Shared CareShared CareDesign ofDesign of a Quality Pilot Projecta Quality Pilot Project

Carol Gray, Service Excellence Project ManagerCarol Gray, Service Excellence Project Manager

January 13, 2009January 13, 2009

Meeting LogisticsMeeting Logistics• Facilitator, Carol GrayFacilitator, Carol Gray• Leader, Sue GronostajskiLeader, Sue Gronostajski• Design Team, All of Us Design Team, All of Us • Clinical Directors, Staff ManagersClinical Directors, Staff Managers• Meet Once / WeekMeet Once / Week• Decisions Made – Discussion / ConsensusDecisions Made – Discussion / Consensus• Be Here…Cells & BBs – Vibrate, SilentBe Here…Cells & BBs – Vibrate, Silent

AgendaAgenda• Project / Meeting ObjectivesProject / Meeting Objectives• Information Sharing Information Sharing • Expected OutcomesExpected Outcomes

– Pilot Teams Pilot Teams – ProjectProject

• Questions / Next StepsQuestions / Next Steps

Project ObjectivesProject Objectives• Design a Pilot Team ProjectDesign a Pilot Team Project• Duration - 3 MonthsDuration - 3 Months• Produce 2 Pilot Teams in New Produce 2 Pilot Teams in New

HanoverHanover• Achieve Outcomes Achieve Outcomes

– Determined by Design Team Determined by Design Team • Begin Late Spring 2009Begin Late Spring 2009

Meeting ObjectivesMeeting Objectives• Share InformationShare Information

– Definition of Shared CareDefinition of Shared Care– Purpose and Value of Shared CarePurpose and Value of Shared Care

• Determine Expectations of Determine Expectations of – Pilot TeamsPilot Teams– Pilot Project Pilot Project

• Answer QuestionsAnswer Questions

HistoryHistory• Senior Leaders Questioned Current Care Senior Leaders Questioned Current Care

ModelModel• Heard Great Success of Shared CareHeard Great Success of Shared Care

Hospice Surveys•Hospice Care of Boulder & Broomfield

Counties – Boulder, CO•San Diego Hospice & Palliative Care - CA•Capital Hospice – Washington DC•Hospice of the Western Reserve –

Cleveland, OH•Hosparus – Louisville, KY

LCFH Types of CareLCFH Types of Care

• Adult Home CareAdult Home Care• InpatientInpatient• Routine Home CareRoutine Home Care• Nursing Home CareNursing Home Care• On CallOn Call• Continuous CareContinuous Care• Extended careExtended care

• Routine Home CareRoutine Home Care• Adult Home CareAdult Home Care• Nursing Home CareNursing Home Care

Shared Care

Purpose of Shared CarePurpose of Shared Care• Better Hospice CareBetter Hospice Care• Nursing ShortageNursing Shortage

What is Shared Care?What is Shared Care?• Interdisciplinary Care Not Interdisciplinary Care Not

Multidisciplinary CareMultidisciplinary Care• All Team Members Equally Aware Of All Team Members Equally Aware Of

Pt’s Physical, Emotional, & Spiritual Pt’s Physical, Emotional, & Spiritual StatusStatus

• Increase Focus On Patient NeedsIncrease Focus On Patient Needs– WHAT IS PT/FAMILY’S GOAL, WISH, WHAT IS PT/FAMILY’S GOAL, WISH,

IMPORTANT?IMPORTANT?

What is Shared Care?What is Shared Care?• Workload Shared Among All Team Workload Shared Among All Team

MembersMembers• Response To Pt & Family Needs Is Response To Pt & Family Needs Is

Shared By All Team MembersShared By All Team Members• Emphasis On Team Support Rather Emphasis On Team Support Rather

Than Individual Team Member’s Than Individual Team Member’s DisciplineDiscipline

What is Shared Care?What is Shared Care?• Team Schedules & Makes Admission Team Schedules & Makes Admission

Visit TogetherVisit Together• Admission Tasks SharedAdmission Tasks Shared• Discipline-Specific Assessments Discipline-Specific Assessments

CompleteComplete• Admission Visit Takes 1.5 HoursAdmission Visit Takes 1.5 Hours• Half the Time of Our Admission Visit Half the Time of Our Admission Visit

What is Shared Care?What is Shared Care?• Allows Each Discipline New Allows Each Discipline New

OpportunitiesOpportunities• Shift in ResponsibilitiesShift in Responsibilities

– 4 P’s4 P’s– Case CoordinationCase Coordination

• Enable Disciplines to Utilize Improved Enable Disciplines to Utilize Improved Skills Skills

• Builds Pt / Family RapportBuilds Pt / Family Rapport

What is Shared Care?What is Shared Care?• Each Hospice Care Each Hospice Care

TeamTeam– 1 Social Worker 1 Social Worker

(SW) (SW) – 1 Registered Nurse 1 Registered Nurse

(RN) (RN) – ½ Chaplain (CP)½ Chaplain (CP)– 1 Hospice Aide (HA)1 Hospice Aide (HA)– ~18 Patients~18 Patients

• Visit LengthVisit Length– 45-60 minutes45-60 minutes– 45-60 minutes45-60 minutes

– 45-60 minutes45-60 minutes– > 1 Hour> 1 Hour

4 P’s – Most Common 4 P’s – Most Common ConcernsConcerns

• PainPain• PoopPoop• PillsPills• ProductsProducts

4 P’s4 P’s• AT EVERY VISIT, EACH TEAM AT EVERY VISIT, EACH TEAM

MEMBER WILL ASSESS THE 4 P’s BY MEMBER WILL ASSESS THE 4 P’s BY ASKING THESE 4 QUESTIONS:ASKING THESE 4 QUESTIONS:

1.1. HOW IS YOUR PAIN?HOW IS YOUR PAIN?2.2. DO YOU NEED ANY MED REFILLS?DO YOU NEED ANY MED REFILLS?3.3. HOW ARE YOUR BOWELS?HOW ARE YOUR BOWELS?4.4. DO YOU NEED ANY SUPPLIES?DO YOU NEED ANY SUPPLIES?

Day to DayDay to Day• Team Roles Rotate Team Roles Rotate

– Point Person of the Day (PPD)Point Person of the Day (PPD)– FacilitatorFacilitator– TimekeeperTimekeeper

• Care Coordination Meetings (CCM) & Care Coordination Meetings (CCM) & Comprehensive AssessmentsComprehensive Assessments

PPDPPD• Designated For Each Day At The CCM Designated For Each Day At The CCM • Responds To Incoming Phone Calls To Responds To Incoming Phone Calls To

Team That Day To Coordinate Team That Day To Coordinate Communication For The Patient Communication For The Patient Among All DisciplinesAmong All Disciplines– Transfers/Changes in POCTransfers/Changes in POC– Pain/Symptom AssessmentPain/Symptom Assessment– DME & SuppliesDME & Supplies

Weekly MeetingsWeekly Meetings• IDT: Doctor, Director, Bereavement IDT: Doctor, Director, Bereavement

Present; Status & POC Updated. Half Present; Status & POC Updated. Half of Patients Discussed.of Patients Discussed.

• Care Coordination: Planning This Care Coordination: Planning This Week- New Admissions, Team Week- New Admissions, Team Assessments of Patients’ Needs Assessments of Patients’ Needs – ““Who needs to be seen today and who Who needs to be seen today and who

needs to go?” needs to go?”

Care Coordination MeetingCare Coordination Meeting• 1 Team Only1 Team Only• Required - RN, SW, CP, HARequired - RN, SW, CP, HA• Rotating Roles Of Facilitator & Time Rotating Roles Of Facilitator & Time

Keeper Named Each Meeting Keeper Named Each Meeting • The PPD For That Day Should Not Be The PPD For That Day Should Not Be

The Facilitator Or TimekeeperThe Facilitator Or Timekeeper

Initial VisitInitial Visit• Admissions RN Will Complete:Admissions RN Will Complete:

– Admissions PaperworkAdmissions Paperwork– Nursing AssessmentNursing Assessment– (Not Psychosocial Or Spiritual (Not Psychosocial Or Spiritual

Assessments)Assessments)

• Admissions RN Then Contacts PPD Admissions RN Then Contacts PPD And Reports Key Issues For PatientAnd Reports Key Issues For Patient

Initial VisitInitial Visit• PPD Then Contacts Pt/Family To Set PPD Then Contacts Pt/Family To Set

Up A Time For The Team To VisitUp A Time For The Team To Visit• This Is The “Family Visit / This Is The “Family Visit /

Comprehensive Assessment ” Comprehensive Assessment ” – Done Jointly By SW, RN, & CPDone Jointly By SW, RN, & CP

• All Three Visit Together If At All All Three Visit Together If At All Possible; At Least Two RequiredPossible; At Least Two Required

Pilot TeamsPilot Teams• Member TraitsMember Traits

– Clinically SoundClinically Sound– Open MindedOpen Minded– Not NegativeNot Negative– Not Afraid of ErrorsNot Afraid of Errors– Not Afraid of Giving/Receiving FeedbackNot Afraid of Giving/Receiving Feedback

Benefits of Shared CareBenefits of Shared Care• ImprovedImproved

– Coordination/CommunicationCoordination/Communication– Clinical CareClinical Care– System EfficiencySystem Efficiency– Customer SatisfactionCustomer Satisfaction– Employee SatisfactionEmployee Satisfaction

• Increased Utilization of SWs & CPs in Increased Utilization of SWs & CPs in Appropriate SituationsAppropriate Situations

Anticipated OutcomesAnticipated Outcomes• Improve Quality of Care DeliveredImprove Quality of Care Delivered• Address Clinical Issues of StaffAddress Clinical Issues of Staff

– # Interruptions During the Day# Interruptions During the Day– Resolving Patient/Family CrisesResolving Patient/Family Crises– Waiting to Hear From / Inability to Reach Waiting to Hear From / Inability to Reach

a Team Membera Team Member• Improve Employee Satisfaction Improve Employee Satisfaction

Pilot Team ExpectationsPilot Team Expectations

Project ExpectationsProject Expectations

Questions & Questions & Next StepsNext Steps