Phase Two Learning Session 0 6 May 2013 Diana Dowdle - Campaign Manager David Grayson – Campaign Clinical Leader
Phase Two Learning Session 0 6 May 2013 Diana Dowdle - Campaign Manager David Grayson – Campaign Clinical Leader.
Dec 28, 2015
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Phase TwoLearning Session 0
6 May 2013 Diana Dowdle - Campaign Manager
David Grayson – Campaign Clinical Leader
Background
The increasing demand on resources across Counties Manukau is driving the need for continuing improvements in the way that we keep our community healthy.
To meet the predicted 5.5% increase in bed days, we need to save 20,000 days.
The Campaign aims to give back to our community 20,000 healthy & well days, so
reducing hospital bed days by 20,000.
20,000 Days Campaign
Campaign Driver Diagram
Version: 1.0Dated: 3/05/2013
20,000 Days Campaign Dashboard
Draft April 2013
Campaign Manager : Diana DowdleClinical Leader: David GraysonImprovement Advisor: Ian Hutchby & Prem Kumar
Contacts
Comments: Best estimate cumulative bed day saving as at 30 th April is approx 19,50019,493
Comments: The graph shows the difference between the Predicted and actual cumulative bed days.
Comments: There were no Dot Days in April
Comments: Admissions are stable and only normal variation existsComments: Unplanned readmissions is stable and only normal variation exists * April data has yet to be finalised so is showing
Dashboard Summary: Cumulative bed day saving of approximately 19,493 is a reflection of the difference between actual bed day usage and the predicted growth. This is reflection of the system as whole.
EC presentations and occupancy are showing special causes in February with lower than expected values. All other measures are stable and exhibiting normal variation.
Comments: ALOS is stable and only normal variation exists. Comments: EC Presentations have been growing but stable until February 2013 when a special cause has occurred with lower than expected presentations.
Comments: Special cause in February.
Assessment and Observation
unit in EC
EHB Phase 2Gastro, 35N
EHB Phase 1
Ward 33,34
Assessment and Observation
unit in EC
EHB Phase 2Gastro, 35N
EHB Phase 1Ward 33,34June 2009
Assessment and Observation
unit in EC
EHB Phase 2Gastro, 35N
EHB Phase 1Ward 33,34June 2009
Assessment and Observation
unit in EC
EHB Phase 2Gastro, 35N
EHB Phase 1Ward 33,34June 2009
Days between Dot Days
0
50
100
150
200
250
300
29/0
6/20
09
16/0
6/20
10
04/0
8/20
10
12/0
1/20
11
01/0
3/20
11
26/0
5/20
11
13/0
6/20
11
21/0
6/20
11
15/0
8/20
11
27/0
2/20
12
27/0
6/20
12
10/0
7/20
12
23/0
7/20
12
04/0
9/20
12
14/0
9/20
12
30/0
4/20
13
Date of Dot Day
Da
ys
be
wte
en
Do
t D
ays
CL = 13
LCL = 0
UCL = 199
EC Presentations-Growth
UCL
CL
LCL
6200
6700
7200
7700
8200
8700
9200
9700
10200
Jul 2
009
Sep
200
9
Nov
200
9
Jan
2010
Mar
201
0
May
201
0
Jul 2
010
Sep
201
0
Nov
201
0
Jan
2011
Mar
201
1
May
201
1
Jul 2
011
Sep
201
1
Nov
201
1
Jan
2012
Mar
201
2
May
201
2
Jul 2
012
Sep
201
2
Nov
201
2
Jan
2013
Mar
201
3
May
201
3
Jul 2
013
To
tal
Mo
nth
ly P
res
en
tati
on
s
Readmission rate
CL
UCL
LCL
3%
4%
5%
6%
7%
Jul 2
00
9
Oct
20
09
Jan
20
10
Ap
r 2
01
0
Jul 2
01
0
Oct
20
10
Jan
20
11
Ap
r 2
01
1
Jul 2
01
1
Oct
20
11
Jan
20
12
Ap
r 2
01
2
Jul 2
01
2
Oct
20
12
Jan
20
13
Ap
r 2
01
3
Jul 2
01
3
Rea
dm
issi
on
Rat
e
Average Length of Stay
UCL
CL
LCL
3.40
3.60
3.80
4.00
4.20
4.40
4.60
4.80
5.00
Jul 2
00
9
Oct
20
09
Jan
20
10
Ap
r 2
01
0
Jul 2
01
0
Oct
20
10
Jan
20
11
Ap
r 2
01
1
Jul 2
01
1
Oct
20
11
Jan
20
12
Ap
r 2
01
2
Jul 2
01
2
Oct
20
12
Jan
20
13
Ap
r 2
01
3
Jul 2
01
3
AL
OS
Admissions
UCL
CL
LCL
80
90
100
110
Jul 2
00
9
Oct
20
09
Jan
20
10
Ap
r 2
01
0
Jul 2
01
0
Oct
20
10
Jan
20
11
Ap
r 2
01
1
Jul 2
01
1
Oct
20
11
Jan
20
12
Ap
r 2
01
2
Jul 2
01
2
Oct
20
12
Jan
20
13
Ap
r 2
01
3
Jul 2
01
3
Ave
rag
e D
aily
Ad
mis
sio
ns
Cumulative Bed Days Saved Since June 2011
-2,000
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
Jun
-11
Au
g-1
1
Oct
-11
De
c-1
1
Fe
b-1
2
Ap
r-1
2
Jun
-12
Au
g-1
2
Oct
-12
De
c-1
2
Fe
b-1
3
Ap
r-1
3
Jun
-13
Actual vs Predicted Bed Days
120000
125000
130000
135000
140000
145000
150000
155000
160000
165000
170000
Jul-0
9Au
g-09
Sep-
09O
ct-0
9N
ov-0
9De
c-09
Jan-
10Fe
b-10
Mar
-10
Apr-
10M
ay-1
0Ju
n-10
Jul-1
0Au
g-10
Sep-
10O
ct-1
0N
ov-1
0De
c-10
Jan-
11Fe
b-11
Mar
-11
Apr-
11M
ay-1
1Ju
n-11
Jul-1
1Au
g-11
Sep-
11O
ct-1
1N
ov-1
1De
c-11
Jan-
12Fe
b-12
Mar
-12
Apr-
12M
ay-1
2Ju
n-12
Jul-1
2Au
g-12
Sep-
12O
ct-1
2N
ov-1
2De
c-12
Jan-
13Fe
b-13
Mar
-13
Apr-
13M
ay-1
3Ju
n-13
Jul-1
3
Tota
l Bed
day
util
isati
on o
ver a
rolli
ng 1
2 m
onth
per
iod
Actual bedday cumulative total Predicted bedday cumulative total
Occupancy
UCL
CL
LCL
10000
10500
11000
11500
12000
12500
13000
13500
14000
14500
Jul 2
009
Oct
200
9
Jan
2010
Apr
201
0
Jul 2
010
Oct
201
0
Jan
2011
Apr
201
1
Jul 2
011
Oct
201
1
Jan
2012
Apr
201
2
Jul 2
012
Oct
201
2
Jan
2013
Apr
201
3
Jul 2
013To
tal
Mo
nth
ly B
ed D
ays
Occ
up
ied
5 essential Collaborative components
1. A specified topic
2. Clinical, Management & Quality Improvement experts
3. Multi-professional teams from multiple sites /sectors
4. Model for improvement with clear & measurable targets
5. Series of structured activities- Schouten et al. BMJ 2008
Collaborative Structure
Select Topic
Expert Meetings
Identify Change
Concepts
Pre work
LS 125-26 June
S
P
A D
LS 231 Oct -1 Nov
Collaborative TeamsPhase Two
Supports: emails/ visits/ reports/ sponsors / meetings/ assessments / conference calls
P
A D
S
The Breakthrough Series: IHIs Collaborative Model for Achieving Breakthrough Improvement
LS – Learning Session
LS 06 May 2013
LS 3April 2014
Spread in
LocalitiesDivisions
WardsSectors
The Steps to Change
Campaign Milestones
Dragons’ Den session 25 March 2013
Interventions selected 5 -19 April 2013
Collaborative Teams established April/ May 2013
Learning Session 0 6 May 2013 (4 hours)
Learning Session 1 25-26 June 2013
Learning Session 2 31 October – 1 November 2013
Learning Session 3 April 2014
Celebration of Achievements June 2014
Savings Achieved 1 July 2014
Phase Two Collaboratives
• Medical Admission Pair (MAP)• Improved Management of Complex Pain• Early supported discharge of Stroke• Enhanced Primary Mental Healthcare• Inpatient care for people with diabetes• Reducing disparities for people with gout• Acute Geriatric Care Unit• Medical Assessment Unit• Franklin Co-ordination Service• Mental Health EC Adult Observation Unit • Dementia Care Locality• Prevention of Skin Infections in Community• Environmental Cleaning
Phase One CollaborativesImplementing changes permanently:• Very High Intensity Users (VHIU)• SMOOTH – Safer Medicines Outcomes on Transfer to
Home• Better Breathing- Pulmonary Rehabilitation • ERAS – Enhanced Recovery after Surgery• Delirium Care• Hip Fracture Management• Transitions of Care - Goal Discharge Date (GDD)
Transition to Phase Two:• Healthy Hearts – Community Rehabilitation for people with heart
failure
• Helping High Risk People - At Risk Individuals Localities Pilot
Support for Collaboratives
• Campaign Team• Learning Sessions • Coaching &
Mentoring• Monthly reporting• Measurement
analysis• Methodology
expertise• Master classes• IHI Open School
Campaign Team Roles
Collaborative Project Manager:•Responsible for BTS Collaborative methodology•Manages overall Collaborative progress•Coaches teams at Learning Sessions and action periods
Improvement Advisor (IA):•Expert in model of improvement & methods.•Responsible for driving the outcomes•Co-ordinates development of theory for the topic•Change package development•Designs measurement system & data analysis
Average Length Of Stay for Primary Hips and Knees
UCL
CL
LCL4
5
6
7
8
9
10
11
Jun 2
011
Jul 2
011
Aug 2
011
Sep 2
011
Oct 2
011
Nov 2
011
Dec 2
011
Jan 2
012
Feb 2
012
Mar 2
012
Apr 2
012
May 2
012
Jun 2
012
Jul 2
012
Aug 2
012
Sep 2
012
Oct 2
012
Days
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