1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
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Implementation of a Day of Discharge Patient
Information Leaflet: A User Engagement Initiative.
Sinead Reynolds, MSc Leadership.
Abstract
Background: A Level 4 Dublin Academic Teaching Hospital subject to increased activity resulting from regional reconfiguration required strategic capacity planning to maintain organisational patient flow. Discharge planning is a key component of patient flow and of achieving Health Service Executive patient experience time targets. Analysis undertaken identified a gap in patient engagement in discharge planning.
Aim: Development and introduction of a Day of Discharge Patient Information Leaflet to enhance compliance with Discharge policy by user engagement.
Rationale: HIQA and the HSE Service Plan 2015 standards direct service providers to engage the patient in care pathways and improve discharge effectiveness. Research supports patient engagement improves health outcomes, reduces Length of Stay and improves patient flow.
Change process: The Health Service Executive Change Model was utilised as a change framework. The project was supported by a literature review and detailed analysis of the pre project status. The author was project leader and the project team of key stakeholders was guided by a collaborative project implementation plan. A Day of Discharge Patient Information Leaflet was developed based on evidence and tested within an identified ward receiving emergent admissions.
Evaluation: ‘Before and After’ data analysis of average length of stay, ‘Home by 11am’ and Predicted Date of Discharge compliance was conducted. A patient feedback questionnaire was distributed and results correlated regarding service user benefit from the leaflet. Amendments were made to the organisational discharge policy to incorporate the Day of Discharge Patient Information Leaflet.
Results: Data gathered evidenced an improving trend but performance targets were not reached. Patient feedback regarding the leaflet and the communication opportunity with staff was very positive. Continuing improvements were indicated.
Conclusion: The HSE Change Model methodology was appropriate to guide the project. Involvement of staff in change processes must be adequately resourced. Patient engagement in discharge planning is enhanced by an appropriate patient information leaflet.

2. Introduction & Background Organisational Impact
Implementation of a Day of Discharge Patient
Information Leaflet: A User Engagement Initiative Sinead Reynolds, MSc Leadership
Introduction & Background
Methodology
Evaluation
A Dublin Academic Teaching Hospital was experiencing a 30% increase in emergent admissions following regional reconfiguration. Discharge planning was fundamental to sustaining patient flow and achievement of Health Service Executive1 targets for patient experience time (PET) despite increased activity.
Review of discharge processes and data analysis revealed a lack of communication and advance planning with patients resulting in poor compliance with ‘Home by 11am’ (Figure 1.) and protracted length of stay (LOS).
Figure 1. ‘Home by 11am’ data
Engaging patients in their care planning can improve health outcomes and timely access to beds for emergent admissions1
The HSE Change Model (2008) (Figure.2) was utilised for project implementation.
Figure 2. HSE OD Change Model2
The project was evidenced by analysis of the pre project status to support the process change. A committed project team developed an implementation plan with clear roles and targets. Patients and the MDT (multidisciplinary team) took ownership at ward level. The DDPIL was designed to meet local service user needs and engage them in discharge planning (Figure 3.)
Figure 3. DDPIL front page.
Introducing and testing the DDPIL was conducted with education for staff, project team guidance and the Clinical Nurse Manager 2 as change champion. Patient feedback was crucial and was sought by questionnaire.
Healthcare Evaluation attributes value to an intervention by analysing data and evaluating outcomes of objectives3. A ‘Before and After’ analysis was conducted (Figure 4) and patient feedback was reviewed. 68% of questionnaires were returned with 90% stating the leaflet was either very good or excellent.
Figure 4.’Before & After’ Analysis.
Discharge Time
Number of Discharges %
Before 11am 26
5.6%
After 11am
441
94.4%
Total
467
100%
Organisational Impact
A culture shift was evolving towards shared responsibility for discharge planning. A reduced LOS and increased compliance with PDD and ‘Home by 11’ was evident but reopening a discharge lounge was recommended.
Conclusion
Aim & Objectives
The HSE Change Model successfully guided the project however staff involvement in change needs adequate resource investment. Engaging patients in discharge is enhanced by a quality patient information leaflet4
1.HSE,(2015).Health Service Executive Service Plan .Dublin.
2.HSE,(2008).Improving our Services. A Users Guide to Managing Change in the Health Service Executive. HSE.
3.Øvretveit,J.(2010). Evaluating Health Interventions. 6th Edn. McGraw Hill Education. England.
4.Foot et al.,(2014) People in control of their own health and care. The State of Involvement. The King’s Fund. NHS.
Aim: Develop and implement a Day of Discharge Patient Information Leaflet (DDPIL), a user engagement initiative in a medical ward.
Objectives:
Develop and test a Day of Discharge Patient Information Leaflet in a medical ward.
Reduce Average Length of Stay during the test timeframe.
Develop a Key Performance Indicator (KPI) to improve “Home by 11am” compliance.
Increase compliance with Predicted Date of Discharge (PDD) completion.
References