G3 Rita Janke - All in Good Time: Reducing the Lead time for multidisciplinary summary assessment reports to Zero

All In Good Time: Reducing the Lead time for multidisciplinary summary assessment reports to Zero

30 days 0 days

Context Complex Developmental and Behavioral

Conditions Team (CDBC). Sunny Hill Health Centre for Children (SHHC),

Child Development and Rehabilitation Program of BC Children’s Hospital.

CDBC at SHHC is part of a Provincial Network providing multidisciplinary diagnostic assessments for children with complex needs.

Current State Process

The Problem

Team Summary n=16

27%

No Team Summary n=44

73%

Percentage of Families who received a Team Summary n=60

Sunny Hill Standard: Families will receive a Team Summary within 6 weeks of their family conference.

The Problem: Community Service Provider Voice

Telephone message: “ Hi Veena, this is Jane (Community Social Worker), you worked on a team that saw my client and I am trying to connect her to services in the community. I’ve looked through the reports and…. I can’t figure out what the diagnosis is. Can you please call me back for some clarity.”

Letter received by Sunny Hill from a Community Pediatrician: “I just received a 7 page report on the speech and language evaluation of this boy. It is difficult to use such a report when there is no summarizing of the results and simply reams of detail. To simply include long lists of things that he can and can’t do without there being an overall summary does not seem very helpful to those receiving such a report in the community. The most important point with ANY consultation/assessment is the summary.

The Problem: Family Voice

When will my child’s reports be

ready?

Actions undertaken

Team of clinicians to engage in process Value stream of process Identified opportunities for improvement Team idea to develop new process for Team

Summary Simulation to trial the process

The TEAM

Developmental Pediatrician Occupational

Therapist Psychologist Speech

Language Pathologist Social Worker Program

Manager Process

Improvement Support

Value Stream: Identifying Improvement Opportunities

Before….. Team synthesis of

assessment results and diagnosis

Aim

To develop a CDBC team summary process which supports distributing the team summary report immediately following the family/team conference. To develop a team summary process which

support team synthesis of diagnoses. To reduce lead time from family conference to

receiving the team summary report to zero.

The Idea

Specific Issue Addressed

Development of a agreed upon team summary content and format. Development of team standards for timeliness

of reports Scheduling of rounds and family conference Required Technology for real-time

documentation. Team dynamics.

Increase team completion of report during team rounds process from 0% to 100%.

UCL

LCL

0%

20%

40%

60%

80%

100%

120%

4/2/

12

4/9/

12

4/16

/12

4/23

/12

4/30

/12

5/7/

12

5/14

/12

5/21

/12

5/28

/12

6/4/

12

6/11

/12

6/18

/12

6/25

/12

7/2/

12

7/9/

12

7/16

/12

7/23

/12

7/30

/12

8/6/

12

8/13

/12

8/20

/12

8/27

/12

9/3/

12

CDAS Completed by Staff During Team Rounds Percent

Measures for Analysis & Results

Increase consistency of reports delivered to families from 27% to 100%

UCL LCL

0%

20%

40%

60%

80%

100%

120%

9/10

/12

9/17

/12

9/24

/12

10/1

/12

10/8

/12

10/1

5/12

10/2

2/12

10/2

9/12

11/5

/12

11/1

2/12

11/1

9/12

11/2

6/12

12/3

/12

12/1

0/12

12/1

7/12

12/2

4/12

12/3

1/12

1/7/

13

1/14

/13

1/21

/13

Percent of Children with a Completed Team Summary Percent

Measures for Analysis & Results

Measures for Analysis & Results

Reduce the lead time of families receiving the team summary from 30 days to 0 days

UCL

LCL

0%

20%

40%

60%

80%

100%

120%

9/10

/12

9/17

/12

9/24

/12

10/1

/12

10/8

/12

10/1

5/12

10/2

2/12

10/2

9/12

11/5

/12

11/1

2/12

11/1

9/12

11/2

6/12

12/3

/12

12/1

0/12

12/1

7/12

12/2

4/12

12/3

1/12

1/7/

13

1/14

/13

1/21

/13

Percentage of Families who received the Team Summary at the Family Conference Percent

Results……

Lessons learned

Preparation time is important Involvement of clinicians in the development

of the process Technology has to support process Champions of change-peer coaches Visible management support

Overall impacts of the work

Anecdotal feedback Decrease in family request for information related

to diagnosis Positive community feedback

Family Evaluation in progress Team Survey measure- early results

Contact Information

Lesley Howie Program Manager Complex Developmental Behavioural Conditions Network Sunny Hill Health Centre for Children [email protected] 604-453-8300

Rita Janke Quality, Patient Safety & Accreditation Leader Sunny Hill Health Centre for Children [email protected] 604-453-8300