The BC Arthroplasty Collaborative Grand Finale Learning session 4

1. The BC Arthroplasty Collaborative Grand FinaleLearning session 4 A Tribute to Teams: The Collaborative Update Valerie MacDonald MSN CNS ONC Collaborative Director

2. Why an orthopaedic collaborative?

3. The crippling giant - arthritis: • 4 million suffer pain, activity restrictions and progressive disability. • 1 million more will have arthritis in 10 yrs. • The economic costs are estimated at $4.4 billion annually (Dunlop et al, 2003).

4. 6 month wait time targets by 2009. Provincial annual increases required: • Knee replacements: up by 77% to 9600. • Hip replacements: up by 43% to6200. IRMACS, 2006. How Many More Cases are Needed? A report on hip and knee surgery waits in British Columbia prepared for the Ministry of Health. Simon Fraser University

5. UBC Centre for Surgical Innovation Focused factory concept. 1600 ASA 1 & 2 patients per year. • Rapid Recovery paths, orders and patient education materials • Excellent, well resourced team. • High patient satisfaction • 3-4 day length of stay

6. Provincial initiatives to reduce wait times • UBC CSI – Provincial resource for non complex hip and Knee arthroplasty. • VCH OASIS – Single point of entry for people at all stages of osteoarthritis.

7. A provincial imperative…. Developing focused, streamlined programs that improve recovery, access and contain costs for patients requiring hip and knee replacement surgery.

8. The collaborative “ Brings teams together to learn and implement best practice through quality improvement methodology.”

9. Support Network

10. Plan Act Study Do Action Periods

11. Arthroplasty: Chronic Disease Mgmt Health System CIS Audits for evaluation. SMS Workshop Booklet CD ROM Community DSD Timing Risk screening Handoff protocols GP, conditioning, rehab options, home support DS Clinical pathways & protocols Productive Interactions Informed, Activated Patient Prepared, Proactive Practice Team Improved Outcomes

12. Collaborative Goal – Engage Teams to: • Develop and implement focused proactive 3 day pathways & orders. • Provide education and support to build patient and family capacity.

13. Model for Accountable Care (MAC) Predictable problems delay recovery and result in added morbidity, mortality and functional decline. Anticipation, prevention, screening and timely managementof predictable problems will improve outcomes.

14. IHI Rapid Cycle Improvement Plan Do Study Act Testing out clinical ideas so they can be refined and improved in context. Builds competence, confidence and Will.

15. Collaborative Goal – Engage Teams to: • Monitor progress through systematic audits of meaningful outcomes. • Reduce ALOS to 4 days for 75% of primary hip and knee patients.

16. So how do we measure up?

17. Optimization Education Programs

18. 3-4 days paths in place or in draft

19. LOS is influenced by: • Team focus, expertise and drive. • Complexity of cases • Resources

20. LOS increased at some sites due to: • High proportion of non complex patients patients going to UBC CSI. • Staffed for less complex patient mix – e.g. community hospital. • Limited access to specialized and intensive services for higher risk patients.

21. Knee LOS MOH data comparing 05/06 & 06/07 periods

22. Aims / Outcome Reports • Optimized for surgery: educated, assessed, problems addressed. • Antibiotic prophylaxis: Optimal timing. • Early mobility: Standing Day 0 • Pain prevention • Nausea prevention • 75% discharged by Day 4. • Home supports in place.

23. What does this mean to patients? • More beds available - less time waiting in agony. • In better shape for surgery: mind, body and home. • Less pain and nausea after surgery. • Up and about and home sooner. • Greater confidence in the system.

24. What does this mean to the system and to tax payers?

25. Provincial Bed Usage Comparison for Knee Replacements .8 reduction in ALOS Annualized Bed Days Savings: 4,487 Capacity Increase: 17% Pre-Collaborative Mid-Collaborative (FY 05/06 P6YTD) (FY 06/07 P6YTD) Cases 2,138 2,545 ALOS 5.6 4.8 Bed Days 12,024 12,242

26. Additional achievements • Rehab task group: Standards of care, recovery curve research. • National and international presentations. • Community of practice and research established.

27. What is the legacy of the collaborative? • Prepared, proactive, mobilized teams – who know their value. • A climate of innovation. • Frontline leaders who are skilled change agents. • Satisfaction and joy in the workplace. • Ongoing collaboration. • Satisfaction and joy in the workplace.

28. Factors for success: Passionate, visionary, leadership team. ‘Servant leader philosophy. What do you need, how can we help?’ Frontline teams recognized and engaged as leaders in practice and system improvements. .

29. Factors for success: Partnerships with senior and operations leaders. “My role is to clear the barriers so teams can do what needs to be done.” Ida Goodreau CEO Vancouver Coastal Political will.

30. Factors for success: Best practice knowledge and tools. Organizational structures. People resources Project design

31. Collaborative Vision: Patients in the province of BC will have the same excellent standard of care – where ever they go!We’re almost there!

32. Next steps… • Sustainability structures for each region. Leadership, teams, communication measurement. • Ongoing structured provincial networking. • Resources. • More learning and innovation • Learning session 5.