Title: UHNBC Capacity Response Guidelines 

Authors: Julie Dhaliwal 

Objective: To develop a plan of action to proactively respond to fluctuations in Capacity at UHNBC in a standardized manner.  

Methods: Matching capacity phases to capacity demands. Testing processes to inform community, acute and leadership of capacity changes. Mapping out roles and responsibilities for various roles in both acute and community to manage capacity. Development of tools to track data for tracking, trending, and reporting.  

Person/Family/Community Partner Engagement: Patient partners were engaged in developing a quality improvement plan for capacity response guidelines and provided input on survey design.  

Results: Evaluation Survey:  

1. How effective are the Capacity Response Guidelines in supporting the management of acute care bed capacity? 

2. Do the guidelines outline clear process, roles, responsibilities, and accountabilities?  

3. How are the related tools working with the guidelines to support capacity management (e.g. email and text alerts?) Continuous Quality Improvement through weekly key learnings during implementation phase and using key learnings to guide immediate change and longer-term considerations. 
4. Right patient, right bed, right facility
5. Staff, Physicians and leaders will have increased understanding of their role in managing capacity fluctuations. 
6. UHNBC has been tracking capacity phases since September 2016 so the future goal will be to decrease the number of times per year we are in Capacity response phase 3.  

Lessons Learned:  

• Dedicated leadership to focus the work 

• Physician, frontline and unit leaders to contribute at the beginning of the work 

• Frontline leaders supported to help lead the work 

• Come alongside and apply lived experiences to the rich learning 

• Testing it out and using key learnings on a weekly basis to inform change and enable quick wins for immediate improvement 

• Develop the business aspect of how this will be sustained 

• Going electronic for the bed meeting was easier than some expected 

• Staff learned more quickly how to use the electronic system 

• Do with your team 

Keywords: Acute care, community care, survey method, capacity response guidelines

Evaluation Abstract 

Title: Evaluating the Edmonton Zone Triple Aim Initiative: building and implementing a shared measurement system for healthcare improvement with complex, vulnerable clients.

Authors:

Objectives: The Edmonton Zone Triple Aim Initiative supports Complex High Needs Patients in Edmonton’s Eastwood Area. The aims of the initiative are to improve population health, enhance experience of care, and reduce per capita costs. The objective of the outcome evaluation was to determine whether participating organizations had met these aims.

Approach: Participants in the Triple Aim Initiative include over 40 providers and 445 patients identified by seven different community Teams. The Evaluation Team used Triangulation Theory in an effort to validate the data for all Teams. Data collection for quantitative and qualitative measures come from a variety of sources including accessing administrative data, as well as conducting patient and provider surveys, interviews, and focus groups. Analysis of system level data, such as emergency department visits, inpatient stays, and physician continuity includes descriptive and statistical modeling approaches in a pretest-posttest study design.  

Results: The outcome evaluation demonstrates that participating Teams improved care for their patients. There were significant improvements in experience of care metrics for patients across all Teams, demonstrating progress toward the aim of enhancing patients’ experience of care. Additionally, all teams performed significantly better in experience of providing care metrics than control groups, achieving an added fourth aim that was set for the initiative. Some Teams demonstrated a reduction in acute care utilization and cost, as well as higher continuity of care with a family physician. There is evidence that suggests Teams who scored higher on elements of the Managing Complex Change model (vision, skills, incentives, adequate resources, and action plan) were more likely to achieve better patient health outcomes in the evaluation.

Conclusion: Lessons learned from this evaluation are critical for the initiative moving forward and for those working with similar populations. Our experience with the Triple Aim Initiative will help build support for the development and implementation of a shared measurement system as we continue to foster our collaborative healthcare improvement partnerships.

Keywords: 

Workshop Abstract