© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Module 4Re-Engineering Patient Discharge:

The Hospital Launch!

Faculty from Joint Commission Resources

Deborah M. Nadzam, PhD, FAAN

Project Director

and

Kathleen Lauwers, RN, MSN

Consultant

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Patient Admission

Care and TreatmentEducation

Demonstrationof Learning Patient

DischargeProblemSolved!

Re-engineering Patient Discharge: Project RED

Critical pathwayReconcile admission medsEducate the patient aboutthe plan of careInitiate discharge planningrounds

Reinforce care planReinforce teachingProvide explanations fortests and studiesDiscuss family supportoptions at homeClarify primary care provider

Written dischargeplanInitiate teach backSchedule follow upappointmentsSchedule postdischarge phone call

Confirm medication planPending test resultsFollow up appointmentscheduleReinforce AHCPSend PCP written AHCPDischarge telephone call

Module 4

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Accomplishments to Date (Module 1)

Project charter initiated

Primary care practitioner referral base defined

Process map of current discharge process completed

Care plan structure (template, location, how DA will access it) finalized

Dates for training frontline staff set

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Accomplishments to Date (Module 2)

Project metrics identified and planned

Patient inclusion criteria defined

Process for identifying patients and notifying DA defined

Multidisciplinary involvement and communication plan determined

Care plan process finalized (what and how to gather data for inclusion)

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Accomplishments to Date (Module 3)

Processes in place to finalize care plan once discharge order is written

Teach-back methods outlined

Quality/PI staff understand project measurement requirements and are prepared to gather data

Process for transmitting DC summary and care plan to PCP finalized

Plans for teaching frontline staff finalized

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Module 4 Objectives

To design an ideal “future state” process map

To finalize best practice solutions that include system redesign of the discharge process

To initiate the monitoring plan for sustainability

To celebrate staff accomplishments and discuss the application of the knowledge transfer framework across the hospital/system

To prepare to provide case studies

To participate in a LIVE interactive session

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Module 4 Outline

Creation of Ideal Process Map

Brainstorming Improvements

Pilot Test Improvements

Create Final Deployment Plan

Develop Monitoring Plan (Act/Control)

Planning your Team Celebration!

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Sample CalendarSynthesize and Launch!

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Performance Improvement Structure

PLAN

DO

CHECK (STUDY)

ACT

Deming, Shewhart, Lean Lean Six Sigma

DEFINE MEASURE ANALYZE IMPROVE CONTROL

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Patient isadmitted

MD writesadmission

orders

Pharmacistprovides

medications

Nursing initiateadmission

assessment

Care andtreatmentprovided

Dischargeorder iswritten

Dischargesheet is filled

out

Patient isdischarged

Discharge sheetis reviewed withpatient/family

Your Current State May Have Looked Like This…

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Physician

Nursing

DischargeAdvocate

Pharmacy

Sample Process Map: Patient Discharge

Patient AdmissionOrders

Initiate postdischarge phone

call

EstablishClinical

Pathway

AdmissionAssessment

MedicationReconciliation

Educate patientabout diagnosis,

tests, and studies

Identifytarget patient

Initiate dailydischarge

huddle

Initiate AfterHospital Plan

Collect data reProcess and

Outcome metrics

Schedule Postdischarge f/uappointment

Verify MDorders

Create MARAssist withmedication

reconciliation

Assist withmedicationteaching

Participate inDC Rounds

Educate patientabout diagnosis,

tests, and studies

Initiate DCorders

ReinforceDischarge Plan

Provide careand treatment

CompleteAHCP

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Define Your “Ideal” Future State

Initiate a new high-level process map

Multidisciplinary participation

Patient admission is the starting point

After hospital care provision is the ending point

Ask each discipline what steps they will NOW take to prepare the patient for discharge

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

DischargeAdvocate

Physician

Nurse

Pharmacist

Sample "Ideal State" Project RED Flow Map

AdmissionOrder

EstablishClinical

Pathway

Receives REDPatient

AdmissionAssessment

Verifies MedOrders

Med Rec andMAR

DischargePlanningRounds

Initiates andTeaches DCCare Plan

Care Plan

EducatesPatient about

diagnosis,tests andstudies

EducatesPatient aboutPlan of Care

andMedicationTeaching

Assists withMedicationTeaching

DischargeOrder

ReinforcesDischarge Plan

Schedules F/UTests, and

Appointments

Schedules F/UPhone Call

MedicationReconciliation

SchedulesDC Rounds

Participates inF.U Phone

Call

CompletesPatient's DC

Care Plan

DC Plan andSummary

sent to PCP

PatientDischarge

DC MedRec

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Double Check for Failure Modes

Omission

Excessive repetition

Wrong sequence

Early or late execution

Incorrect identification/selection

Incorrect information

Incorrect counting or calculating

Overlooking Misreading or

misunderstanding Incorrect decision Incorrect transcription Incorrect route, position,

setting

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Current State Data Analysis

As we have discussed, collect your baseline data from 5-10 patients if possible

Analyze expected to actual time stamps (Process Metrics)

Analyze completed care plans as defined

Analyze current state outcome metrics

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Metrics for Target Population

Outcome metrics (readmission rate)

Financial metrics

Process metrics – time stamps

Process metrics – care plan completion

Pre and post data – frontline staff, physicians, and patient surveys

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Check/Improve

ROOT CAUSES OF VARIATION

Identified in “Analyze” step

Rank in relative importance

Brainstorm potential solutions for each root cause.

Prioritize root causes with solutions

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Designing a Pilot Launch

Establish baseline performance

Train employees on pilot solution

Measure results of pilot solution

Analyze results of pilot solution

Decide to proceed to full-scale deployment

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Deployment Planning

Review team mission and vision

Review strategic challenges

Align strategic objectives with action steps

Determine roles and goals

Establish communication plan

Align tactics with time horizons

Determine next steps

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Deployment Plan

Solution Tactical Action Step ResponsibilityTarget Date

Resources Needed

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Post Implementation Data Collection

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Post Survey – The Voice of Your Customer

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Act / Control

Monitor pre and post project data

Define the monitoring plan for sustainability

Communicate results to the PI steering

Transfer knowledge to hospital staff and the community

Celebrate!

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Executive Summary

Use your updated one-page Project Charter, adding pre and post data with target dates complete

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Project Presentation to Senior Leaders

1. Create your presentation as you move through the PI phases of your project

2. Follow your systematic PI methodology

3. Consider team members presenting specific content

4. Link your project presentation with your opportunity to recognize the team

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Celebrate!

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Planning Your Team Celebration

Celebrate team success in style

Cater to your team

Let the whole world know

Personalize your thanks

Ask your team members to share their key learnings

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Module 4: SummaryExpected Outcomes

Understanding of how to design an ideal “future state” process map

Understanding of best practice solutions that include system redesign of the discharge process

Understanding of how to initiate a monitoring plan for sustainability

Discussion of hospital-based case studies

Understanding the importance of staff celebration and the application of the knowledge transfer framework across the hospital/system

Participation in a LIVE session

© J

oint

Com

mis

sion

Res

ourc

es©

Joi

nt C

omm

issi

on R

esou

rces

Progression to Launch Checklist

Modules 1 – 3 deliverables have been accomplished _____

Ideal process map has been completed ____

Pilot run scheduled ____

Final deployment plan created ____

Project monitoring plan is in place ____

Plan for celebration developed _____