Montreal Health Centre Slashes Errors and Spurs Patient Engagement

Dramatic results of process improvements presented at 6^th International Conference on Patient- and Family-Centered Care in Vancouver, B.C., August 6-8, 2014

VANCOUVER, Aug. 7, 2014 /CNW/ - A 60% drop in medication transcription errors and a 75% reduction in admission times for mental health patients were just two of the significant improvements seen from a major care re-design project at the McGill University Health Centre (MUHC).

"Nothing about me, without me" has been the guiding principle for the MUHC's Tranforming Care at the Bedside initiative says Patricia O'Connor, RN, MScN, Senior Advisor, Patient Engagement, MUHC.  She cites three goals: understand care through the eyes of patients and their families; invite patient representatives onto teams with frontline staff to redesign care processes that respond to their real needs; and increase registered nurse time in direct patient care. 

The highlights of the multi-year project will be presented at the 6^th International Conference on Patient- and Family-Centered Care: Partnerships for Quality and Safety taking place in Vancouver, British Columbia, August 6-8. The conference is hosted by the Institute for Patient- and Family-Centered Care, in partnership with the Canadian Foundation for Healthcare Improvement and Providence Health Care of British Columbia.

"The legacy of this work was a profound cultural shift," says Stephen Samis, Vice President, Programs, Canadian Foundation for Healthcare Improvement. "It helped transform behaviours, improve multi-disciplinary team collaboration and communication that ultimately benefits patients and reduces costs."

To date, MUHC has enhanced safety, quality and the work environment across several areas:

• When nurses do medication charting, a huge factor in documentation and count errors is interruptions.  Errors plummeted by 60% after MUHC implemented a quiet space for charting, and started training staff to leave nurses alone when they're at the medications cart: "You need to picture a zone that's a boundary and impenetrable," says O'Connor, who is also Executive Lead of the Transforming Care at the Bedside Program.
  
  
• In psychiatry, the admitting process for acutely ill patients fell from 4.3 hours to one hour – a 75% reduction.  Before, each discipline (e.g. doctor, nurse, social worker) conducted their own history.  Now, they team up for 45 minutes of joint interviews and 15 minutes for a plan of care, done together with the patient.  As O'Connor says, "There's better efficiency and effectiveness, as everyone has the same information at once."
  
  
• To increase time at the bedside, nurses relocated commonly used equipment and supplies to cut down on "hunting and gathering" down hallways.  For one piece of equipment alone, the average time to retrieve it has dropped from almost four minutes to 26 seconds.  In another case, whiteboards were placed at the foot of beds, so patients and their families can easily see the names of the members of the care team and the plan of care for the day, and write down questions.
  
  
• Overall, there's been an 8% increase in RN time spent in direct and value-added care, and a 50% decrease in waste activities, stated O'Connor. There's also been a 20% increase in the responsiveness of care providers, and an 18% improvement in communication with nurses (as defined by the HCAHPS patient survey tool). Staff ratings of the initiative are consistently positive e.g. improved work satisfaction,  team effectiveness and capacity to lead quality improvement.

"Staff and patient representatives learned about rapid cycle improvement processes and change management skills, allowing them to test innovations and get better results.  These improvement methods have been derived from the Toyota production system, and other "best practice" business principles," says O'Connor.

Since 2010, the project has targeted 45% of clinical areas across six hospitals, and involved over 1,500 nurses and other health care providers.  In December 2013, Accreditation Canada recognized both the overall initiative, and the specific inter-professional admission process in mental health as Leading Practices.

Initial funding for this project was from the Canadian Foundation for Healthcare Improvement (CFHI) and  the Max Bell Foundation, the Newton Foundation, Montreal General Hospital Foundation and the Roasters Foundations, with subsequent support from the Quebec Ministry of Health. 

SOURCE: Canadian Foundation for Healthcare Improvement

Elissa Freeman, For the Canadian Foundation for Healthcare Improvement, Cell: 416.565.5605, [email protected]; Holly Roy, Cell: 780.991.2323, [email protected]