© Joint Commission Resources Module 4 Re-Engineering Patient Discharge: The Hospital Launch! Faculty from Joint Commission Resources Deborah M. Nadzam, PhD, FAAN Project Director and Kathleen Lauwers, RN, MSN Consultant

© Joint Commission Resources Module 4

© Joint Commission Resources Accomplishments to Date (Module 1)  Project charter initiated  Primary care practitioner referral base defined  Process map of current discharge process completed  Care plan structure (template, location, how DA will access it) finalized  Dates for training frontline staff set

© Joint Commission Resources Accomplishments to Date (Module 2)  Project metrics identified and planned  Patient inclusion criteria defined  Process for identifying patients and notifying DA defined  Multidisciplinary involvement and communication plan determined  Care plan process finalized (what and how to gather data for inclusion)

© Joint Commission Resources Accomplishments to Date (Module 3)  Processes in place to finalize care plan once discharge order is written  Teach-back methods outlined  Quality/PI staff understand project measurement requirements and are prepared to gather data  Process for transmitting DC summary and care plan to PCP finalized  Plans for teaching frontline staff finalized

© Joint Commission Resources Module 4 Objectives  To design an ideal “future state” process map  To finalize best practice solutions that include system redesign of the discharge process  To initiate the monitoring plan for sustainability  To celebrate staff accomplishments and discuss the application of the knowledge transfer framework across the hospital/system  To prepare to provide case studies  To participate in a LIVE interactive session

© Joint Commission Resources Module 4 Outline  Creation of Ideal Process Map  Brainstorming Improvements  Pilot Test Improvements  Create Final Deployment Plan  Develop Monitoring Plan (Act/Control)  Planning your Team Celebration!

© Joint Commission Resources Sample Calendar Synthesize and Launch!

© Joint Commission Resources Performance Improvement Structure  PLAN  DO  CHECK (STUDY)  ACT Deming, Shewhart, Lean Lean Six Sigma  DEFINE  MEASURE  ANALYZE  IMPROVE  CONTROL

© Joint Commission Resources Your Current State May Have Looked Like This…

© Joint Commission Resources

Define Your “Ideal” Future State  Initiate a new high-level process map  Multidisciplinary participation  Patient admission is the starting point  After hospital care provision is the ending point  Ask each discipline what steps they will NOW take to prepare the patient for discharge

© Joint Commission Resources

Double Check for Failure Modes  Omission  Excessive repetition  Wrong sequence  Early or late execution  Incorrect identification/ selection  Incorrect information  Incorrect counting or calculating  Overlooking  Misreading or misunderstanding  Incorrect decision  Incorrect transcription  Incorrect route, position, setting

© Joint Commission Resources Current State Data Analysis  As we have discussed, collect your baseline data from 5-10 patients if possible  Analyze expected to actual time stamps (Process Metrics)  Analyze completed care plans as defined  Analyze current state outcome metrics

© Joint Commission Resources Metrics for Target Population  Outcome metrics (readmission rate)  Financial metrics  Process metrics – time stamps  Process metrics – care plan completion  Pre and post data – frontline staff, physicians, and patient surveys

© Joint Commission Resources Check/Improve ROOT CAUSES OF VARIATION  Identified in “Analyze” step  Rank in relative importance  Brainstorm potential solutions for each root cause.  Prioritize root causes with solutions

© Joint Commission Resources Designing a Pilot Launch  Establish baseline performance  Train employees on pilot solution  Measure results of pilot solution  Analyze results of pilot solution  Decide to proceed to full-scale deployment

© Joint Commission Resources Deployment Planning  Review team mission and vision  Review strategic challenges  Align strategic objectives with action steps  Determine roles and goals  Establish communication plan  Align tactics with time horizons  Determine next steps

© Joint Commission Resources Deployment Plan

© Joint Commission Resources Post Implementation Data Collection

© Joint Commission Resources Post Survey – The Voice of Your Customer

© Joint Commission Resources Act / Control  Monitor pre and post project data  Define the monitoring plan for sustainability  Communicate results to the PI steering  Transfer knowledge to hospital staff and the community  Celebrate!

© Joint Commission Resources Executive Summary  Use your updated one-page Project Charter, adding pre and post data with target dates complete

© Joint Commission Resources Project Presentation to Senior Leaders 1.Create your presentation as you move through the PI phases of your project 2.Follow your systematic PI methodology 3.Consider team members presenting specific content 4.Link your project presentation with your opportunity to recognize the team

© Joint Commission Resources Celebrate!

© Joint Commission Resources Planning Your Team Celebration  Celebrate team success in style  Cater to your team  Let the whole world know  Personalize your thanks  Ask your team members to share their key learnings

© Joint Commission Resources Module 4: Summary Expected Outcomes  Understanding of how to design an ideal “future state” process map  Understanding of best practice solutions that include system redesign of the discharge process  Understanding of how to initiate a monitoring plan for sustainability  Discussion of hospital-based case studies  Understanding the importance of staff celebration and the application of the knowledge transfer framework across the hospital/system  Participation in a LIVE session

© Joint Commission Resources Progression to Launch Checklist  Modules 1 – 3 deliverables have been accomplished _____  Ideal process map has been completed ____  Pilot run scheduled ____  Final deployment plan created ____  Project monitoring plan is in place ____  Plan for celebration developed _____