20,000 Days Campaign Storyboard Learning Session 3, 11-12 March 2013

1. Better Breathing Programme Collaborative Clinical Leads: Sarah Candy & Fiona Horwood Team:Jen Mepham, Charulata Kulkarni, Prof Harry Rea, Fiona Smyth, Samuel Menia, Barbara Lambert, Meg Goodman, Rose Ikimau, Michelle Mills, Ta-Mera Rolland, Richard Small, Sarah Mooney Project Manager:Alison Howitt Improvement Advisor:Prem Kumar Decision Support:Penny Wilkings 20,000 Days Campaign Storyboard Learning Session 3, 11-12 March 2013

2. Aim • The aim of this project is to keep more people with chronic respiratory disease well in the community by increasing the number of participants enrolledinto Better Breathing (community based pulmonary rehabilitation) from 60 to 250 per year. This will result in; a reduction of unplanned admissions, increased exercise tolerance and improved health related quality of life.

3. Driver Diagram - Include Collaborative Driver Diagram

4. Change Packages

5. Change Packages

6. Most Successful PDSA Cycles? - Include PDSA Tree diagram

7. Act Plan Study Do Most Successful PDSA? • Continue to refine and measure the programmes. • Offer as a Franchise model with flexibility to suit patient demographice • Additional pulmonary rehabilitation programme into the community • Otara • Pukekohe • Programmes need to be design to suit the community they serve and each community is different. • Having the flexibility to provide programmes tailored to the patient demographics is essential for best outcomes • Identify & secure venues • Supply equipment • Design programme • Engage Community • Identify patients • Arrange staffing & speakers • Start programme

8. Measures Summary • Outcome Measures • The number of patients enrolled in each community Better Breathing programme • The number of unplanned hospital admissions • Process Measures • The number of referrals to Better Breathing • The number of participants who start Better Breathing • The number of participants completing the programme • The change in distance walked on 6 minute walk test • The change in health related quality of life questionnaire scores

11. Implementation Adapted from “The Improvement Guide. A Practical Approach to Enhancing Organizational Performance” Gerald Langley et al., 2009, p180.

12. Highlights and Lowlights Highlights • Accessibility – patients report they are now able to attend a programme • Patients feel safe and supported in a familiar environment which is in the heart of their community • As a whole, the pulmonary rehabilitation service is able to offer an increased number places on the programme (240 – 450) • Increased profile of pulmonary rehabilitation in South Auckland Lowlights • Recruitment of staff • Practise nurse involvement in Otara • Pukekohe site size and availability

13. Achievements to date • Moving Pulmonary Rehabilitation to the community • Venues, equipment, programme, speakers, referrals, assessments, staff, speakers, advertising, patient information, cultural support • Starting the Better Breathing Programme in Otara (running for 7 months) • Starting the Better Breathing Programme in Pukekohe. (4 intakes) • Testing and refining everything while we are doing it. • Learning from the patients and the community • Co-ordinating all the various groups, departments, stakeholders and people. • Thank you to everybody that has been involved

14. Better Breathing Clinical Pathway Clinical Leads: Fiona Horwood, Richard Hulme Team: Katie Coulter, Nicola Corna, Diana Hart, Sue Beaumont-Orr, Michelle Mills, Ta-Mera Rolland, Richard Small Project Manager: Alison Howitt Improvement Advisor: Prem Kumar Decision Support: Tanesha Patel 20,000 Days Campaign Storyboard Learning Session 3, 11-12 March 2013

15. Aim • The overall aim of the Better Breathing Collaborative is to work together with the Counties Manukau Community to help people with breathing problems to manage their condition well in the community. • This will be accomplished by • Providing community based pulmonary rehabilitation, for 250 in Otara and Pukekohe. • Introducing a COPD care bundle for patients with a primary diagnosis of COPD patients in Middlemore Hospital. • Increasing the numbers of COPD patients, identified in primary care and by piloting the introduction of an “early diagnosis primary care bundle.”

16. Driver Diagram - Include Collaborative Driver Diagram

17. Primary Care Change Packages

18. Primary and Secondary Change Ideas to be tested

19. Most Successful PDSA Cycles? Based on UK developed Care Bundle Tested Resp Ward Order changed Y/N added Tested Resp Ward Further info added for non Resp wards Tested on Gen Ward Referral Check box, sign & date added Tested Resp & Gen Ward Testing continues and we’ve learn’t a lot One box removed, not enough patients to test Tested Resp Ward & Gen Ward Re-think and Simplify Tested Resp Ward

20. Measures Summary • Measures related to Aim • Graphs of key measures - Which of your run charts would you give to senior leadership to use? - Include Collaborative Dashboard

21. Measures Summary Outcome Measure • Unplanned admissions to Middlemore Hospital • Length of Stay in Middlemore • Readmission rate Process Measures • Numbers of patients identified with COPD in primary care. • Numbers of patients receiving all or parts of early diagnosis primary care bundle. • Numbers of patients offered, attending and completing community based pulmonary. • Numbers of patients receiving discharge care bundle. • COPD patients by localities

22. Highlights and Lowlights • Highlights • Working across primary and secondary care. • Forming, what has become the COPD Team to work on the secondary care bundle. • Having the opportunity to review best practices, adapting and testing them for our patients and community. • Partnering with Auckland & Waitemata DHB’s for the COPD primary care pathway. • Sharing ideas and learning’s with Northland DHB and Canterbury • Lowlights • The challenges of testing when there are no patients. • Finding a meeting time that everybody can attend.