the future hospital model - hfma · the future hospital model: value based sustainability “the...
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Dr Michael Daly Executive Director Clinical Governance, Metro South Health 20 April 2018 | HFMA Congress
The Future Hospital Model:
Value Based Sustainability
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“The problem isn’t knowing what to do, its how to do it that is the
challenge”
Mary Dixon-Woods, Centre for Health Services Research, Cambridge
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“The necessary changes are cultural as much as technical and leadership is an essential
ingredient”Leape, Berwick, BMJ 2000
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What is the state of Australia’s healthcare system?
• Great health system
• Universal healthcare• Amongst longest life expectancy
in world• Amongst lowest perinatal
mortality• Highly trained and expert
clinicians• %GDP on health consistent with
OECD peers
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What are we left with?
@jmhuddleston
Human Capacity
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“The pathway to higher quality is the same pathway to reduced cost”
Dr Gary Caplan, President and CEO Virginia Mason
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TodayBeginning ofTime
PercentageRisk of Dying
0
100
50
Timeline
Individual’s lifetime risk of death since time began
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• 82 year old male with severe COPD and pancreatic cancer was hospitalized for bowel obstruction.
• Postoperative delirium• Postoperative respiratory failure• Pain meds held• Per nursing notes:
– patient routinely called out in pain– family members consistently asked
that he be kept comfortable.
• Average pain score was 8/10 in the 24 hours preceding death.
• Patient was made comfort care only and died within hours.
@jeannehuddleston
Joshua Bright: A Good Death
Can patients have a “good”
death?
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Brent Dykes, Forbes Blog post Apr 26, 2016
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Intern cannulation credentialing
Medical students and JHO cannulation training
International medical graduates
Interhospital transfer cannula
surveillance
VAST established
Inpatient PIVC Bloodstream Infection (BSI)
ieMR report implemented
IV starter kit introduction
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MAKE IMPROVEMENT
SIMPLEEach clinician needs to be
able to access a quality ‘expert’
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Best in class?
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Workforce Capability to Improve
• Improvement Science– Tier 1 Introduction to Improvement Science– Tier 2 Improvement Fundamentals– Tier 3 Formalised Training (Green Belt)
• Manage 4 Improvement• Leadership and Continuous Improvement
training• IMPROVEMENT EXPERTS
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Empowering staff and creating a groundswell of front line problem solvers
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Initial Quality Improvement Initiatives
• Virtual Fracture Clinic• Radiology hours realigned to need• Reducing late stage pressure injuries• Manage for Improvement projects (24)
Better care and better value
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Promoting Professional Accountability Program
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Will it Work?
Will the Status Quo Work?
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SNAAP Results: Effectiveness
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Standard Notice SNAAP
% R
espo
nder
s
Survey results accurately reflected day-to-day level of Q&S in the organisation
Strongly agree
Agree
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SNAAP Results: Efficiency
0%
5%
10%
15%
20%
25%
30%
35%
40%
6-12 monthsbefore
3-6 monthsbefore
1-3 monthsbefore
2-4 weeksbefore
1 week before week of
Perc
enta
ge o
f usu
al h
ours
per
wee
k
Time range prior to onsite arrival of surveyors
All participants OWS
All participants SNAAP
Percentage of day spent preparing for accreditation
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