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

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Integration of health and social care – predicting the quality, costs and consequences 17.4.2018

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

  1. 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. 2. Deakin University CRICOS Provider Code: 00113B The Project
  3. 3. Deakin University CRICOS Provider Code: 00113B Mapping Clinical Pathways for tracker conditions Shine a torch on the patient’s experience
  4. 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. 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. 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. 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. 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. 9. Deakin University CRICOS Provider Code: 00113B HbA1c among type 2 diabetes patients in North Karelia, 2013-2014
  10. 10. Deakin University CRICOS Provider Code: 00113B Type 2 diabetes report, North Karelia
  11. 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. 12. Deakin University CRICOS Provider Code: 00113B The pilgrim and the patient’s experience
  13. 13. Deakin University CRICOS Provider Code: 00113B The outset of the journey can look well organised and paved for an easy path
  14. 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. 15. Deakin University CRICOS Provider Code: 00113B Others have been there first and may not be interested in your journey
  16. 16. Deakin University CRICOS Provider Code: 00113B Different paths can look equally plausible
  17. 17. Deakin University CRICOS Provider Code: 00113B It helps to have guidance
  18. 18. Deakin University CRICOS Provider Code: 00113B We need to remember our fallibility.
  19. 19. Deakin University CRICOS Provider Code: 00113B We need to have belief in our journey
  20. 20. Deakin University CRICOS Provider Code: 00113B The journey can get rocky and slippery
  21. 21. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable
  22. 22. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable Beware of false prophets
  23. 23. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluable Advice can sometimes be confusing
  24. 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. 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. 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. 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. 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. 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. 30. Understanding the Patient Journey Process Mapping
  31. 31. CONTEXT ‘80% of the problem is in the system not the people’ W. Edwards Deming
  32. 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. 33. Process has inputs and outputs Input OutputProcess Definition - a process is a series of connected steps or actions to achieve an outcome
  34. 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. 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. 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. 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. 38. Walk the Patient Journey for yourself
  39. 39. Deakin University CRICOS Provider Code: 00113B A piece of very simple advice can be invaluableCathedral of Santiago de Compostela
  40. 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. 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

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