Patients and families help plan breakthrough change in care processes

patients and families help plan breakthrough-1

Shuffled between physicians, units and hospitals; discharged home without proper assessment; unable to access needed therapies and supports over the weekend and holidays; confused when orders issued by one provider were ignored and changed by the next. These were just some of the system failures that plagued Carol Schmidt’s father.

“What I ask you this week is to change what the outcome might have been for us.” (Carol Schmidt, daughter)

“What I ask you this week is to change what the outcome might have been for us,” Schmidt told more than 60 employees and physicians sitting in a north end warehouse, emotion bringing home the reality of how decade-old care processes are affecting patient care today.Schmidt addressed a team focused on revolutionizing processes to improve the patient and family experience to ensure care providers spend more time for direct care, assessment and teaching. The group is assembled as part of a 3P (production, preparation, process), which is a week-long, lean-based method for transformational change. This 3P is supporting one of the Region’s priorities for this year – Children’s Hospital of Saskatchewan Care Delivery Review and Design.

The team is looking at care processes and interdisciplinary roles from admission through to care planning, care co-ordination, team communication and discharge. Team members include staff and physicians from Clinical Teaching Unit 6200 and Acute Care Pediatrics at Royal University Hospital which include representation from occupational therapy, physiotherapy, social work, speech language pathology, respiratory therapy, pharmacy, diagnostic imaging, lab, client patient access services (CPAS), spiritual care, eHealth, supply chain and unions.

“On average, our patients spend 10.5 hours waiting for a bed after the orders have been written up to admit,” explained Karen Levesque, director of adult medicine and complex care as she walked participants through how patients and families currently experience care in 6200 at Royal University Hospital.

“From October to December 2013, the average time for a patient to get up to 6200 from emergency was 19.9 hours. These very lengthy delays are what have prompted the Region and the province to make patient flow one of our top priorities.”
(Karen Levesque, director of adult medicine and complex care, Saskatoon Health Region)

Unit 6200 plays an important role in patient flow from emergency and the new maternal and children’s hospital will be home to a new adult emergency for the Royal University Hospital site. Acute Care Pediatrics is one of the main services in the new hospital.

“Our chart reviews show that about 25 per cent of patients have a physiotherapy consult, 23 per cent have dietary consult, 20 per cent have speech language pathology and 35 per cent social work,” said Bette Boechler, Saskatoon Health Region’s director of children’s services. “These services are not available on weekends and are not replaced for short term illnesses.”

Parent Erin Burr told the audience that there are many wonderful aspects of our current system that work well and should be celebrated; that the system is not broken beyond repair.

“I’ve always felt comfortable at RUH, more so than in other hospitals,” she says. “This isn’t just because Saskatoon is home for us; it’s also because I have trust that our medical team cares about us as a family and about my son’s health, happiness and quality of life.”

But she explains that there are areas for improvement including clearer communication, especially when discharging a child home; creation of standard processes for communicating with and engaging patients and families in decision-making; ensuring someone is consistently and clearly responsible for safety, security and basic care needs; and elimination of patients receiving conflicting information.

“I’ve experienced two physicians arguing over the current course of treatment for my son,” says Burr. “Every time that happens I’m placed in the position of middle-man as each doctor stops by when the other isn’t present, disagreeing with his colleague’s orders and changing them. It’s an uncomfortable position for a parent to have to inform one doctor of another’s conflicting opinion. …We are parents, not arbitrators.”

Burr hopes the team’s work will result the removal of duplication and gaps in coordination of services. “Parents are often asked the same questions over and over again by numerous people, making a stressful time even more difficult.”

Burr reminded everyone that patients and families need to be involved in the process and she is proud to act as her son’s advocate and will never abandon that role. But she explained that it’s not a parent’s job to serve as the solitary hub of communication.

“When he’s sick, I want to be able to focus on being his mom, on singing him songs, rocking him to sleep, playing peek-a-boo with him.” (Erin Burr, parent)

“When he’s sick, I want to be able to focus on being his mom, on singing him songs, rocking him to sleep, playing peek-a-boo with him,” Burr says as she finished sharing her story with her fellow 3P team members. “Parents need to be just that when our children our sick – parents first. I’m excited to be part of this process for change and I am looking forward to work with all of you this week to bring a better model of care to sick kids and their families at RUH and the future children’s hospital.”

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