edition - university of utah...stretching the limits of what a body can do is central to what...
TRANSCRIPT
JULY 12, 2016
Open House
EDITION
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Welcome to the Imagine Perfect Care Resource Center
Julia Beynon Director, Imagine Perfect Care
I became involved with Imagine Perfect Care as a result of a project that I have been working on with Dr. Joseph Tonna. Our “imagine statement” is simple: How would outcomes improve if we allowed patients to sleep in the Intensive Care Unit? As we began exploring sleep and how to improve it, we were introduced to many different people and groups in our system. Although everyone we spoke with seemed excited about our project, we struggled to find a way to move it forward. Imagine Perfect Care changes that. With the support of Dr. Vivian Lee, UUMG and Hospitals and Clinics, Imagine Perfect Care is designed to help move ideas forward in our system. The Imagine Perfect Care Resource Center will be a place to explore ideas and to seek input and feedback on projects; it will also provide seed funding to help projects get started. I look forward to seeing what we are able to accomplish when everyone imagines perfect care.
Teri Olsen
Director, Executive Projects
I remember first hearing the phrase imagine perfect care. I was sitting across a desk from Dr. Vivian Lee, learning about her vision for health care. University of Utah had recently launched the Imagine U campaign, while our own orthopedic providers were successfully measuring their patients’ perception of perfect care. Dr. Lee discussed bringing these two concepts together to change the health care industry. “What if each of us imagined perfect care?” she said. I left that meeting energized by Dr. Lee’s commitment to removing the barriers to change that exist in large and diverse organizations. Since then, I have been honored to work with teams that are brainstorming priorities for improving care, starting pilot projects, and creating strategies to spread the vision of Imagine Perfect Care. With the opening of the Imagine Perfect Care Resource Center, we can now better engage each of you in this transformational journey. If anyone can fix, improve, innovate, inspire, execute and transform, it is absolutely the University of Utah Health Care family.
Brayden Haws Project Facilitator, Imagine Perfect Care
During my undergraduate studies, I would hear and read so much about innovations in healthcare and providing better care to patients. It was exciting, but also frustrating because it often seemed to be just talk or theory. So I was overjoyed at the announcement of the Imagine Perfect Care Resource Center—proud that the place where I worked and attended school was moving from theory and ideas to actions and results. I was even more excited to join the Resource Center to help support innovations being brought to life. I believe that each of us has a role to play in providing quality patient care, and that inside all of us are ideas and potential that can improve the quality of care patients receive. I am excited to be a part of this team, and invite each of you to explore the center and Imagine Perfect Care.
pulse.utah.edu/site/imagine-perfect-care [email protected] 801.213-6900
Imagine Perfect Care is a way of framing our daily work to
inspire and empower each of us to improve our health system and deliver perfect care.
The Imagine Center is the place where ideas and people connect
to perfect care across our health system.
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All of us have connectors at work—those “go-to” colleagues you can contact with almost any question. Connectors seem to
know everyone and a little bit about everything.
In large, complex organizations, connectors see opportunities for collaboration and creative resource sharing. Through their networks and collegial relationships, they often have the ability to elevate isolated project work to highly successful organizational initiatives.
Recognizing this critical function, the Imagine Perfect Care Resource Center is developing a connector network to accelerate information sharing, foster collaboration and alignment, and engage the entire Health Sciences workforce in reimagining our healthcare delivery system.
One of the newest connectors for the Imagine Center is Lisa Carcelli, academic affairs program
manager. Carcelli will help connect the work being done in the Office for Community
Faculty, the Office of the Ombudsman, faculty development research and
education initiatives, and academic affairs processes.
“I am thrilled to be a connector for Imagine Perfect Care,” Lisa said. “As a manager in the Office for Health Sciences Faculty and Academic Affairs, I can help connect Imagine Perfect Care with groups that achieve University of Utah Health Care’s mission to improve patient care by actively supporting faculty member academic success.”
The connector network is developing quickly. As it grows, the Imagine Center will publish connector contacts, identified by entity, geographic location, mission, and more.
Connecting ideas and people in an era of increasing specialization is no easy task—but such is the purpose of the Imagine Center. Better patient outcomes become possible when clinicians, researchers, academic faculty, staff and students understand how their own work fits into the larger project of providing perfect care.
Health Care Innovations Stem from Making Connections
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Compassionate care without compromise, ground-breaking transparency, and patient-centered practices. Clinicians at University of Utah Health
Care are nationally known for their innovation, quality outcomes, and collaboration. They are also key to leading and engaging interdisciplinary clinical, research, and academic teams in imagining—and delivering—perfect care.
An inaugural Physician Champion for the Imagine Perfect Care Resource Center will be selected this fall, via a peer nomination process, to develop and advance institutional initiatives and culture around patient-centered, high-value care.
The selected candidate will play a key role on the Imagine Perfect Care leadership team, working alongside the director to guide the future of perfect care.
“This leadership opportunity will drive the way we think about perfect care, not only as an advocate for other physicians, but also at the institutional level as a key participant in the Imagine Center’s success,” said Dr. Ed Clark, president of UUMG and executive sponsor of Imagine Perfect Care.
The Imagine Center facilitates innovation by providing funding, connecting people and ideas, and developing the growth of front-line initiatives. It takes informal ideas and connects them to other initiatives throughout the organization to create a grassroots movement with the patient as its focus.
A call for nominations for the Imagine Perfect Care Physician Champion will be announced this fall. Please contact Julia Beynon, [email protected], for more information about the nomination process.
PHYSICIAN CHAMPION
Imagine Perfect Care
Resource Center
The Physician Champion is a two-year compensated appointment, with a time commitment of up to 0.5 FTE.
The Physician Champion will:
• provide strategic and programmatic leadership over the resource center
• communicate IPC vision, outcomes, and opportunities to clinicians, researchers, academic leaders, and others across the organization
• educate and train colleagues, residents, fellows, students, and other leaders
• integrate IPC vision into research, academic, and clinical work
• determine opportunities for enhancing organizational change and successfully implementing target behaviors
Imagine Perfect Care Seeks a Physician Champion
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So many ideas never make it out of the shower—not because they are bad or frivolous, but because the structures that
create strong institutional cultures can sometimes unintentionally let good ideas slip down the drain.
The Imagine Perfect Care Resource Center offers a way through some of those institutional barriers by providing small funding sources to those good ideas that so often occur outside of the normal budgeting process.
The following criteria will guide the selection of funding requests:
• Requests from front-line staff (individuals or small teams) are strongly encouraged.
• Smaller projects may be more likely to be funded than larger projects, but all submissions are welcome.
• Funds are for one-time use only. Should your project require ongoing funding,
please consider how you will find additional funds.
• Trainings and conferences are eligible for funding if the information will be brought back and shared with others in the organization.
• Project participants who receive funding will be required to create a Value Summary on Pulse and submit a post-project report.
Front-line staff shouldn’t be intimidated by the funding process. It has been streamlined to make sure the idea, and not the paperwork, remains at the forefront. Staff at the Imagine Center will not only walk newcomers through the funding process, but will even help develop project ideas.
Funding requests will be accepted beginning in mid-September, and funds for approved projects will be distributed shortly thereafter. Timeline information and the application form can be found on pulse.utah.edu/site/imagine-perfect-care.
Giving Great Ideas a Little Boost
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Interested members of the Health Sciences community are encouraged to stop by the Imagine Center—walk-ins are welcome!—to meet with a staff member. Face-to-face time can also be scheduled via email at [email protected].
Roughly 350 years after the Dutch philosopher Spinoza asked what a body can do, Rehabilitation Services staff
at University of Utah Hospitals and Clinics is discovering the body is more capable than imagined.
Stretching the limits of what a body can do is central to what Rehabilitation Services calls a culture of mobility—an interdepartmental
collaboration since 2014 that includes physical therapists, occupational therapists, nurses, ICU physicians, researchers and educators working on three related projects: measuring mobility outcomes, early mobility in the ICU, and mobility on the medicine floors. Rehabilitation Services Director Christopher Noren calls it “the first major project beginning the collaboration between the research and clinical sides of physical therapy.”
Early mobility in the ICU
The rapid recovery of an ECMO patient demonstrates how the
Imagining a Culture of Mobility
Does your team have an Imagine Perfect Care success story? Let us know—we’d love to share it in our next journal.
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center’s culture is making early mobility in the ICU, one of those three projects, possible. Extracorporeal membrane oxygenation, or ECMO, refers to a medical procedure that uses a machine to add oxygen to red blood cells when the lungs aren’t capable of doing it themselves. The invasive, though lifesaving procedure, can keep patients in bed for weeks.
Dr. Joseph Tonna, assistant professor and associate director of ECMO services, was the attending physician on the project. He had witnessed in his own rounds how critically-ill patients who were moving earlier, by sitting up in bed or standing and walking, slept better at night, were less delirious when awake and ultimately recovered faster.
“Critical illness is hard on bodies not only because of the trauma or injury, but because of the resultant immobility and alteration of normal body homeostatic functions,” Tonna said. “Our best treatment of rest is probably the worst thing we could do for patients.”
And so, on an unusually warm winter day late last year, Bryan Lohse, one of the physical therapists leading the project, helped one of his patients out of bed and outdoors to shoot hoops. “I wanted to challenge my patient in a new way, to show him there’s still a real world outside,” Lohse said. Staff were surprised by what happened next.
Standing near the hoop, two one-inch diameter tubes protruding from his neck, the patient grabbed the ball and took aim. He missed, but only once. The patient went on to land seven
consecutive baskets, each at a greater distance from the basketball stand.
“The expectation of mobility has gone through the roof,” Lohse said,
referring to how the patient’s recovery has changed the team’s approach to early mobility. “Instead of saying, ‘No, we can’t do that,’ we say, ‘Let’s figure out how to make it happen.’”
Measuring patient mobility outcomes
The rapid recovery of an ECMO patient was made possible by implementing a plan to start measuring patient mobility—a joint effort in July 2014 between Rehabilitation Services and the College of Health’s Department of Physical
Therapy.
Rehabilitation services was a natural fit for a cultural change that emphasized patient outcomes because rehab is already so outcome focused. Despite that focus, acute care physical therapists had never
before measured outcomes, Noren said. “This was a huge cultural shift.”
Physical therapists now use a simple questionnaire, called AM-PAC “6-clicks,” to assess patient mobility when they first visit with a physical therapist, and then every visit thereafter to determine the progress or decline of a patient.
AM-PAC, which stands for Activity Measure for Post-Acute Care, was developed as a functional outcomes measurement system by researchers at Boston University. The AM-PAC measures function in three domains: basic mobility, daily activities and applied cognition. Patients can respond to AM-PAC test items or the instrument can be completed by clinicians or family members. The AM-PAC is available as a computer-adapted test or in a variety of short forms. Acute care physical therapists use one of these short forms, the AM-PAC “6-clicks” basic
“We do not even know what a body
is capable of.”-Baruch Spinoza
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mobility form. It relies on six validated questions to replicate the longer, more involved form.
The AM-PAC scores are now totally integrated into EPIC, allowing a caregiver to track exactly how a patient is faring. When visiting with a patient, staff can see the AM-PAC scores as a line graph to visualize improvement or decline. This data is not only used across the hospital system to improve the value of care, but has also resulted in national presentations to advance the field of knowledge. Josh Johnson, a graduate student and physical therapist, is using the data to measure the effectiveness of various treatment plans, to
maximize clinical resources and to investigate the impact of mobility outcomes on hospital readmissions.
“The ability for health care providers to work with patients to optimize mobility by measuring it objectively had been elusive, especially in the acute care setting,” Johnson said. “That’s the outcome no one has worked through in the past,” Noren said. The integration of the AM-PAC measure provides a compelling data point for understanding how a patient is doing and
whether or not she should be released and with what services or home follow-up.
“Our goal was to exhaust our patients physically each day, while they were critically ill!” Tonna said. It worked. Patients saw fewer sleep problems
and faster recovery times, all while decreasing the length of stay in the ICU and saving money, Tonna said.
Mobility on the medicine floor
The AM-PAC measure, first implemented in the summer of 2014, was the first of three projects aimed at improving patient mobility. It was then used as an outcome when the ICU mobility project launched in September 2015 to facilitate more aggressive mobility interventions and quicker recovery—like that experienced by the ECMO patient mentioned earlier in this article. In January of this year, physical therapists Christy Ryan and Paul Vandersteen, along with Shegi Thomas, West Pavilion 5 nurse manager, and Andrew Davies, Acute Internal Medicine-A nurse
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manager, have led the charge to increase mobility on the medicine floors. Using the “6-clicks” basic mobility measure they are transitioning to a team model of care. Their motto, “bed rest is bad,” undergirds a commitment to improving mobility in appropriate patients prior to discharge.
Hospital inpatients spend, on average, 43 minutes per day out of bed, according to a 2009 article in the Journal of the American Geriatrics Society. Internal data is a bit better, but not by much. Negative effects of bedrest include pneumonia, blood clots, pulmonary embolism, bedsores and delirium, not to mention impaired mobility function that can lead to an increased risk of falling and long-term disability. These symptoms are exacerbated for the very ill, but even otherwise healthy patients can begin to show signs of these symptoms if they stay in bed too long.
One of this latest project’s goals has been to create an algorithm for nursing staff to use as a guide to promote safe mobilization. Patients on the medicine floors are evaluated by a physical therapist who creates a plan for the patient. That plan, for example, might include getting
out of bed four times, or taking a lap around the unit floor. These patients don’t need physical therapists per se—the key is to prevent any deterioration to their mobility.
After a plan has been put together, physical
therapists work with nurses to ensure the plan is executed. The result is a streamlined process where individuals from different teams are integrated into the goal of increasing mobility. Instead of physical therapists performing their respective role, while nurses perform theirs, they work together as a team, breaking down the barriers between different specialty areas.
A new standard for physical therapyThough still in its infancy, the culture of mobility is already eliciting positive feedback across the
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health system for the way it demonstrates the power of collaboration, lowers costs and even improves job satisfaction.
Although patients are the main benefactors in this cultural shift, its effect on staff satisfaction has been no less remarkable. “The shift not only improves patient care, but improves therapists’, nurses’, physicians’ perceptions of their jobs,” Robin Marcus, chief wellness officer and one of the project’s sponsors, said. “It’s not only triple-aim worthy [improved patient experience, improved population health, reduced costs], but quadruple-aim worthy when you consider improving the work-life of health care providers as the fourth.”
The culture of mobility has drawn from experts across the hospital and health sciences, including
physical therapists, occupational therapists, nurses, cardiac rehab, physicians, and senior leaders. That level of integration, particularly notable for the work of imagining perfect care, enages all three of the health system’s missions. Clinicians draw on the very best from education and research, including the help of students from physical therapy, while allowing “researchers to know what frontline clinicians go through,” Noren said.
This combination of theory and practice demonstrates the aspiration to imagine perfect care. It acknowledges the reality that change is both possible and practical across the health system and that working together in new and meaningful ways can change lives.
While there were many contributors to this project, main contacts are:
Christopher Noren, OT, Director of Inpatient Therapy Services
Joseph Tonna, MD, FAAEM, Assistant Professor and Associate Director of ECMO Services
Robin Marcus, PT, PhD, Associate Professor and Chief Wellness Officer
A higher AM-PAC score indicates greater mobility. For more information about the data visualized in this chart, send an email to [email protected].
AM-P
AC M
obili
ty S
core
• Culture of mobility
• Price transparency for patients
• Integrated business operations
• Patient bill improvements
• U-Bar
• Healthi4U videos
• Patient-education document repository
• #asksolve
• Online self-scheduling
• Empathy training
• Improving sleep in the ICU
• Virtual visits
• Patient room of the future
• Virtual design goggles
• Patient advisory board
• PlusOne baby monitor
• Central line infection improvements
• Online wayfinding
• Epic bedside
• Value summary improvement portal
Inaugural Imagine Stations
Do you have an Imagine Perfect Care idea or success you would like to showcase in the Resource Center? New Imagine Stations will be added 2-3 times a year, so please contact us with your idea or suggestion.
Contact Us At:
Imagine Perfect Care Resource Center
Monday-Friday, 10:00 am – 3:00 pm, or by appointment
2C467, School of Medicine
801-213-6900
http://pulse.utah.edu/site/imagine-perfect-care