Minding the Gap at InnovationEX 2019
A sell-out crowd at this year’s event celebrated the collective will amongst the Joint Centres’ hospitals for creating smoother transitions in care.
For patients, caregivers and providers, perhaps the most difficult and frustrating part of the healthcare experience is a transition in care. It’s a critical time when a mismanaged hand-off can lead to poor patient experience, complications and outcomes.
So, it was exhilarating to see the range of creative and bold projects at the 6th annual InnovationEX, all dedicated to “Minding the Gap” or removing the barriers to facilitate smoother and safer transitions. In her opening address, Joint Centres Chair and Markham Stouffville Hospital President & CEO Jo-anne Marr told the sold out audience at the BMO Institute for Learning that “families and patients face challenges in transitions of care, but by working together we can bring the voice of the patient to the table”.
The need for patients – and their advocates and family members – to feel safe and respected was the focus of a video shown early in the morning’s proceedings. Once confined to the periphery of the system, the video confirmed the crucial role played by patients, families and patient advisors as integral members of the healthcare team.
Home care could solve the problem of hallway care
We accept that transitions are inevitable in healthcare, but when it comes to care of older people, those transitions are being poorly managed or not at all. In order to truly ‘mind the gap’ Shirlee Sharkey, Saint Elizabeth Health President and CEO, told the audience that we need to first deal with the crushing problem of “hallway care”.
“There are really three options,” said Sharkee, “we can discharge these patients, designate them for ALC (Alternate Level of Care) at the right time, or best of all, keep them out of hospital in the first place.” Home care offers the wonderful intersection of healthcare and everyday life, she says, but to really support independent living, it needs to be flexible and customizable.
Maybe we just need to reframe the problem. Rami Lama, Group Director of Accenture, erupted on to the stage with an inspiring message – we can take the complex problems in our midst and make them simple, but it’s going to require a cultural shift. At the heart of that shift is putting people first. “Don’t talk to me about thinking outside the box,” said Lama. “The real troublemakers are human – we all need simple nudges to change our behaviour and habits.”
Unpacking the empathy
Audience involvement is not new to InnovationEX (last year it was a version of Dragon’s Den). This year Rami launched a “Design Jam” to demonstrate how simple nudges work in practice. What information did we need to approach the problem of ‘Philip’: a repeat visitor to the ED, presenting with chest pain and abdominal pain, and no family doctor? Teams at each table followed the predictable work-up – cardiac investigations, stress test, referral to a specialist.
It was soon apparent that we had violated one of Lama’s critical rules of the road – don’t be a solution without a problem. We took care of the clinical problem but hadn’t triaged the human. Who is Philip, where does he live, who is his support network, what is his mental health history, what is his backstory. Buried in the “Jam” was Lama’s nudge that we need to put people first. “We need to do more empathy mapping,” he said. “What are the things we can unpack to get to the source of the problem?”
Before the crowd spilled out in the light-filled atrium to view the posters, the six winners of the Innovation Awards were announced:
- Humber’s Elderly Assess and Restore Team (HEART) – A mobile service aimed at restoring functional status of hospitalized older adults and facilitating return to community – Humber River Hospital
- Increased Adoption of Barcode Medication Administration – Implemented real-time Workflow Safety scoring and Executive Dashboard to monitor BCMA compliance – Mackenzie Health
- iCARE Compassion in Action – Through developing communication standards and championing hospital-wide rollout, the iCARE team has blazed a culture of compassion across MSH – Markham Stouffville Hospital
- Toronto Mobile Crisis Intervention Team Expansion – An MCIT team (expanded in 2014) includes a mental health nurse and a specially trained police officer who together respond to 9-1-1 emergency and police dispatch calls involving individuals experiencing a mental health crisis in the community – Michael Garron Hospital
- Presenting Post-partum Hemorrhages through Clinical Simulation – Introduced a model of simulation that served to enhance the comfort and reduce the anxiety of participants, while ensuring that learning opportunities were capitalized upon “in the moment” – North York General Hospital
- Community Engaged Stroke Model of Care – A hospital-to-home interprofessional team with specialized skill sets in working with a neuro population and providing continuum of care from in-patient into the home for an underserved patient population – Southlake Regional Health Centre
- Preventing Workplace Violence – Championed WVP efforts at SJHC, including the use of a Universal Precautions tool that identifies patients at risk for violence in our emergency department – St. Joseph’s Health Centre
Constantly looking inside and outside
The final event of the morning put the Joint Centres’ hospital CEOs at centre stage, asking them to shed their ‘superhero’ suits and reveal their more humble and modest sides. We quickly learned from all seven leaders – Barbara Collins (HRH), Altaf Stationwala (MH), Jo-anne Marr (MSH), Sarah Downey (MGH) Dr. Joshua Tepper (NYGH), Arden Crystal (SRHC) and Dr. Tim Rutledge (SJHC/UHT) – that leaders are constantly looking inside and outside, juggling their confidence and ambition with strategy and the greater good.
Gilda Radner called it “delicious ambiguity, taking the moment and making the best of it without knowing what is going to happen next” – did the leaders see ambiguity the same way? “It’s all about your team and learning to live with uncertainty and ambiguity,” said Sarah Downey. For Tim Rutledge, it means embracing our VUCA world (Volatile, Uncertain, Complex and Ambiguous). “I love the hope that ambiguity brings,” he said. “It’s uncomfortable but it’s also exciting.”
People’s Choice Award Winners
Jo-anne Marr led the climactic closing of the event with her announcement of the three winners of the InnovationEx 2019 People’s Choice Awards:
First: Green Innovation: Reinvesting Energy Savings into Patient Care, Markham Stouffville Hospital – MSH partnered with Honeywell to implement several cutting edge green technologies, including loT sensors, infrared scanners and smart lighting.
Second: Southlake@Home: Streamlining the Transition from Hospital to Home, Southlake Regional Health Centre – Southlake@Home is a novel transitional care prototype initiative aimed at streamlining the transition from hospital to home with home care or community services.
Third: Antimicrobial Stewardship Program: Implementation of Spectrum App, Markham Stouffville Hospital – Spectrum, a customizable antimicrobial stewardship mobile app for healthcare professionals to reference at point of care, was implemented by the ASP team to reinforce appropriate prescribing practices at MSH.
The Joint Centres for Transformative Healthcare Innovation is comprised of Humber River Hospital, Markham Stouffville Hospital (MSH), Mackenzie Health, Michael Garron Hospital, North York General Hospital, Southlake Regional Health Centre and St. Joseph’s Health Centre Toronto.
Here is an overview of all the projects presented at InnovationEX 2019:
Joint Centres for Transformative Healthcare
- Integrated Care in Ontario: A conversation about the role of community hospitals – The future of health services delivery in Ontario will see the community hospital take on the dual role of provider of acute care services, and coordinator of care.
Humber River Hospital
- Improving a Walk Project to Improve Length of Stay in the Post-Anaesthesia Care Unit – The goal of the “walk project” was to separate the ambulatory patients from the inpatients in the recovery room to better monitor and manage the LOS. This was accomplished by dedicating a section of the recovery room to ambulatory patients.
- Standardizing content for Patient Room Whiteboards to improve Provider-Patient Communication – HRH took a human factors approach to improving provider-patient communication by talking to frontline nurses and patients and families.
- Mackenzie Health Safety Heroes – Improving quality and safety at all transitions of care – The hospital introduced a new Patient Safety Reporting System that is aligned with their new electronic medical record, and is designed to engage staff and empower them to report incidents and be part of the solution.
- Revolutionizing Antimicrobial Stewardship – To expand Antimicrobial Stewardship using existing resources, an innovative practice model utilizing the unit pharmacists was developed. The electronic medical record was optimized for efficient clinical assessments and improved continuity of care.
Markham Stouffville Hospital
- Green Innovation: Reinvesting Energy Savings into Patient Care, Markham Stouffville Hospital – Using an innovation procurement approach, MSH partnered with Honeywell to implement several cutting edge green technologies, including loT sensors, infrared scanners and smart lighting. (1st prize winner of the People’s Choice Award)
- Antimicrobial Stewardship Program: Implementation of Spectrum App, Markham Stouffville Hospital – The misuse of antimicrobials can result in adverse patient reactions, the generation of antibiotic resistance and increased costs to the healthcare system. Spectrum, a customizable antimicrobial stewardship mobile app for healthcare professionals to reference at point of care, was implemented by the ASP team to reinforce appropriate prescribing practices at MSH. (3rd prize winner of the People’s Choice Award)
- 2018 Highlight: 3rd Place Winner: COPD Cloud Dx Project – A technology-enabled, clinician-supported self-management program for patients with COPD.
Michael Garron Hospital
- Toronto Mobile Crisis Intervention Team Expansion – an MCIT team (expanded in 2014) includes a mental health nurse and a specially trained police officer who together respond to 9-1-1 emergency and police dispatch calls involving individuals experiencing a mental health crisis in the community.
- Building Partnerships to Enhance Accessibility and Efficiency of Diagnostic Imaging Services – Through engaging patients and referring physicians, improving quality through process redesign and establishing clear standards of work, MGH’s Diagnostic Imaging Department was able to improve accessibility, decrease wait times and improve financial sustainability.
- Surge Relief and Community Care in East Toronto – MGH, in collaboration with a variety of East Toronto health partners, was able to invest to deliver much-needed surge relief and community care services to the East Toronto community during the period of November 2018-April 2019.
North York General Hospital
- An Interprofessional and Patient-Centred approach to Improving Transitions from Intensive Care Unit (ICU) to the Ward – NYGH ICU collaborated with the Medical/Stroke Unit (MSU) and the Patient and Family Advisor to develop a standardized discharge protocol. The result was improved communication, a reduction in medical errors associated with transitions, reduced anxiety of patients and families during transitions of care, and improved staff and physician satisfaction.
- Using Advanced Analytics to Transform Quality of Patient Care in Emergency Department by Analyzing Drivers Impacting Patient Wait Times – Real-time interactive dashboards help to optimize patient flow across zones and identify process gaps, providing insights to the real drivers of hospital performance.
- Care Beyond Transitions: North York General Integrated Care Collaborative for CHF and COPD – A collaborative partnership designed to provide integrated care to patients with mid to endstage CHF and COPD measured the impact of a bundled care model over a period of 60 days post-discharge and assessed the benefit of focussed education on promoting self-management behaviours.
Southlake Regional Health Centre
- Southlake@Home: Streamlining the Transition from Hospital to Home, Southlake Regional Health Centre – Southlake@Home is a novel transitional care prototype initiative aimed at streamlining the transition from hospital to home with home care or community services. (2nd prize winner of the People’s Choice Award)
- Assess the Impact of a Centralized Scheduling Platform for Imaging Procedures – SRHC modeled wait times for MRI scans using NextUpCare’s intelligent scheduling platform and compared those times to the hospital’s historic wait times. The platform moves patients closer to the centre of their care by enabling them to schedule their own appointments.
St. Joseph’s Health Centre
- Reducing ED Admissions through External Partnerships and Improved Patient Transitions – SJHC ED Admit Reduction Project focuses on reducing ED admittance and readmissions through hospital-community partnerships.
- Improving the Patient Experience at Discharge – Co-Designing Better Communication – SJHC is implementing Patient Oriented Discharge Summaries (PODS) to improve communication gaps when patients transition from hospital to home. PODS was co-designed with physicians, staff and patients.
- Working together to build a Resource-Supported Care Transition – CoHealth is a digital platform that consolidates resources into a single access point for patients to conveniently manage care and collects meaningful insights from patients for healthcare organizations.