patient & clinical engagement...• 18 individual storyboards visualised using essomenic...

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


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)


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


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


LEAN THINKING


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


ESSOMENIC METHODOLOGY


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


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


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


PERSON

INTERACTION

STAFF ROLES

PROCESSES

INFORMATION

CREATION/

UPDATE

(medium)

PERSON

NEEDS/

CLINICAL

GUIDELINES/

POLICIES

METRICS

31mins

7-10 days

CURRENT STATE - SUITABILITY ASSESSMENT PROCESS


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%


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


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


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


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


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……


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’


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


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


Day Hospital Model(p1)

PATIENT INTERACTION

STAFF ROLES

PROCESSES


UPDATE (medium)

PATIENT NEEDS/


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




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


Day Hospital Modelp.2

CONDUCT AxPROVIDE PRE-OP EDUCATION

& PREP INFOADMIT PATIENT

Patient

Nursing

team

PROVIDE PROCEDURE/POST OP INFO


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: Pt & Asset Tracking (RTLS)

O4I: Pt & Asset Tracking (RTLS)

O4I: Surgical workflow Tracking


PATIENT INTERACTION

STAFF ROLES

PROCESSES


UPDATE (medium)

PATIENT NEEDS/


POLICIES

METRICS


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: eMR - Transmit straight

to GP


O4I: eMR – Patient Tracking

O4I: Identification of data required for analytics/accreditation

PATIENT INTERACTION

STAFF ROLES

PROCESSES


UPDATE (medium)

PATIENT NEEDS/


POLICIES

METRICS


Clinician Mobility


Patient Engagement and Mobility


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


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

[email protected]

patient & clinical engagement...• 18 individual storyboards visualised using essomenic...

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