Verna Yiu, MD, FRCPC VP Quality and Chief Medical Officer

Alberta Health Services Professor of Pediatrics, Faculty of Med/Dent

University of Alberta 7th Canadian Quality Congress Sept 28th, 2015

Humanizing the Patient Experience through an Improvement Lens

• Alberta Health Services: Who we are and what we do • AHS Improvement Way: creation of a large scale sustainable

improvement methodology • Going beyond traditional process improvement methodologies to

including the patient and staff experiences: EIN collaboration • The next phase………..

Humanizing the Patient Experience through an Improvement Lens

The State of Healthcare – Alberta Health Services 2008

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Mission: To provide a patient-focused quality health system that is accessible and sustainable for all Albertans • 120,000+ Staff and Volunteers

• 7500+ physicians

• 110 Acute Care Hospitals/Facilities (~8800 beds)

• 172 Long Term Care Facilities (>14,000 beds)

Alberta Health Services

4 million Albertans served over 661,848 square kilometers

The Opportunity • Multiple Improvement Methodologies (legacy systems) • Fragmented infrastructure for Quality improvement • Frontline health care providers confused with

improvement jargon • No connection between “training”, “improvement

projects” and “improvement capacity building” • Need for front line driven improvement culture, rather

than “top-down” approach

• In 2010, AHS designed the AHS Improvement Way (AIW)

• Customized • Easy to understand, common improvement

language • Principles of Lean, Six Sigma, Change

management and other established improvement philosophies

• Integrated system of training, certification and facilitation services to improving patient care

AHS Improvement Way (AIW) is Born!

• Continuum of Services o “I want to learn about how AHS does Improvement; where do I go?” AIW Fundamentals 1-day Workshop o “I attended the AIW Fundamentals and thought it was interesting; how do I apply this to

my workplace?” AIR Core 5-day Workshop OR AIW Small Scale Project Stream o “We improved processes on my unit; how do I tackle issues that span multiple

departments?” AIW Large Scale Project Stream o “We reduced infections in our hospital; how do I spread that knowledge across AHS?” AIW Collaboratives

• Knowledge Transfer o “I want to learn how to lead improvement initiatives; how do I qualify to do that?” AIW Certification Programs (Yellow Belt and Green Belt)

The AIW Approach

The AIW Components

The AIW Journey to date Milestones • 2010-11: AIW Fundamentals Workshop Developed by team

responsible for training and certification o Team of AIW Facilitators created

• 2011-12: First batch of successful AIW initiatives (Cancer Care, Emergency Departments) o Merger of Training and Facilitation teams into one cohesive unit

• 2013: Development of AIW Yellow Belt and Green Belt Modules • 2014-15: Development of the AIW Collaborative (Falls

Collaborative)

The AIW Journey to date Results • 200,000+ patients positively impacted every year • AIW Initiatives in every health sector (Acute Care, Continuing Care,

Public Health, Addictions and Mental Health) – over 200 small and large scale improvement initiatives

• 11,000+ staff trained • 1500+ staff trained in Advanced AIW techniques • 1300+ staff certified to the AIW Yellow Belt level • 40+ AHS Staff certified to the AIW Green Belt level

The AIW Journey to date Specific Examples of Results • Within 6 months of embarking on AIW implementation, Cross

Cancer Institute saw its Radiation Oncology wait times from referral to consult drop by 40%

• The Sturgeon Community Hospital saw its Emergency Department increase capacity by over 20% without adding any new staff or equipment.

• The Endoscopy department in the University of Alberta Hospital increased capacity to see more complex cases while at the same time increasing overall capacity to perform the procedures…..

AIW Impact • In 2013, AHS conducted a comprehensive evaluation of

AIW o In Phase 1 (Qualitative) of the Evaluation (4000+ staff

surveyed) o 85% of respondents agreed that attending AIW workshops has

increased their commitment to improvement work o 82% of respondents have identified improvement opportunities o 64% of respondents have become involved with improvement

work within a team, with 50% of those leading the improvement

AIW Impact • CancerControlAlberta has made AIW one of their top

three strategic priorities (after seeing major improvements in patient outcomes)

• Addictions and Mental Health and Public Health are increasing their participation rates in AIW training, certification and AIW initiatives

• Provincial Services like Labs, Pharmacy, Capital Management and IT have embraced AIW as their improvement method of choice

The AIW Journey to date

Scanning Across the Industry

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Quality & Safety Improvement

Performance Improvement

Service Excellence

Methodologies Measures Outcomes

Methodologies Measures Outcomes

Methodologies Measures Outcomes

Key focus: Implement evidence-based guidelines

Key focus: Strip out waste

Key focus: Service recovery & nonclinical support

Inefficiency

Initiative fatigue

Fractured attention

Redundant infrastructure

Lack of enduring change

Burnout

The Traditional, Siloed Improvement Approach

Parallel initiatives duplicate efforts and limit efficiency

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Human Experience =

Making a Difference

Empathy +

Communication, Relationship, Emotional

Support

Experience Mapping

= Efficiency

Quality, Safety, Efficiency

Process Improvement

+

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The Key to the Ideal Experience

Page 17

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Alignment Intelligence Discovery Design Realization Sustainability

Set patient experience goals, develop strategy and identify resources to catalyze patient experience transformation.

Collect experience data; assess current experience, perform initial benchmarking and set measureable project goals.

Process for observing the moments of truth along the continuum of care and capturing patient, family, staff and physician voice.

A visioning exercise that brings together multi-disciplinary stakeholders to prioritize experience gaps and identify solutions.

Implementation of evidence based interventions or “Always Events” that transform the patient, family, staff and provider experience.

The spread, measurement and monitoring of interventions that optimize the experience.

Experience Design and Mapping blends LEAN/Six Sigma and ethnographic research principles to assess current experience and design new standards of care that optimize

operational efficiency and differentiate the healthcare experience.

What is Experience Design + Mapping?

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Identifying Moments of Truth along the Journey

What matters most?

With fresh eyes, step into the role of a family member with a loved one to observe the experience and identify the “Moments of Truth” across four dimensions.

Communication-Did the patients, families, staff, and physicians receive the right information at the right time?

Clinical-How did the patients, families, staff, and physicians perceive the quality of care?

Physical - Did the physical environment support the patients, families, staff, and physicians needs?

Emotional - Were the patients, families, staff, and physicians emotional needs met?

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Experience Observation

Relationship Building Quality & Safety Perceptions

Emotional Wellbeing Information

Human Experience

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Standard Design + Mapping Project Timeline

Alignment and Intelligence Design Realization and Sustainability

[Team & Goals]

[Data Analysis]

[Pulse Survey, Interviews, Planning for Onsite]

[Observation, Focus Groups, Design Session]

[Future State Map]

[Project Plans]

[Coaching & Implementation Support]

1 2 3 4 5 6 7 8 9 10 11 12 Week

Note: Multiple projects can be run in parallel

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Case Study: Enterprise Design and Mapping

Unify medical staff and administration in redesigning the patient and employee experience across a two hospital campus.

APPROACH

• 100+ Patient, Family Caregiver Interviews

• Patient & Family Perspectives and Videos

• Facilitation of 14 Service Line Meetings (300+ Clinicians)

• Developed Experience Road-map

• What immediate process improvements will enrich the patient and caregiver experience at Mission Health?

• What changes in the physical plant will improve the patient and caregiver experience at Mission Health?

• What innovations will differentiate the serve line for patients and families and make Mission Health the place where employees and medical staff choose to spend the rest of their careers?

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Map Efficiency + Empathy

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Unify medical staff and administration in redesigning the patient and employee experience across a 2 hospital campus.

“Now that I have done a lean event with experience mapping integrated, I would not do it any other way.”

- Dawn Burgard, MBB, MBA

Developed patient experience strategic plan.

Mapped 14 clinical service areas for redesign.

Trained process improvement team in experience mapping and design methodology..

Deployed technologies to create sustainable improvements.

Emergency Department Future State Experience Map

Approach

Results

36%

81% 74% 75%

93% 88% 95% 92%

0%

20%

40%

60%

80%

100%

MD Comm Quality of Care Teamwork Safety

2011 2014

Case Example – Aligning Process Improvement with xMapping

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Humanizing Healthcare Efficiency Experiential Innovation Network

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Date Created: Wednesday, July 01, 2015

77 Total Responses

Complete Responses: 69

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Q7: How often in your improvement projects do you measure a baseline and subsequent measure for each of the following? Answered: 75 Skipped: 2

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Q8: How frequently do you have patients/families present during your: Answered: 74 Skipped: 3

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Q10: Which of the following best describes your organization's adoption of structured, experience-focused improvement methodologies? Answered: 74 Skipped: 3

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Q15: How well does your organization “people-ize” the data (i.e. put a human face on quality, safety, and efficiency measures)? Example: “Last year we reduced avoidable readmission by 21%, that is 8,000 readmissions, or 21,000 nights patients spent in their own beds.” Answered: 73 Skipped: 4

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Q17: Many process improvement efforts start well but aren’t sustained. Please select the top 3 reasons why improvement initiatives stall or fail. Answered: 71 Skipped: 6

• Demand comes from the front line staff and/or operational leaders: o Success stories on AHS intranet o Support from Senior leadership o Collaboration with local quality leaders

• Fiscal Sustainability o Internal Coaches o Focus on Improvement with existing or fewer resources

(space, overtime, supplies) o Return on Investment (ROI) as foundational concept

The AIW Approach – what did we learn?

• Aligning Process Improvement with XMapping: o UAH Hospital/Medicine + Patients/Families + Process

Improvement + Engagement/Patient Experience = Experiential Process Improvement of the Over Capacity Protocol (OCP)

o Detailed interviews/focus groups/surveys with affected groups to defining the experiences (first starting with baseline survey of pts/families/staff who have experiences of the OCP)

o Strategies on designing solutions and messages will be developed based on the input

o Project team working in collaboration with Physician+nursing unit manager

AIW+Xmapping– next phase

Changing Experience Expectations

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Meet me where I am. Empathize with me.

Make it easy for me. Nurture me.

It takes a village………

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Kimberly Petty

Elizabeth Boehm Anurag Pandey

Carolyn Hoffman

Glenda Coleman-Miller

Laurie Taylor

Rhonda Vandenberg