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James Dunbar: Evidence-based clinical pathways: the application of health economics, data systems and quality improvement

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STN IMPRO
STN IMPRO

This document discusses mapping clinical pathways for patients across healthcare services. It describes standardizing pathways for common conditions that involve evidence-based, multidisciplinary care plans. The pathways would identify the appropriate sequence and timing of clinical interventions and outcomes. Mapping the existing patient journey can reveal inefficiencies and waste. Redesigning pathways based on analyzing the process maps could improve quality of care, convenience for patients, and reduce costs by removing unnecessary steps.

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Deakin University CRICOS Provider Code: 00113B Improving the information base and optimising service solutions to support social welfare and healthcare reform. Evidence-based clinical pathways: the application of health economics, data systems and quality improvement. THL Helsinki, Finland 16th-19thApril, 2018 Professor James Dunbar Deakin University Victoria, Australia
Deakin University CRICOS Provider Code: 00113B The Project
Deakin University CRICOS Provider Code: 00113B Mapping Clinical Pathways for tracker conditions Shine a torch on the patient’s experience
Deakin University CRICOS Provider Code: 00113B Mapping Clinical Pathways for tracker conditions Shine a torch on the patient’s experience • Standardised pathway for each tracker condition, • evidence-based, multidisciplinary management plans,
Deakin University CRICOS Provider Code: 00113B Mapping Clinical Pathways for tracker conditions Shine a torch on the patient’s experience • Standardised pathway for tracker condition, • evidence-based, multidisciplinary management plans, • identified appropriate sequence of clinical interventions, timeframes, and outcomes.
Deakin University CRICOS Provider Code: 00113B Quality of Care • Minimum Data Set derived from Duodecim guidelines • Registries and other databases • (access and equity) Evaluation of health care interventions
Deakin University CRICOS Provider Code: 00113B Quality of Care • Minimum Data Set derived from Duodecim guidelines Convenience for patients • Only patients experience the whole pathway • Their priorities are different from doctors • Patients can contribute to redesign Evaluation of health care interventions
Deakin University CRICOS Provider Code: 00113B Quality of Care • Minimum Data Set derived from Duodecim guidelines Convenience for patients • Only patients experience the whole pathway • Their priorities are different from doctors • Patients can contribute to redesign Cost • Economic decision tree component costs must match clinical algorithm Evaluation of health care interventions
Deakin University CRICOS Provider Code: 00113B HbA1c among type 2 diabetes patients in North Karelia, 2013-2014
Deakin University CRICOS Provider Code: 00113B Type 2 diabetes report, North Karelia
Deakin University CRICOS Provider Code: 00113B Tracker conditions are: Clinical pathways for a few key conditions that cross primary, secondary and social care. • Map each process (step) on the patient’s journey. • Look for waste – slips, lapses and errors especially at hand overs, • Determine cost for each process. • Basis for redesign of an improved pathway
Deakin University CRICOS Provider Code: 00113B The pilgrim and the patient’s experience
Deakin University CRICOS Provider Code: 00113B The outset of the journey can look well organised and paved for an easy path
Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable The journey can be long and daunting but starts with a single step
Deakin University CRICOS Provider Code: 00113B Others have been there first and may not be interested in your journey
Deakin University CRICOS Provider Code: 00113B Different paths can look equally plausible
Deakin University CRICOS Provider Code: 00113B It helps to have guidance
Deakin University CRICOS Provider Code: 00113B We need to remember our fallibility.
Deakin University CRICOS Provider Code: 00113B We need to have belief in our journey
Deakin University CRICOS Provider Code: 00113B The journey can get rocky and slippery
Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable
Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable Beware of false prophets
Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable Advice can sometimes be confusing
Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable Sometimes when you reach an apparent impasse you have to wade through
Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable Others have right of way and should be given due courtesy
Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable The journey can be tough and you have to be prepared to have a few blisters and bruises
Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable There is a time for work and a time for rest
Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluableAlong the journey rewards are all the sweeter for having earned them
Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluableI would really like to emphasise that last point!
Understanding the Patient Journey Process Mapping
CONTEXT ‘80% of the problem is in the system not the people’ W. Edwards Deming
Process mapping…. • Views the system from the patient perspective following their journey across organisational boundaries • Helps staff understand how complex and confusing processes appear to the patient • Diagnostic and used as a basis for redesign, actively involving frontline staff in the process. (Shows how things actually are)
Process has inputs and outputs Input OutputProcess Definition - a process is a series of connected steps or actions to achieve an outcome
A Diagnostic process B Looking at Patient Processes C D E • 30 - 70% of work doesn’t add value for patient • up to 50% of process steps involve a “hand- off”, leading to error, duplication or delay • no one is accountable for the patient’s “end to end” experience • job roles tend to be narrow and fragmented Organisational /departmental boundaries Emergency care process Treatment process
High level process map 6 – 12 steps – Generate in set time e.g. 20 minutes – Use to identify scope and identify problem Low Level or Detailed process map dozens of steps – To establish loops and complexity – Good to establish roles and relationships within processes – Use again in later phase to show effect of redesign
Appts Hospital GP Another Hospital Appts. Appts. Hospital Register on System Consultant Secretary Consultant Screening Referral 1 – 3 days Consultant Secretary Appt. made Letter sent Patient Attends OPD Appts hospital 1 – 3 days 1 Day -12 weeks GP Referral – Attend OPD Appointment High Level Map
Analysing the process map • How many steps in your process? • How many duplications? • How many handovers? • What is the approximate time of or between each step? • Where are possible delays? • Where are major bottlenecks? • How many steps do not add value for patients? • Where are the problems for patients and staff?
Walk the Patient Journey for yourself
Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluableCathedral of Santiago de Compostela
Outcome from redesigned Processes: • Comparison with first process map • Waste removed • Cost savings calculated • Health and social care better integrated • Minimum data set for quality set up.
Deakin University CRICOS Provider Code: 00113B Thank you and any questions? Photos of the Camino de Santiago by courtesy of Professor James D Best Dean, LKC School of Medicine, NTU, Singapore Professor James Dunbar Deakin University Victoria, Australia

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James Dunbar: Evidence-based clinical pathways: the application of health economics, data systems and quality improvement

  • 1. Deakin University CRICOS Provider Code: 00113B Improving the information base and optimising service solutions to support social welfare and healthcare reform. Evidence-based clinical pathways: the application of health economics, data systems and quality improvement. THL Helsinki, Finland 16th-19thApril, 2018 Professor James Dunbar Deakin University Victoria, Australia
  • 2. Deakin University CRICOS Provider Code: 00113B The Project
  • 3. Deakin University CRICOS Provider Code: 00113B Mapping Clinical Pathways for tracker conditions Shine a torch on the patient’s experience
  • 4. Deakin University CRICOS Provider Code: 00113B Mapping Clinical Pathways for tracker conditions Shine a torch on the patient’s experience • Standardised pathway for each tracker condition, • evidence-based, multidisciplinary management plans,
  • 5. Deakin University CRICOS Provider Code: 00113B Mapping Clinical Pathways for tracker conditions Shine a torch on the patient’s experience • Standardised pathway for tracker condition, • evidence-based, multidisciplinary management plans, • identified appropriate sequence of clinical interventions, timeframes, and outcomes.
  • 6. Deakin University CRICOS Provider Code: 00113B Quality of Care • Minimum Data Set derived from Duodecim guidelines • Registries and other databases • (access and equity) Evaluation of health care interventions
  • 7. Deakin University CRICOS Provider Code: 00113B Quality of Care • Minimum Data Set derived from Duodecim guidelines Convenience for patients • Only patients experience the whole pathway • Their priorities are different from doctors • Patients can contribute to redesign Evaluation of health care interventions
  • 8. Deakin University CRICOS Provider Code: 00113B Quality of Care • Minimum Data Set derived from Duodecim guidelines Convenience for patients • Only patients experience the whole pathway • Their priorities are different from doctors • Patients can contribute to redesign Cost • Economic decision tree component costs must match clinical algorithm Evaluation of health care interventions
  • 9. Deakin University CRICOS Provider Code: 00113B HbA1c among type 2 diabetes patients in North Karelia, 2013-2014
  • 10. Deakin University CRICOS Provider Code: 00113B Type 2 diabetes report, North Karelia
  • 11. Deakin University CRICOS Provider Code: 00113B Tracker conditions are: Clinical pathways for a few key conditions that cross primary, secondary and social care. • Map each process (step) on the patient’s journey. • Look for waste – slips, lapses and errors especially at hand overs, • Determine cost for each process. • Basis for redesign of an improved pathway
  • 12. Deakin University CRICOS Provider Code: 00113B The pilgrim and the patient’s experience
  • 13. Deakin University CRICOS Provider Code: 00113B The outset of the journey can look well organised and paved for an easy path
  • 14. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable The journey can be long and daunting but starts with a single step
  • 15. Deakin University CRICOS Provider Code: 00113B Others have been there first and may not be interested in your journey
  • 16. Deakin University CRICOS Provider Code: 00113B Different paths can look equally plausible
  • 17. Deakin University CRICOS Provider Code: 00113B It helps to have guidance
  • 18. Deakin University CRICOS Provider Code: 00113B We need to remember our fallibility.
  • 19. Deakin University CRICOS Provider Code: 00113B We need to have belief in our journey
  • 20. Deakin University CRICOS Provider Code: 00113B The journey can get rocky and slippery
  • 21. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable
  • 22. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable Beware of false prophets
  • 23. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable Advice can sometimes be confusing
  • 24. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable Sometimes when you reach an apparent impasse you have to wade through
  • 25. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable Others have right of way and should be given due courtesy
  • 26. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable The journey can be tough and you have to be prepared to have a few blisters and bruises
  • 27. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable There is a time for work and a time for rest
  • 28. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluableAlong the journey rewards are all the sweeter for having earned them
  • 29. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluableI would really like to emphasise that last point!
  • 30. Understanding the Patient Journey Process Mapping
  • 31. CONTEXT ‘80% of the problem is in the system not the people’ W. Edwards Deming
  • 32. Process mapping…. • Views the system from the patient perspective following their journey across organisational boundaries • Helps staff understand how complex and confusing processes appear to the patient • Diagnostic and used as a basis for redesign, actively involving frontline staff in the process. (Shows how things actually are)
  • 33. Process has inputs and outputs Input OutputProcess Definition - a process is a series of connected steps or actions to achieve an outcome
  • 34. A Diagnostic process B Looking at Patient Processes C D E • 30 - 70% of work doesn’t add value for patient • up to 50% of process steps involve a “hand- off”, leading to error, duplication or delay • no one is accountable for the patient’s “end to end” experience • job roles tend to be narrow and fragmented Organisational /departmental boundaries Emergency care process Treatment process
  • 35. High level process map 6 – 12 steps – Generate in set time e.g. 20 minutes – Use to identify scope and identify problem Low Level or Detailed process map dozens of steps – To establish loops and complexity – Good to establish roles and relationships within processes – Use again in later phase to show effect of redesign
  • 36. Appts Hospital GP Another Hospital Appts. Appts. Hospital Register on System Consultant Secretary Consultant Screening Referral 1 – 3 days Consultant Secretary Appt. made Letter sent Patient Attends OPD Appts hospital 1 – 3 days 1 Day -12 weeks GP Referral – Attend OPD Appointment High Level Map
  • 37. Analysing the process map • How many steps in your process? • How many duplications? • How many handovers? • What is the approximate time of or between each step? • Where are possible delays? • Where are major bottlenecks? • How many steps do not add value for patients? • Where are the problems for patients and staff?
  • 38. Walk the Patient Journey for yourself
  • 39. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluableCathedral of Santiago de Compostela
  • 40. Outcome from redesigned Processes: • Comparison with first process map • Waste removed • Cost savings calculated • Health and social care better integrated • Minimum data set for quality set up.
  • 41. Deakin University CRICOS Provider Code: 00113B Thank you and any questions? Photos of the Camino de Santiago by courtesy of Professor James D Best Dean, LKC School of Medicine, NTU, Singapore Professor James Dunbar Deakin University Victoria, Australia