November 3 & 4, 2016 November 3 & 4, 2016 Jönköping, Sweden IHI Health Improvement Alliance Europe Year 1 Autumn Meeting Welcome & Introductions Derek Feeley, Göran Henriks, Pedro Delgado & Maureen Bisognano 1
November 3 & 4, 2016 Why We’re Here • To bring together innovating leaders • To surface common challenges • To leverage shared ideas and spread internationally • To learn from past & present • To shape the future 2
November 3 & 4, 2016 Where We Hope to Go • Establishing a powerful collective voice to spread throughout Europe and globally • Developing a strong framework that allows capability and innovation to thrive • Fostering collaboration on areas of common interest – Alliance wide priorities Radical Redesign Principles for Virtual All Europe Member Meetings Strong Relationships, Networking Opportunities Shared In Person for All Learning All Members with US Continual Member Alliance Meetings Focus on Adding Value Shared Virtual Collective Learning Topic Voice of within Meetings HIAE HIAE Sharing Learning Globally and Locally Actionable Initiatives, Progress within Topic Areas 3
November 3 & 4, 2016 Some Proposed Principles for the Next 48 Hours… • Accept and encourage messiness • Share assets and ideas – be solution focused • Be energising and fun • Leave with stronger relationships • All teach, all learn – wealth of perspectives Design Sessions PM • Joy in Work • QI in Resource Limited Environment • Population Health – Split if you are from same organisation – 2 out of 3 sessions for all – Feedback will be for everyone 4
November 3 & 4, 2016 9 Fun Facts Is It Time for Radical Redesign? Health Improvement Alliance Europe Maureen Bisognano Derek Feeley 5
November 3 & 4, 2016 The New Health Care Environment? • Ageing of the population • Growth in chronic disease and multi-morbidity • Economics • Workforce challenges • Globalization, Consumerism and Personalization • Health care and social care everywhere • Wellness And in Europe? 6
November 3 & 4, 2016 Obesity How Do We Address These Challenges? 7
November 3 & 4, 2016 More of the Same? 8
November 3 & 4, 2016 Leadership Alliance - Radical Redesign (from the inside out) Radical Redesign Principles Change the Balance of Power – Co-produce health and wellbeing in partnership with patients, families, and communities. Standardize What Makes Sense – Standardize what is possible to reduce unnecessary variation and increase the time available for individualized care. Customize to the Individual – Contextualize care to an individual’s needs, values, and preferences, guided by an understanding of “what matters” to the person in addition to “what’s the matter.” 9
November 3 & 4, 2016 Radical Redesign Principles Promote Wellbeing – Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require health care. Create Joy in Work – Cultivate and mobilize the pride and joy of the health care workforce. Make it Easy – Continually reduce waste and all non-value-added requirements and activities for patients, families, and clinicians. Radical Redesign Principles Move Knowledge, Not People – Exploit all helpful capacities of modern digital care and continually substitute better alternatives for visits and institutional stays. Meet people where they are, literally. Collaborate/Cooperate – Recognize that the health care system is embedded in a network that extends beyond traditional walls. Eliminate siloes and tear down self-protective institutional or professional boundaries that impede flow and responsiveness. Assume Abundance – Use all the assets that can help to optimize the social, economic, and physical environment, especially those brought by patients, families, and communities. Return the Money – Return the money from health care savings to other public and private purposes. 10
November 3 & 4, 2016 1. Change the Balance of Power Introducing Christian The Old Way • Ryhov Hospital, Jönköping, Sweden had traditional hemodialysis and peritoneal dialysis center. • In 2005, a patient, Christian, asked about doing it himself. 22 Co-Design of Dialysis Care 11
November 3 & 4, 2016 From patient to employed From patient to patient support 2009 2010 2012 Patri k The Microsystem Festival March 1 – 4 2016 plus.rjl.se/microsystemfestival Self-Dialysis • Now 60% of Ryhov Hospital dialysis patients are on self-dialysis • Their aim: 75% of patients 12
November 3 & 4, 2016 Self-Dialysis Results • Costs reduced 50% • Complications dramatically reduced • Measuring success by “number of patients working” 2. Standardize What Makes Sense 13
November 3 & 4, 2016 2. Standardize What Makes Sense 3. Customize to the Individual 400 Teams in 10 Countries 14
November 3 & 4, 2016 3. Customize to the Individual • Associação Congregação de Santa Catarina- São Paulo, Brazil Reablement- Oslo Kommune • Inter-professional team who are the first to meet with new patients in need of home-based care – occupational therapists – physiotherapists – nurses – social workers • Work towards independence and mastery of everyday life, transitioning patients to either: - discharge without need of further healthcare, or - home-based care with the best possible function Thomas Lystad 15
November 3 & 4, 2016 Reablement- Oslo Kommune • Assess the needs of the patient: – Interests – Resources – Limitations – Current function – Goal – Plan • Assessment of the care and adaptation of the plan is ongoing • Goal: transfer or discharge the patient when we have achieved best possible function and a stable need for healthcare Thomas Lystad Jarle History: – 70 year old man with COPD, type 2 diabetes, and two previous heart attacks – Suffered a major stroke, and spent a month in the hospital – Left side paralysis, poor cognitive and physical function Began prescribed reablement program, which was continuously reassessed; made good progress and entered health rehab Came back to reablement after challenges; they helped him find a new, more accessible apartment Now largely independent, and needs a wheelchair only for long distances Thomas Lystad 16
November 3 & 4, 2016 Breathe Magic The Breathe Magic Foundation uses intensive occupational therapy to help children with hemiplegia – Teach magic tricks, juggling, origami, and other creative arts to develop coordination and self-esteem Video link: http://breatheahr.org/breathe-magic/ Humanizing Healthcare 17
November 3 & 4, 2016 4. Promote Wellbeing St Ninian’s Primary School Stirling, Scotland 420 Students: 20% of pupils in deciles 1-3 35% of pupils in deciles 4-7 45% of pupils in deciles 8 and 10 At the Start: 45% of Pupils Were Overweight 18
November 3 & 4, 2016 “The Daily Mile” “Fit to play, fit to learn” Three years later, St Ninians Primary School and, of 57 Primary Stirling One children, not Scotland Ms Elaine Wyllie one is overweight wylliee48s@stirling.gov.uk 5. Create Joy in Work Joy is more than the absence of burnout 19
November 3 & 4, 2016 39 Burnout Also Affects Patients A variety of studies have shown association of provider burnout with: • Lower levels of empathy • More mistakes • Less patient satisfaction • “Workplace safety is Reduced adherence to treatment plans inextricably linked to patient • Overuse of resources safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams.” L. Leape Bodenheimer, T., Sinsky, C.. Annals of Family Medicine, Inc, 2015 How to Create a Joyful, Engaged Workforce Outcome: ↑ Patient experience ↑ Organizational performance ↓ Staff burnout 4. Use improvement science to test approaches to improving joy in your organization 3 . Commit to making Joy in Work a shared responsibility at all levels 2. Identify unique impediments to Joy in Work in the local context 1. Ask staff “what matters to you?” 20
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