DRAFT Simcoe Epsilon Processes

1. Improving Healthcare from the Inside Out DRAFTSimcoe Epsilon Processes Jan 24 2013 Jeff Doleweerd, Tim Berezny Doleweerd Consulting Inc. Not for wide distribution. Not yet validated at Branch level. These ideas and observations are being reviewed by Bayshore.

2. Epsilon + APR Submissions

3. Provide Intake

4. Provide Intake (Nursing) Change Ideas Observations Use assignment method that aims to give 100% of initial assessment visits to primary nurse (instead of spreading initials among nurses on a given day) Trial moving assignment of nurses to area CSC (with other changes) Distribute accepted referral to relevant nursingarea CSC for final registration, primary nurse assignment and initial visit scheduling. (needs careful testing) Deploy digital tool to lookup service areas Name the nursing and client areas consistently in Procura. Change coverage area sizes according to the following principal: It takes 10 minutes to drive (or walk if densely urban) from edge to edge of each area Assigning initial visits is a “hot potato” (nurse rejections, calling/pleading with nurses, dividing the load, etc…) Using voicemail to give nurses a heads up of initials Intake is busier at the end of the day There are ~12 maps on the walls of the office. Staff walk to them to reference frequently. Using a paper based referral progress tracking form. Naming convention in CIS inbox is confusing (offers, referrals, reports, “process”) relative to the rest of the process and Procura Simcoe Summary Intake is a relatively streamlined process with few handoffs within Bayshore Simcoe. CIS Inbox (for offers) – Simplifies the paper handling elements of the registration step significantly. It would benefit from improvements to error reconciliation, notifications, terminology, configurations for different roles and flow through of data (e.g., automatically enter PED).

5. Provide Intake (Home Support) Change Ideas Observations Design for 100% initial assessment visit (HS Supervisor) within 24 hours. Book the HS supervisor at the first CSC call with the client. (eliminate phone tag, waste, increase timeliness and effective set up of Care team) See Change Ideas 3-5 from Provide Intake (Nursing) + Procura ideas Volume of HS referrals is low in Simcoe See observations 3-7 in Provide Intake (Nursing) Intake and coordination functions are combined into one role at Simcoe. There are multiple calls to client shortly after admission (HS Coordinator, PSW, Home support manager – in that order) The home support coordinator starts a preliminary care plan (not the manager) Visit times and frequencies indicated by CCAC often require adjustment. This results in rescheduling re-work, Manager assessment can take up to 2 weeks. Client requirements may not be met up to this time. Nurses can do first assessment in place of manager. Simcoe Summary See summary comments on Provide Intake (Nursing) The Simcoe HS intake process won’t scale efficiently to larger operations.

6. Maps are Important

7. Provide Care

8. Provide Care (Home Support) Change Ideas • Provide care through care teams that are a) specific to each client and b) have a size that is directly related to the visit frequency (not too many or too few PSWs)Clients, PSWs, Coordinators, Managers should all know who is on the care team. Care team members should be first to pick up visits for a client. Build care team concept into Procura. • Provide select clients with a written overview of care team members+ visit schedule + overview of care plan • Deploy consistent “moments to truth” questions for PSWs to ask clients during visits • Create an online education module (with tests) to ensure staff can leverage all features of Procura Mobile & mHealth. • Create teaching tools (e.g., video) for “BB Ninja Skills” (e.g., vibrate, shortcuts, delete multiple emails at once, etc…) • Top PSW request: Use BB to phone clients Observation PSWs are not aware of basic blackberry functionality that could simplify their work. Suspect that continuity is sub-optimal due to scheduling approach Can be difficult to call client day before if working in evening. The PSW is not able to answer the client question “who is visiting me next?”. Simcoe Summary Procura Mobile seems to be a robust method for communicating scheduling matters, and documentation, for PSWs. The client, provider and system would benefit from knowing who is going to visit them and when in the future (i.e., care team).

9. Provide Care (Nursing) Change Ideas Observations Select a laptop model with full day battery life, anti glare screens Provide car chargers for laptops. Put in process to ensure that clients are called/informed so that they are available, not calling Bayshore.Consider CSC in certain cases. Teach (or enable?) nurses to scan docs directly to Procura (rather than fax to office) Provide better finger tip resources for nurses in field to consistently connect clients with other services. Clarify who clients call with issues (nurse, CSC, CCAC, manager?) Consider directing routine communications to email Stop reminding CMs about APRs responses before the end date. Email minimally used for communication. Person Cell is primary communication tool with office and client. Nurses work 1) in their cars on their laps, 2) at own homes, 3) in the client’s home.(probably in that order) Nurses re-use completed supply orders Syncing/uploading/connected/check for data etc… are not well understood terms Not all nurses know the “Procura Performance Workarounds” e.g., syncing only today instead of full day. mHealth layout not optimized for small screens Primary nurses are (mostly) able to communicate intelligently about client’s next visit. Simcoe Summary Procura Portal is stable, functional, and helpful. ProcuramHealthPoint of care documentation is the best we’ve seen, but suffers from stability issues. APR Submissions – simplifies the nurses workflow significantly and is appreciated by nurses. Could benefit from error prevention/checking mechanisms at the nurse level. Consequences of of mHealth downtime is costly, IT support and system stability must be extremely robust and responsive.

10. Provide Care (Nursing) cont… Simcoe

11. Coordinate Care

12. Coordinate Care (Nursing) Change Ideas • Use an electronic directory and electronic fax cover sheets for sending unsigned orders to physicians • Create a windows shortcut to temporary folder to reduce clicks on file saves for documentation clerk. Observations There seems to be a lot of chasing business documentation (e.g., PEDs, APRs, supply orders, unsigned orders, etc…) There is one area using nurse teams instead of the primary nurse model. Documentation desk exists for purpose of saving files to Procura (which is awkward) and chasing pending documentation. Processing unsigned physician orders is labourintensive Groups view has bugs when using drag-and-drop Simcoe Summary The scheduling philosophy of nursing seems to be well defined (primary nurse + sub-regional teams) and functioning well There is a documentation desk that exists solely for the purpose of saving files to Procura and chasing down documentation. Components of nursing coordination split between many roles: reception + clinical administrative resource + documentation + coordinator APR Submissions – Are a marginal improvement for clerical, and in some ways more work than before.

13. Coordinate Care (Home Support) Change Ideas • Don’t manage PED for homes support internally. Wait for funder to trigger discharge (Applies to elswhere in Ontario.) • See intake process Observations Simcoe Bayshore does notmanage PED end dates for home support, they wait for the CCAC to trigger discharge. Replicate this practice across all branches. There seems to be a lot of chasing business documentation (e.g., PEDs, APRs, supply orders, unsigned orders, etc…) Some coordinators don’t use headsets. Home support intake doesn’t using referral tracking form or a call log like nursing intake does. There is an almost overwhelming volume of tasks related to unverified visits, many of which are in fact verified. Shift nurses are still using telephone based method of check-ins and check-outs. Scheduling genius is not used. Simcoe Summary Procura Mobile seems to be a robust method for communicating scheduling matters, and documentation, for PSWs. The philosophy for scheduling PSW assignments needs to be clearly defined, and the process+technology needs to be designed to meet that philosophy. The current approach is inconsistent. Scheduling Genius is not used. It doesn’t seem to work better than the filters functionality for finding appropriate PSWs.

14. See process map Pay Bill

15. Burnaby