cases
Demonstrate compliance for accreditation
Specify new IT solution configurations
COMMON LANGUAGE, MULTIPLE USES
September 7, 2017 24DXC Proprietary and Confidential
Day Hospital Model(p1)
PATIENT INTERACTION
STAFF ROLES
PROCESSES
INFORMATION CREATION/
UPDATE (medium)
PATIENT NEEDS/
CLINICAL GUIDELINES/
POLICIES
METRICS
Patient
Specialist
CONDUCT CONSULT
OBTAIN CONSENT
COMPLETE PRE-
ADMISSION DOCUMENTS
Agree to procedure?
DELIVER TO HOSPITAL
Patient Patient
Admin
CREATE/UPDATE PT RECORDS
CONTACT PATIENT
Nursing
team
Patient
Nursing
team
ENTER PRE-ADMISSION
DETAILS
Admin
Pre-admission booklet
Pre-admission booklet
Pre-admission booklet
Pre-admission booklet
Patient recordPre-admission bookletPatient
Management System
Patient Record
24-48 hours B4 procedure
Admission Guidelines
Interpreter
required?
O4I: Electronic forms and digital signature for consent. Electronic transmission of forms direct to relevant work list.
O4I: eMR O4I: PatientAide App
September 7, 2017 25DXC Proprietary and Confidential
Day Hospital Modelp.2
CONDUCT AxPROVIDE PRE-OP EDUCATION
& PREP INFOADMIT PATIENT
Patient
Nursing
team
PROVIDE PROCEDURE/POST OP INFO
Pre-admission booklet
Patient record Patient education
Procedure prepPre-admission
booklet
Patient record Pt Handouts
30 mins B4 procedure
Do pts absorb information given?
CONDUCT PROCEDURE
Patient
Specialist
MOVE PT TO RECOVERY
CHECK DISCHARGE
ARRANGEMENTS
Escort person arrranged
Patient record
2-4 hours obs (on avg)
Patient
Nursing
team
Patient
Dx Nurse
Admission Guidelines
Interpreter
required?
O4I: eForm straight into eMR
O4I: PatientAide App
O4I: PatientAide App
++
O4I: Pt & Asset Tracking (RTLS)
O4I: Pt & Asset Tracking (RTLS)
O4I: Surgical workflow Tracking
O4I: PatientAide App
PATIENT INTERACTION
STAFF ROLES
PROCESSES
INFORMATION CREATION/
UPDATE (medium)
PATIENT NEEDS/
CLINICAL GUIDELINES/
POLICIES
METRICS
September 7, 2017 26DXC Proprietary and Confidential
Day Hospital Model(p3)
MAKE FOLLOW-UP SPECIALIST APPT
DISCHARGE PTCREATE Dx SUMMARY
Patient record
Dx Summary
CONFIRM POST-OP
INSTRUCTIONS
Pt Handouts
Patient
Dx Nurse
O4I: PatientAide App
O4I: eMR - Transmit straight
to GP
O4I: PatientAide App
O4I: eMR – Patient Tracking
O4I: Identification of data required for analytics/accreditation
PATIENT INTERACTION
STAFF ROLES
PROCESSES
INFORMATION CREATION/
UPDATE (medium)
PATIENT NEEDS/
CLINICAL GUIDELINES/
POLICIES
METRICS
September 7, 2017 27DXC Proprietary and Confidential
Clinician Mobility
September 7, 2017 28DXC Proprietary and Confidential
Patient Engagement and Mobility
September 7, 2017 29DXC Proprietary and Confidential
WHY MODEL THE PATIENT JOURNEY?
• Understanding the patient journey must be the key driver for system change
• Requirements must be gathered from a cross-section of patients and staff (not just
clinicians)
• Visualisation of the patient journey increases engagement of clinical/managerial staff
and upskills IT staff
• Allows for simple comparison of services across sites
• Promotes agreement on best-practice service delivery across sites – consistent patient
journey
• Clearly demonstrates impact of new systems on patient journey and workflows
• Allows for workarounds to be designed well in advance of system implementation
• Models can be re-used as training material
September 7, 2017 30DXC Proprietary and Confidential
THE ESSOMENIC TRANSFORMATIONAL CHANGE METHODOLOGY
• Provides a visualisation of the patient journey
• Acknowledges cultural behaviour and organisational attitude to
change
• Is cognisant of manual and automated workflows involved
• Demonstrates new solutions aligned with stakeholder workflows
• Allows for both quantitative and qualitative analytics of current and
future states
DXC Proprietary and Confidential
Dr Joanne Curry
DXC Healthcare Solutions Specialist
Ph: 0438 448 648