A little over two weeks ago, on February 3, Saskatoon Health Region launched the first Region-wide, employee-inspired, patient flow process improvement initiative: The Better Every Day 14-Day Challenge.
"We launched the challenge because frontline healthcare providers asked for help. They were caring for patients in temporary units and trying to cope with an ongoing, unceasing demand for care," states Dan Florizone, President and CEO, Saskatoon Health Region.
Out of concern for patient safety, and the well-being of staff and physicians who had been dealing with a growing overcapacity situation for12 weeks, the Region set aside other activities and focused on one priority: patient flow.
The goals were to eliminate temporary bed pods, to eliminate long waits for patients admitted to the hospital from the emergency room, to be prepared for surges in normal demand by having the right number of beds ready, and to put in place a consistent admission and discharge process, all while improving patient satisfaction along with staff and provider engagement.
"We knew these were ambitious goals, but we were in an unacceptable situation and needed to do everything we could to make things better for our patients and staff," says Florizone.
When the challenge began, six teams were assigned key streams of work. Teams used all of the Lean tools at their disposal to take short-term actions and develop plans to meet long-term demand for services.
The past two weeks were focused on providing patients with the right care in the right setting at the right time, ensuring that the emergency department was not their only option. A snapshot of results can be viewed
The past two weeks saw the Region:
- Decrease the number of temporary beds from 112 to 59.
- Decrease the number of patients admitted to hospital but who continue to wait for a bed in the emergency room. The target was to have 85 per cent of patients admitted to hospital from the emergency room in the right bed within five hours. This target was met only 40 per cent of the time prior to the Challenge. By Day 15, the target was met 84 per cent of the time at St. Paul's Hospital and 74 per cent at Royal University Hospital.
- Work with Saskatchewan Health Quality Council to develop a predictive model that will help the Region prepare for changes in demand. The predictive model is based on multiple factors, including but not exclusive to monthly admission data, emergency department visits, influenza trends and weather conditions. The forecast can predict inpatient and emergency department demand by day, by week or as far out as a year. Right now, the model works at the site level; the next step will be to get it down to the unit level, then link it to staffing needs. Eventually, the system will help forecast the impact of decisions around beds and unit openings, and alert units as demand rises on specific segments of healthcare services.
- Establish a new admission process that provides patients with an up-front estimated date range for when they will leave the hospital.
- Successfully pilot
a new process for returning rural and out-of-region patients to their home hospitals to improve the transition experience for patients and staff.
Expand service of the Mental Health Transition Team to include weekends, preventing clients from needing to return to the emergency room for care.
- Launch a
paramedicine pilot project at two long-term care homes so that residents experiencing a non-emergent health issue can be treated in their own home.
a new pilot at the Lighthouse Supported Living to increase available beds and expand services.
"Overall, there's a renewed sense of hope and optimism within the organization," says Dr. George Pylypchuk, Unified Department Head of Medicine for Saskatoon Health Region and University of Saskatchewan, and one of the team leads. "We got rid of some of the red tape, and have really shaken up our perceptions about what we can make happen in just two weeks."
There have been plenty of "aha moments" over the course of the challenge as teams discovered more about the organization, what goes on and why, what's working well and what needs to change.
"We have learned that we have a lot of data, but it exists in disparate systems that are not easy to access," noted Nilesh Kavia, Vice President of Finance and Corporate Services, and one of the team leads. "This means we haven't had the right information at the right time for management purposes. But we are developing a way to get that data into one place - onto a dashboard - so we have the right information to make the right decisions at the right time."
One of the major learnings of the 14 Day Challenge has been what can happen when the organization focuses on one priority at a time. This focus continues into the future as the Region prepares to launch a series of 90-day cycles, each devoted to a single priority.
"The Challenge highlighted that we need better systems, that we need to engage even more people, that we need a continued focus on idea generation, and that we need to fundamentally change how we work," states Florizone.
Although the Better Every Day 14 Day Challenge is over, the work to enhance patient flow continues.
The key to the Region's success in the days to come will be clear and focused actions to build on the improvement created, make continued gains and ensure sustainable change.
The next cycle will begin shortly and will be dedicated to creating and implementing an early warning system that will signal areas where patient waits are emerging. This forecasting will result in early and immediate corrective actions that will create a better healthcare experience for patients.
"Beginning immediately, we will engage staff, physicians, patients and members of the public in the detailed formulation of the next 90-day improvement action cycle so that we can hit the ground running on March 2," Florizone stated.