Source: O’Leary et al. 2006. How hospitalists spend their time: insights on efficiency and safety. Journal of hospital medicine, 1, 88-93.
Hospitalists use of time
- Indirect patient care 69%
- Communication 24%
- Indirect patient care 69%
- Communication 24%
Causes of adverse events
- 93% organizational causes
- 93% organizational causes
Source: Smits et al. 2010. Exploring the causes of adverse events in hospitals and potential prevention strategies. Qual Saf Health Care, 19, e5-e5.
Rate of preventable adverse events
- 51% highly preventable
- 51% highly preventable
Source: Wilson et al. 1995. The quality in Australian health care study. Medical journal of Australia, 163, 458-471.
The Problem: Reactive Care
Reactive care is the greatest constraint hospitals face and it exacts a massive price.
Details are missed and windows of opportunity close. Complications multiply. Patients suffer. Staff try to catch up while they slowly burn out. Time and resources are wasted.
Yet reactive care is considered normal because care teams are fragmented geographically and have no standard for what, when, or how to communicate with each other.
We think that’s not good enough.
Source: Buchbinder et al. 2001. Primary care physician job satisfaction and turnover. The American journal of managed care, 7, 701-713.
Source: Shanafelt et al. 2012. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of internal medicine, 172, 1377-1385.
Source: Jones, C.B., 2008. Revisiting nurse turnover costs: adjusting for inflation. Journal of Nursing Administration, 38, 11-18.
Source: Mchugh et al. 2011. Nurses’ Widespread Job Dissatisfaction, Burnout, And Frustration With Health Benefits Signal Problems For Patient Care. Health Affairs, 30, 202-210.
The Solution: Proactive Care
Proactive care delivers dramatically different results.
But proactive care is possible only when doctors and nurses coordinate with the patient at the bedside to plan ahead and stay ahead.
Our solution creates the conditions to make proactive care routine.
How?
We give our fellow physicians and nurses a new care model that lets them communicate at a much higher level and deliver better care together.
That care model is called the Accountable Care Unit (ACU) and its defining feature is Structured Interdisciplinary Bedside Rounds (SIBR). With ACUs and SIBR, healthcare organizations finally have a way to make proactive care routine.
What does proactive care look like for you?
Patients
Hospitalizations are a stressful time for patients and their families: the lack of autonomy, control, interval updates and communication contribute to the sense of frustration and uncertainty.
As patients and healthcare professionals ourselves we understand that the current delivery of hospital care does not meet your needs. Demand more, demand better!
Proactively including patients in their care plan and decisions from door-to-door is what should be the norm. We have the solution!
“I have the opportunity to ask questions about going home and what I need to do when I get home so that’s good.”
“We knew when to expect [the care team] each day and knew they would answer all of our questions. They knew our names and really involved us in the process. It really is a wonderful”
“When I got to the unit, I was depressed. The team of people on the unit really talked to me and turned my attitude around. They got me on a better path so I was able to go home.”
Nurses
Working as individuals or in silos can only do so much for patients. Proactive care enables more and better quality patient centered care and can create actual teams with shared decision making, open communications, inter- and intra- professional respect and accountability.
Standardized processes and information flows get you the information you need, when you need it and allow you to contribute your critical thinking to patient care every day.
“I don’t know how … we haven’t done this yet. It just makes sense. It makes sense for patient safety, and for patient advocacy. Just to have the physician there and support me as nurse, and know that he or she has my back and I can communicate face-to-face with that physician. That’s very important to patient safety.”
“It’s totally patient-centred… We can tell you exactly what time the doctor is going to come every day… We’re not spending all day trying to get a hold of doctors.”
“I’m not worried about going to work anymore.”
Doctors
Proactive care allows doctors to combine the attention, effort, and skills of the entire care team.
Face-to-face coordination results in a much more efficient and rewarding hospital practice, with better patient outcomes and fewer pages, phone calls, and missed signals.
“The ACU difference is dramatic. It’s like we have twice the number of hands on deck, but we haven’t hired anyone new. We’ve just trained everyone to coordinate with each other and with greater purpose. You can see this remarkable belief here now. We know we’re delivering the care we’d want for our family members or ourselves.”
“Strangely, the chaos in traditional hospitals is still considered normal. Leaders seem genuinely surprised by complications and delays. So many resources and hours are wasted recovering from what could’ve been prevented in the first place. Our ACU reverses all that and the difference is profound. Every hospital unit should work this way.”
“This is the best model for coordinating care that I’ve ever seen. Patients spend less time in the hospital, get better quicker, and don’t bounce back. Our Accountable Care Unit helped us establish a culture of safety. Now we have a unit where patients don’t die and don’t even fall.”
Allied Health
In proactive care based settings, allied health staff gain a valuable way to contribute to patient care and recovery. Allied health resources can be better aligned with care teams and patient needs, to proactively identify issues, optimize the discharge process and prevent undesired events.
By better integrating the vital inputs of allied health staff, the care team can help the patient reach their potential sooner and with greater certainty.
“What we found was … more patients identified actually had an intervention performed by a pharmacist that aligned with our standards compared with the comparator ward.”
Unit Leaders
With an organizational perspective on proactive care, unit managers can recruit, retain, and develop a more stable and high-performing workforce. Managers gain a powerful way to set expectations and hold teams accountable to individual and unit outcomes.
“Strangely, the chaos in traditional hospitals is still considered normal. Leaders seem genuinely surprised by complications and delays. So many resources and hours are wasted recovering from what could’ve been prevented in the first place. Our ACU reverses all that and the difference is profound. Every hospital unit should work this way.”
“I was suspicious. It sounded too good to be true… When I started working on the ACU I felt how different it was. My days used to be filled with running from floor to floor, getting paged by worried nurses to come urgently to see a patient, flipping through patient charts trying to find that important piece of nursing information that would be key to understanding. Now I’m part of a team. And with that team I go and see the patients and listen to them and find out what are their key priorities that need to be addressed… I love my job again.”
“Accountable care gets rid of the chaos and fosters teamwork with all people providing care and with a much improved relationship with the patient and their families. It’s so obvious to me that this is what we’re supposed to be doing.”
Executives
Proactive care gives hospital leaders a powerful platform to control outcomes and costs.
Hospital leaders can ensure proactive care becomes the standard of care by providing doctors and nurses with the practice-based training and performance transparency required to make high-performance patient centered care routine.
“Often in our medical system I think patients sometimes feel they’re left out: what’s going on with their treatment, when are they going to see their doctor next. It was incredible what I saw… Less time waiting for an in-patient bed, shorter hospital stays, better patient outcomes, and an increased patient and family, and staff satisfaction.”
“Two and a half months ago that [we] implemented [our] first Accountable Care Unit… So far this system has had a very positive impact on patient care. On average patients on this unit are heading home two and a half days earlier.‘
“The Accountable Care Unit makes patient interactions more meaningful and predictable, which is decreasing patient length of stay by eliminating barriers to discharge.”
Government
Societal demand on hospital systems is rising rapidly while budgets dwindle. Fortunately, proactive care enables health service leaders to manage, measure and spread the quadruple aim of improving patient experience, health outcomes, avoidable costs and clinical team satisfaction.
Find out about state-wide government initiatives that we have mentored and how you could replicate significant change in your state.
“An innovative model of team based patient care.”
“Less time in hospital, the freeing up of beds. The care is better. The communication is better.”
“Often in our medical system I think patients sometimes feel they’re left out: what’s going on with their treatment, when are they going to see their doctor next. It was incredible what I saw… Less time waiting for an in-patient bed, shorter hospital stays, better patient outcomes, and an increased patient and family, and staff satisfaction.”
