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Redesigning Acute Care for Older People: The Start of Sheffields
Redesigning Acute Care for Older People: The Start of Sheffields
4.3% per year over the last 30 years Driven by technology and
4.3% per year over the last 30 years Driven by technology and
We must redesign services
We must redesign services
Day 2127 as a consultant
Day 2127 as a consultant
A system problem
A system problem
A complex system problem
A complex 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
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
Tests
Tests
Let me introduce George
Let me introduce George
Challenge to UK geriatric medicine traditions:
Challenge to UK geriatric medicine traditions:
Redesigning Acute Care for Older People: The Start of Sheffields
Redesigning Acute Care for Older People: The Start of Sheffields
Batching patients for Post-take ward round Real-time senior
Batching patients for Post-take ward round Real-time senior
Twice weekly senior clinician ward rounds Daily senior decision
Twice weekly senior clinician ward rounds Daily senior decision
MDT planning meetings Assess needs at home once acute hospital
MDT planning meetings Assess needs at home once acute hospital
Redesigning Acute Care for Older People: The Start of Sheffields
Redesigning Acute Care for Older People: The Start of Sheffields
Porters Value Based Design
Porters Value Based Design
Implementation headlines: April 2012 New discharge process from
Implementation headlines: April 2012 New discharge process from
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
Value
Value
Not hospital @ home
Not hospital @ home
Redesigning Acute Care for Older People: The Start of Sheffields
Redesigning Acute Care for Older People: The Start of Sheffields
Improvement in health care is 20% technical and 80% human Marjorie
Improvement in health care is 20% technical and 80% human Marjorie
Conclusion
Conclusion
Thank you Tom
Thank you Tom

: Redesigning Acute Care for Older People: The Start of Sheffields Journey. : Pre-installed;Tom Downes;Sheffield Teaching Hospitals NHS Foundation Trust;UK. : Redesigning Acute Care for Older People: The Start of Sheffields Journey.ppt. zip-: 4329 .

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Redesigning Acute Care for Older People: The Start of Sheffields Journey

Redesigning Acute Care for Older People: The Start of Sheffields Journey.ppt
1 Redesigning Acute Care for Older People: The Start of Sheffields

Redesigning Acute Care for Older People: The Start of Sheffields

Journey

Tom Downes MB BS, MRCP, MBA, MPH (Harvard) Clinical Lead for Quality Improvement Sheffield Teaching Hospitals The Health Foundation / IHI Quality Improvement Fellow 28th November 2012

2 4.3% per year over the last 30 years Driven by technology and

4.3% per year over the last 30 years Driven by technology and

expectation Only 0.4% attributable to ageing Need to deliver over 20% more care in 5 years time Need to deliver over 50% more care in 10 years time UNSUSTAINABLE

Healthcare inflation

Rises in healthcare spending: where will it end? Jon Appleby, BMJ 1st November 2012

Rises in healthcare spending: where will it end? Jon Appleby, BMJ 1st November 2012

3 We must redesign services

We must redesign services

Decisions about service redesign must be clinically led and clinicians must be prepared to challenge the way services - including their own service are organised.

Hospitals on the Edge The time for action Royal College of Physicians, 13th September 2012

4 Day 2127 as a consultant

Day 2127 as a consultant

5 A system problem

A system problem

6 A complex system problem

A complex system problem

7 2003 Toyota Corolla

2003 Toyota Corolla

8 How do others design complex systems

How do others design complex systems

Toyota Oobeya Room

9 First find a room

First find a room

10 The Room

The Room

11 Board 1: The Business objectives:

Board 1: The Business objectives:

12 Board 2: What do these objectives mean for our patients

Board 2: What do these objectives mean for our patients

13 Board 3: How are we doing against the GSM business and patients

Board 3: How are we doing against the GSM business and patients

objectives?

14 Board 4: High Level GSM Process through the complex health and social

Board 4: High Level GSM Process through the complex health and social

care system & Board 5: Real time plan

15 Tests

Tests

16 Let me introduce George

Let me introduce George

82 years old Lives independently and wants to continue doing so Widowed 5 years ago Has mild dementia Daughter lives locally Losing weight and finding walking more difficult

PDSA tests of moving from post take to on take

17 Challenge to UK geriatric medicine traditions:

Challenge to UK geriatric medicine traditions:

Split of inpatient / outpatient care Combined immediate delivery of specialist MDT care

18 Redesigning Acute Care for Older People: The Start of Sheffields
19 Batching patients for Post-take ward round Real-time senior

Batching patients for Post-take ward round Real-time senior

specialist review (7/7) Bedded medical assessment unit could be unnecessary for most geriatric medicine patients

20 Twice weekly senior clinician ward rounds Daily senior decision

Twice weekly senior clinician ward rounds Daily senior decision

capability on every ward

21 MDT planning meetings Assess needs at home once acute hospital

MDT planning meetings Assess needs at home once acute hospital

environment no longer adding value

22 Redesigning Acute Care for Older People: The Start of Sheffields
23 Porters Value Based Design

Porters Value Based Design

VALUE

What Is Value in Health Care? Michael E. Porter, Ph.D. N Engl J Med 2010; 363: 2477-2481December 23, 2010

24 Implementation headlines: April 2012 New discharge process from

Implementation headlines: April 2012 New discharge process from

assessment units Consultant geriatricians on take 7 days per week May 2012 Frailty Unit process initially virtually Frailty Unit opens mid-May July 2012 Ambulatory care area for work formerly considered to be outpatient

25 Outcome measure: 34% increase in discharge within 1 day

Outcome measure: 34% increase in discharge within 1 day

26 Outcome measure: Bed occupancy reduced by over 60 beds

Outcome measure: Bed occupancy reduced by over 60 beds

27 Was reduction in bed usage due to reduced admissions

Was reduction in bed usage due to reduced admissions

No

28 Balance measure: Would it have happened regardless

Balance measure: Would it have happened regardless

29 Balance measure: Decrease in readmissions

Balance measure: Decrease in readmissions

30 Balance measure: Decreased mortality

Balance measure: Decreased mortality

31 Value

Value

Value = Outcome / Cost Return on investment = Saving Investment / Investment = (?3,000,000 - ?750,000) 140,000 / ?140,000 = 2,110,000 / 140,000 = 15

32 Not hospital @ home

Not hospital @ home

Resources have started to move to the community Designing hospital@hospital and home@home

33 Redesigning Acute Care for Older People: The Start of Sheffields
34 Improvement in health care is 20% technical and 80% human Marjorie

Improvement in health care is 20% technical and 80% human Marjorie

Godfrey The Dartmouth Institute

35 Conclusion

Conclusion

Modern health care is complex Iterative testing and prototyping is required Cooperation between and health and social care is essential Our journey has only just started

36 Thank you Tom

Thank you Tom

Downes@sth.nhs.uk @sheffielddoc

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