Care Rationing - Health Improvement and Innovation Resource Centre

Report
National Forum
Productive Programmes
Care Capacity Demand Management
(CCDM) and RTC.
10th May 2013
Lisa Skeet
Director
Safe Staffing Healthy
Workplaces Unit
Safe Staffing Health Workplace Research
Findings at BOPDHB
• Staff on wards participating in RTC were particularly likely to express that
the level of trust and commitment in the organisation is growing.
• Our overall finding was that there was a significant difference in the way
the staff in the RTC wards talked about the organisation and rated safety,
quality and efficiency than other areas and also these staff recommended
faster roll out.
• The safe staffing healthy workplace workforce analysis showed that in one
week 3a only recorded approximately 180 episodes of care rationing
where as 3b and HIA who are only just beginning to implement the
programme recorded approximately 1000 each.
Care Rationing:
Is defined as any time that a patient does not receive an aspect of care
that professional consensus judged to be in their interests.
Releasing Time To Care is not:
• A project - it is a culture change
• A political tool – particularly in regard to the “not enough
resource” question
• A cost cutting tool – though as a consequence savings
are made
THE FIT APPROACH
Releasing Time to Care & Care Capacity Demand
Management
2005-2006
Safe Staffing Healthy
Workplaces
Committee of Inquiry
 Recommendations
Description of the
goals
No road map to
achieve the changes
2007-mid 2009
Establishment of SSHW Unit
by Minister of Health (3
years)
Engagement with DHBs &
NZNO
Focus on escalation planning
Mid 2009-end 2010
Re-assessment of sector status
Three demonstration sites
established
Trialling of tools and resources
Evaluation
Emergence of CCDM approach
2010-2014
On-going commitment from DHBs &
Health Unions
Roll-out of CCDM to DHBs
Broaden to multi-disciplinary approach
Integrate with other sector activity
-productivity
-innovation
-collaboration
-quality
-shared information
Safe staffing healthy workplaces.......................................Care Capacity Demand Management
Care Capacity Demand Management
Forecasting
&
Planning
Base staffing
design
Responding to
variance
(Mix & Match)
(Variance Response
Management)
Naming &
knowing
normal
(Safe Six Data
Set & KHWD
Groups)
TrendCare Work-stream-System platform for CCDM
Focus of Mix & Match
Uses Patient acuity to
determine FTE
Determines skill mix
Determines responsive
schedule
Determines budget
Includes realistic allowance
for non clinically
available time
Mix and Match Part 1: Work Analysis
A Work Analysis is:
oConcentrated data gathering
oNoting real time work (all activities) and Care Rationing
oEach staff member notes down everything that they do
in15 minute blocks, for their entire shift.
oData collection continues for 2 weeks
oAll nursing staff involved in delivering patient care will be
included, e.g. CNM, RN, EN, Students and Bureau.
The Data Collection sheet
99
AM
7am
4p
m
Mo
n
Nov 1st
Information gathered
•
Utilisation,
•
NHPPD -care required verses nursing hours available
•
Ward activity (admits, discharges, transfers)
•
Skill mix
•
Work activity
•
Bureau use & redeployments
•
Staff hours worked
•
Breaks rationing
•
Care rationing
•
TrendCare data – variance, hours required
•
Patient numbers
•
Rostering pattern of ward
Productive Ward
Patient
Observations
Ward Round
Nursing Procedures
Admissions
& Discharge
Management
Knowing How we are Doing
Shift Handovers
Well Organised Ward
Ward Leader’s Guide
Project Leader’s Guide
Executive Leader’s Guide
Meals
Medicines
Patient Status at a glance
Toolkit
Patient Hygiene
Well Organised
Ward - WOW
What is an Activity Follow
• It is an eight hour detailed recording of activities a
member of the nursing staff undertakes
• It captures the task at hand and the location where it
is performed e.g. what the nurse is doing & where
she is doing it,
• These pieces of information are recorded every
minute during the hour
Care Capacity Demand Management
Forecasting
&
Planning
Base staffing
design
Responding to
variance
(Mix & Match)
(Variance Response
Management)
Naming &
knowing
normal
(Safe Six Data
Set & KHWD
Groups)
Where to start VRM
IDENTIFY
In any given moment how can we identify what our situation is ?
Capacity exceeds demand – We can assist other
units
Optimal productive functioning – all care
completed with minimal delay -manageable
workload
Undesirable - quality of care compromised –on
trajectory to compromised staff and patient
safety and creating inefficiencies
Unacceptable compromise of quality and safety –
trajectory to failure
Intolerable –unjustifiable risk – failure
Where to start VRM
QUANITIFY
In any given moment how can we describe to others what our situation is ?
District Hospitals
Event Report
Daily report
Click on
event
Care Capacity Demand Management
Forecasting
&
Planning
Base staffing
design
Responding to
variance
(Mix & Match)
(Variance Response
Management)
Naming &
knowing
normal (Safe
Six Data Set &
KHWD groups)
CCDM ESSENTIAL METRICS
SAFE SIX
STAFF SATISFACTION
– are staff satisfied with
CARE RATIONING – are
patients receiving all of
the care they require?
HARM – are adverse
events or outcomes
occurring?
what they were able to
achieve?
Care
Capacity
Demand
Management
DISCRETIONARY
EFFORT-is the work
effort to maintain service
levels reasonable?
PRODUCTIVITY –is the budget being maintained ?
FLOW – are flow and volumes being achieved?
Knowing How We Are Doing
Improve
efficiency of
care
Improve
staff
wellbeing
Improve
patient
safety
Improve
patient
experience
The KHWD(Local data Council) Teams Purpose in
CCDM
Ward Variance
Response
Management (VRM)
Agree a set of ward level metrics that describe the
ward landscape both in the moment (Variance
Response Indicators) and overtime
Agree and establish service normal's and tolerances
Receive, review and analyse ward level data and
information that reflects the wards functioning ensure
Effectiveness of metrics provide the picture
Make appropriate recommendation to the DHBs
permanent CCDM council to support a cycle of
constant quality improvement.
Support the ward staff with ‘plan- act- study do’
In addition to CDS the KHWD team will
Own the mix & match process for the service
Choose clinical champions
Be part of the set up and ward prep
Actively support the team through data collection
Receive the completed reports
Organize feedback sessions for staff
Compose a response for the Fit Council
Develop unit/service level response strategies
Own the VRM System for the ward/service
Discuss status markers from the screen over the month looking for
patterns
Identify areas of strength and weakness with system design
Identify areas for development within the tools of the VRM system
Discuss redeployment for the month both in & out
Compose a monthly report for Fit Council on service successes and
identify areas where Fit Council assistance is required.
The structure below illustrates the function of this council system whereby
each service has its own KHWD council that reports to a CCDM Council.
The
CCDM
Council
Maternity
ED
Medical
services
Mental
Health
Paediatrics
Surgical
services
This structure enables the DHB to continuously refine and redesign tools and processes that
allow it to more consistently match demand and capacity on the day and over time.
RTC/CCDM
There are fundamental and complimentary differences between the
two programmes.
•
RTC focuses primarily on the resourcing and organisation of the work
environment and the review of all systems and processes with the
ward. The goal being to reduce the amount of non clinical time that is
required to maintain the context of care. RTC therefore does indeed
‘release’ time that is currently being utilised inefficiently and makes
this available for direct care.
•
CCDM has a different goal and methodology based around
identifying the direct and indirect clinical care that will be required by
a particular patient group; thus CCDM does not free up time because
the care hours are as assessed.
Summary Synergises/Benefits
•
KHWD group/Local data council/safe six metrics
•
Well Organised Ward organises the physical
environment and ensures appropriate resources are
available
•
Work analysis helps informs which process modules
are a priority.
•
Work analysis provides robust baseline data for RTC
process modules
RTC/CCDM
•
Two sides of the same coin
•
RTC focuses on systems/process and the environment
within the wards
•
CCDM focuses on right staff in the right place (numbers, skills and schedule) with a organisation
wide approach.
•
Both focus on right care and right use of resources
(productive & efficient)

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