Communication and understanding of system resilience through RAG survey in EDs Sheuwen Chuang, Hon ‐ Ping Ma, Che ‐ Hung Tsai Sheuwen Chuang, Ph. D Health Policy and Care Research Center, Taipei Medical University, Taiwan 2015/Aug/11
Taipei Medical University has three hospitals TMU hospital, 800 beds Wan Fang hospital, 934 beds Shuangho hospital, 730 beds 2
Study aims 1.Direct communicate with five directors of EDs to understand how they think about system resilience. 2.Compare system resilience of EDs across four hospitals 3.Try to develop an approach of implementing resilient health care based on the baseline of system resilience through a RAG survey under the QLLM framework. 3
Background – 1/2 • Almost EDs in medical centers and some regional hospitals are overcrowding • EDs in Taiwan are requested to plan a event list that has a prepared response. During Time Period The event list includes • Extraordinary events: Multiple Casualty Incident, fire incident, violence, emergency power(air) shutoff, • Everyday clinical work 4
Research Method – Questionnaire design Erik Hollngel’s Resilience Analysis Grid • Assessment of four abilities of system resilience • Ability to respond • Ability to monitor • Ability to anticipate • Ability to learn • Four versions, the first version was designed according to SOPs 5
Research Method – Questionnaire design Questionnaire design Face validity test (3 (V1) physicians) Face validity test and Questionnaire design interview time test (V2)) Questionnaire design Test of focus group (V3) interview in one ED Questionnaire design IRB application (V4) 6
Research Method – Questionnaire design The final version has – Structured questions for analysis of the ability to learn – Open questions for analysis of the ability to respond, monitor, anticipate with the modification suiting for EDs’ context – maximum two hours of interview time 7
Hospital characteristics Hospital A B C D Contract - Level Regional Medical Medical Regional Hospital Center Center Hospital Public/Private Public (city Public (city Public (MoD) Public government)/ government)/ (MoHW) private private Beds in ED 34 26 100 20 Patient visits in 98,213 65,397 65,615 59,873 2014 No. of Health 94 75 135 48 care staff 8
Results – 1/5 Overall system resilience of EDs in four hospitals – ECW work: • Four hospitals have similar patter of system resilience • strength is in LEARN, weakness is in MONITOR • Hospital C has the higher resilience than other hospitals • Hospital A, B have less ANTISPATE ability than other hospitals 9
System Resilience ‐ ECW RESPOND RESPOND 10 10 9 9 Hospital B 8 Hospital A 8 5.7 7 7 5 6 6 5 5 4 4 3 3 2 2 1 1 LEARN MONITOR MONITOR 6.3 0 0.6 LEARN 5.6 0 0.9 3.4 4.4 ANTISPATE ANTISPATE RESPOND RESPOND 10 7.9 10 9 9 8 8 5.8 7 7 6 6 5 5 4 4 3 3 2 2 1 1 8.1 0 3.9 LEARN MONITOR MONITOR LEARN 6.2 0 2 5.9 Hospital D Hospital C 8.1 10 ANTISPATE ANTISPATE
Results – 2/5 • Comparison of individual ability in ECW across four EDs – RESPOND • 9 domains: Relevance ， Threshold ,Response list ， Speed ， Delay ， Response capability ， Stop rule ， Duration ， Verification • Lack of verification is in common • Every hospital has different pattern of ability to RESPOND 11
Ability to respond in ECW 4.0 Hospital A Relevance 4.0 Hospital B 4.0 Relevance 4.0 Verification Threshold 3.0 3.0 Verification Threshold 3.0 3.0 2.0 2.0 1.0 1.0 1.0 Duration Response list 1.0 2.0 Duration Response list 1.0 0.0 1.0 1.0 0.0 1.5 1.0 2.0 2.5 Stop rule Speed 1.5 Stop rule Speed 2.0 Response 3.0 Delay Response capability Delay capability 4.0 Relevance Relevance 4.0 3.0 4.0 4.0 3.0 Verification Threshold 3.0 Verification Threshold 3.0 3.0 2.0 2.0 1.0 1.0 1.0 1.0 4.0 4.0 4.0 Duration Response list Duration Response list 1.0 0.0 0.0 2.0 1.0 2.5 Stop rule Speed Stop rule Speed 4.0 4.0 2.0 Hospital D Response 3.0 3.0 Delay Response capability Delay Hospital C 12 capability
Results – 3/5 • Comparison of individual ability in ECW across four EDs – MONITOR • 5 domains: Relevance ， Indicator list ， Indicator type ， Relevance ， Measurement frequency ， Organisational support • Lack of monitor frequency in common • Every hospital has different pattern of ability to MONITOR • Hospital C performs better monitoring in indicator list and indicator type • Hospital A and B have less monitoring ability than other two hospitals 13
Ability to monitor in ECW Indicator list Hospital A Hospital B Indicator list 4 4 3 3 2 2 1 1 Organisational Organisational Indicator type Indicator type support 1 2 support 1 1 1 1 0 0 1 1 1 1 Measurement Relevance frequency Measurement Relevance frequency 4 Indicator list Indicator list 4 4 3 3 2 2 2 4 Organisational Organisation Indicator Indicator type support 1 al support type 2 1 2 2 0 0 1 1 1 2 Measurement Relevance Measureme frequency Relevance Hospital D nt frequency Hospital C 14
Results – 4/5 • Comparison of individual ability in ECW across four EDs – ANTISPATE • 4 domains: Relevance ， Frequency ， Model ， Communication ， Expertise • Hospital D performs better anticipating than other hospitals • Hospital A, B and C have similar patter of anticipating ability 15
Ability to anticipate in ECW Frequency Frequency 4.0 Hospital A 4.0 Hospital B 3.0 3.0 1.5 1.5 2.0 2.0 1.0 1.0 Expertise 0.0 1.0 Model Expertise Model 2.0 0.0 1.0 2.0 1.0 1.0 Communiaction Communiaction Frequency Frequency 4.0 4 2.5 3 3.0 1.5 2 2.0 1 1.0 Expertise Model 0 2 Expertise 0.0 1.0 Model 2 2.0 1.0 3 Hospital D Communiaction Communiaction Hospital C 16
Results – 5/5 • Comparison of individual ability in ECW across four EDs – LEARN • 9 domains: Selection criteria, Learning basis , Formalization , Training , Learning style, Resources , Pipeline, Importance, Implementation • Hospital C performs better learning than other hospitals • Four hospitals have different patter of learning ability 17
Ability to learn in ECW Hospital B Hospital A Pipeline Pipeline 4 4 3 4 Training Importance Training Importance 3 3 3 2 2 2 2 2 4 4 4 1 1 3 Implementation Selection criteria Implementation Selection criteria 0 0 2 3 3 3 Resources Learning basis Resources Learning basis 2 3 Learning style Formalization Learning style Formalization 4 4 Pipeline 4 Pipeline 4 3 4 4 Training Importance 3 Training Importance 3 3 3 2 2 2 4 4 1 1 3 Implementation Selection criteria 3 Implementation Selection criteria 0 0 1 Resources Learning basis 3 Resources Learning basis 4 4 Learning style Formalization Learning style Formalization Hospital D 4 4 4 4 Hospital C 18
Conclusion 1. ED has different levels of system resilience between the situation of ECW and extraordinary events. 2. Hospital with more responsibilities required by the Central government and IT capacity shows a better resilience in the four abilities. 3. The result of RAG survey provides an insight of ED’s resilience to the five hospitals (directors of ED) and facilitates a better understanding how ED’s current ability structure of resilience. 4. It is a good approach of communicating system resilience between researchers and healthcare professionals. 19
Sheuwen Chuang, Ph D Health Policy and Care Research Center, Taipei Medical University, Taiwan sheuwen@tmu.edu.tw 2015/Aug/11 20
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