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Flow Cost Quality: Transforming non-elective healthcare for older people

@sheffielddoc. Flow Cost Quality: Transforming non-elective healthcare for older people . Tom Downes 4 th March 2014. “Right First Time programme is delivering real benefits to patients and the transformation journey across the health and social care system has begun…”.

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Flow Cost Quality: Transforming non-elective healthcare for older people

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  1. @sheffielddoc Flow Cost Quality: Transforming non-elective healthcare for older people Tom Downes 4th March 2014

  2. “Right First Time programme is delivering real benefits to patients and the transformation journey across the health and social care system has begun…”

  3. Older, frail patients ….part of the NHS must be custom-tuned to their needs. Roy Lilley, The Guardian 29th May 2013

  4. A complex system problem

  5. 2003 Toyota Corolla

  6. How do others design complex systems? Toyota Oobeya (Big Room)

  7. First find a room

  8. A place to meet

  9. The Big Room in Action Community Services manager Social Services Manager Physiotherapist Discharge Liaison Service Improvement General Manager For Medicine Secretary GSM Matron Physiotherapist gives an account of the test of change to get a patient home on the day they were discharged by the GSM consultant Senior registrar

  10. PDSA tests of moving from ‘post take’ to ‘on take’ 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 + poor mobility

  11. Implementation dates: • April 2012 • Consultant geriatricians ‘on take’ 7 days per week • May 2012 • Frailty Unit process initially virtually • Frailty Unit opens mid-May

  12. Outcome measure: 34% increase in discharge within 1 day

  13. Midnight bed occupancy dropped by over 60 beds (no similar change in previous 10 years)

  14. Was reduction in bed usage due to reduced admissions? No

  15. Balance measure: No increase in readmissions

  16. The in-hospital mortality dropped by over 13%

  17. Discharge to Assess (D2A) The future hospital will support a system of ‘discharge to assess’ in physiotherapy and occupational therapy. Section 5.20 Future Hospital Report, Royal College of Physicians (September 2013)

  18. Implementation dates: • April 2012 • Consultant geriatricians ‘on take’ 7 days per week • May 2012 • Frailty Unit process initially virtually • Frailty Unit opens mid-May • September 2013 • Testing of ‘discharge to assess’ from base wards • October 2013 • Implementation of ‘discharge to assess’ begins

  19. Time waiting per patient D2A starts

  20. CONCLUSION • Modern health care is complex • Iterative testing and prototyping by front line staff • Our patients want timely quality care • Timely quality care is cheaper and safer • Measure • D2A – don’t worry that it’s obvious • Our journey has only just started

  21. Thank youTom.Downes@sth.nhs.uk @sheffielddoc

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