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Redesigning Acute Care for Older People: The Start of Sheffield’s
Redesigning Acute Care for Older People: The Start of Sheffield’s
Redesigning Acute Care for Older People: The Start of Sheffield’s
Redesigning Acute Care for Older People: The Start of Sheffield’s
Day 2127 as a consultant
Day 2127 as a consultant
A ‘system’ problem
A ‘system’ problem
2003 Toyota Corolla
2003 Toyota Corolla
How do others design complex systems
How do others design complex systems
First find a room
First find a room
The Room
The Room
The Room
The Room
Board 1: The Business objectives:
Board 1: The Business objectives:
Board 2: What do these objectives mean for our patients
Board 2: What do these objectives mean for our patients
Board 3: How are we doing against the GSM business and patients
Board 3: How are we doing against the GSM business and patients
Board 4: High Level GSM Process through the complex health and social
Board 4: High Level GSM Process through the complex health and social
Let me introduce ‘George’
Let me introduce ‘George’
Let me introduce ‘George’
Let me introduce ‘George’
Let me introduce ‘George’
Let me introduce ‘George’
Let me introduce ‘George’
Let me introduce ‘George’
Redesigning Acute Care for Older People: The Start of Sheffield’s
Redesigning Acute Care for Older People: The Start of Sheffield’s
Redesigning Acute Care for Older People: The Start of Sheffield’s
Redesigning Acute Care for Older People: The Start of Sheffield’s
Outcome measure: 34% increase in discharge within 1 day
Outcome measure: 34% increase in discharge within 1 day
Outcome measure: Bed occupancy reduced by over 60 beds
Outcome measure: Bed occupancy reduced by over 60 beds
Was reduction in bed usage due to reduced admissions
Was reduction in bed usage due to reduced admissions
Balance measure: Would it have happened regardless
Balance measure: Would it have happened regardless
Balance measure: Decrease in readmissions
Balance measure: Decrease in readmissions
Balance measure: Decreased mortality
Balance measure: Decreased mortality
Redesigning Acute Care for Older People: The Start of Sheffield’s
Redesigning Acute Care for Older People: The Start of Sheffield’s
Thank you Tom
Thank you Tom
Thank you Tom
Thank you Tom
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Redesigning Acute Care for Older People: The Start of Sheffields Journey

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1Redesigning Acute Care for Older 19Batching patients for ‘Post-take ward
People: The Start of Sheffield’s Journey. round’ Real-time senior specialist review
Tom Downes MB BS, MRCP, MBA, MPH (Harvard) (7/7) Bedded medical assessment unit could
Clinical Lead for Quality Improvement be unnecessary for most geriatric medicine
Sheffield Teaching Hospitals The Health patients.
Foundation / IHI Quality Improvement 20Twice weekly senior clinician ward
Fellow 28th November 2012. rounds Daily senior decision capability on
24.3% per year over the last 30 years every ward.
Driven by technology and expectation Only 21MDT planning meetings Assess needs at
0.4% attributable to ageing Need to home once acute hospital environment no
deliver over 20% more care in 5 years’ longer adding value.
time Need to deliver over 50% more care in 22
10 years’ time UNSUSTAINABLE. Healthcare 23Porter’s Value Based Design. VALUE.
inflation. Rises in healthcare spending: What Is Value in Health Care? Michael E.
where will it end? Jon Appleby, BMJ 1st Porter, Ph.D. N Engl J Med 2010; 363:
November 2012. Rises in healthcare 2477-2481December 23, 2010.
spending: where will it end? Jon Appleby, 24Implementation headlines: April 2012
BMJ 1st November 2012. New discharge process from assessment
3‘We must redesign services. Decisions units Consultant geriatricians ‘on take’ 7
about service redesign must be clinically days per week May 2012 Frailty Unit
led and clinicians must be prepared to process initially virtually Frailty Unit
challenge the way services - including opens mid-May July 2012 Ambulatory care
their own service – are organised.’. area for work formerly considered to be
Hospitals on the Edge – The time for outpatient.
action Royal College of Physicians, 13th 25Outcome measure: 34% increase in
September 2012. discharge within 1 day.
4Day 2127 as a consultant. 26Outcome measure: Bed occupancy reduced
5A ‘system’ problem. by over 60 beds.
6A complex system problem. 27Was reduction in bed usage due to
72003 Toyota Corolla. reduced admissions? No.
8How do others design complex systems? 28Balance measure: Would it have
Toyota Oobeya Room. happened regardless?
9First find a room. 29Balance measure: Decrease in
10The Room. readmissions.
11Board 1: The Business objectives: 30Balance measure: Decreased mortality.
12Board 2: What do these objectives mean 31Value. Value = Outcome / Cost Return
for our patients? on investment = Saving – Investment /
13Board 3: How are we doing against the Investment = (?3,000,000 - ?750,000) –
GSM business and patients objectives? 140,000 / ?140,000 = 2,110,000 / 140,000 =
14Board 4: High Level GSM Process 15.
through the complex health and social care 32Not hospital @ home. Resources have
system & Board 5: Real time plan. started to move to the community Designing
15Tests. hospital@hospital and home@home.
16Let me introduce ‘George’. 82 years 33
old Lives independently and wants to 34‘Improvement in health care is 20%
continue doing so Widowed 5 years ago Has technical and 80% human’ Marjorie Godfrey
mild dementia Daughter lives locally The Dartmouth Institute.
Losing weight and finding walking more 35Conclusion. Modern health care is
difficult. PDSA tests of moving from ‘post complex Iterative testing and prototyping
take’ to ‘on take’. is required Cooperation between and health
17Challenge to UK geriatric medicine and social care is essential Our journey
traditions: Split of inpatient / has only just started.
outpatient care Combined immediate 36Thank you Tom.Downes@sth.nhs.uk
delivery of specialist MDT care. @sheffielddoc.
18
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