1. Designing Care Samantha Ludolf Designing Care Project Team
Department of Human Services

2. What are the 3 major issues facing the delivery of patient care for your organization? How will Designing Care help to address these?
What would the “the government of the day” need to know at the end of the 18 months to continue funding initiatives such as DC?
What are the perceived benefits of reporting to DHS on Designing Care?

3. Questions
What would you like to gain from this session?

4. Objectives Overview of Designing Care Overview of your Designing Care
Next steps

5. Designing Care: a history
Quality improvement Deming / Juran 1960s
Organisational learning / systems theory
Senge 1991
Re-engineering / process redesign Hammer 1993
Breakthrough improvement, Institute for Healthcare Improvement 1996

6. Designing Care Is…….
18 month program to either indirectly or directly improving patient care through
Learning & Networking
Measurement
Projects

7. Priorities for your projects:
Patient flow - across the system of care linking in with the work of the Patient Management Taskforce & the Emergency Demand Project Team
Quality management - linking in with Adverse Events, Risk Management and Clinical Governance

8. Designing Care: is not a quick fix the latest management fad
a way of avoiding challenging
implementation issues
an all-encompassing strategic
approach

9. Designing Care: what it can do
Tackle key issues
Create significant improvement (up to 50%) in key measures of performance
Create new ways of working across professional, departmental and organisational boundaries
Learning & cultural change

10. ‘not all change is improvement but all improvement is change”
Process Improvement
‘not all change is improvement but all improvement is change”
Don Berwick, President, IHI

11. What is a process?

12. Process has inputs and outputs
Definition - a process is a series of connected
steps or actions to achieve an outcome

13. Fractured neck of femur process
Patient processes cross many boundaries
% of work
doesn’t add value for patient
up to 50% of process steps involve a “handoff”, leading to error, duplication or delay
no one is accountable for the patient’s “end to end” experience
job roles tend to be narrow and fragmented
organisational/departmental boundaries B C D E A
endoscopy process
Fractured neck of femur process
outpatient process

14. Berwick and colleagues 1998
“In healthcare, the tendency has been to seek improvement by trying to perfect the elements of care
to make doctors better at doctoring,
to make nurses better at nursing,
to give equipment more functions,
or to replace one drug with a better one.
All of this “subject matter” or “discipline” specific” improvement helps, but modern systems theory suggests that greater leverage often lies in changing the patterns of interaction and in redesigning the overall flow of work.”
Berwick and colleagues 1998
Physicians as leaders in Improving Healthcare

15. Your Designing Care Project is stays in the ED, who would you involve in the project?

16. Designing Care Funding for:
Multi-disciplinary project teams
Cross functional project teams
Dedicated time to meet
Commitment to change
Ownership of the change
Support for the change

17. Designing Care Project Teams
Executive Sponsor
Project Leader
Project facilitator
Multi-disciplinary team members

18. What are the roles?
What do you think is the role of your Executive sponsor, Project Leader & Project Facilitator?

19. Sponsoring Designing Care
provide leadership commitment (clinical/managerial)
identify direction
ensure that the project is feasible
ensure that the project area is strategically important & worth doing
define the aims/objectives and performance measures
remove ‘log jams’
gain ‘top team’ approval for the project outcomes
continually reiterate the importance of the project
celebrate success!

20. Facilitating Designing Care
Manage (drive) the project
Avoid advice giving
“external” facilitator
“mind of a beginner”
Share of talking should 75% team, 25% facilitator

21. Project Leader Manage the project Lead from the discipline area
Champion of the project with peers and team members
Supported by “external” facilitator

22. What skills do you need? - Executive sponsors Project facilitators
Project teams

23. Tools & Learning Project management Process mapping Measurement
Process redesign
Change management - cultural, people & processes
Facilitation
Consumer involvement
Evidence based healthcare

24. Learning Regional learning sessions Internet based learning/tools
Internet based library
Discussion groups
On site learning –e.g process mapping & redesign, coaching & mentoring

25. The toolkit we will have some material for you to create
your own toolkit

26. What is the best way of learning?
“The best learning is by playing”
Harold Bridges, Tavistock Institute

27. 4 organizations are all looking at process of care for COPD Patients
4 organizations are all looking at process of care for COPD Patients. Do you think it would beneficial to share the learning with 4 organizations?

28. Networking & Sharing Program of monthly meetings – key topics
Quarterly project team meetings: Feb 2001
International conference: Feb 2002

29. From you:
By June 2002, the end of Designing Care, what will you have achieved?
How will you measure your achievements?
How will you apply process mapping and redesign methodology?

30. Next steps Feedback from the briefing session
Final submission - Jan 01
Approval - Feb 2001
60% Funding - Feb 2001
Launch event - Feb 2001
Baseline measures