20,000 Days Campaign Storyboard
Learning Session 3, 11-12 March 2013
Better Breathing
Programme Collaborative
Clinical Leads: Sarah Candy & Fiona Horwood
Team: Jen Mepham, Charulata Kulkarni, Prof Harry Rea, Fiona
Smyth, Samuel Menia, Barbara Lambert, Meg Goodman, Rose
Ikimau, Michelle Mills, Ta-Mera Rolland, Richard Small, Sarah
Mooney
Project Manager: Alison Howitt
Improvement Advisor: Prem Kumar
Decision Support: Penny Wilkings
Aim
• The aim of this project is to keep more people with
chronic respiratory disease well in the community by
increasing the number of participants enrolled into
Better Breathing (community based pulmonary
rehabilitation) from 60 to 250 per year.
This will result in;
a reduction of unplanned admissions,
increased exercise tolerance and improved
health related quality of life.
Driver Diagram
- Include Collaborative Driver Diagram
Change Packages
2O Drivers
Change Ideas Tested
(describe process)
Evidence of
Improvement
Access &
Community
Community Location and Venue
Transport options
Attendance &
Feedback
Access &
Community
Patient Engagement
GP support and involvement
Supporting attendance for Maori and
Pacific patients
Attendance &
Feedback
Identifying
patients
Referrals
Assessments
Waiting List,
drop outs &
starting
programme
(Theory of change)
Change Packages
2oDrivers
(Theory of change)
Change Ideas Tested
(describe process)
Evidence of Improvement
Programme
Programme Content
Sessions and format
Equipment
Speakers
Clinical outcome assessments
Based on current
research, modifications
based on testing, user
feedback.
Combined
Programme
Healthy Hearts – Heart Failure Initial set up phase.
Patients
Most Successful PDSA Cycles?
- Include PDSA Tree diagram
Most Successful PDSA?
• Continue to refine and
measure the programmes.
• Offer as a Franchise model
with flexibility to suit
patient demographice
Act
• Programmes need to be
Study
design to suit the community
they serve and each
community is different.
• Having the flexibility to
provide programmes tailored
to the patient demographics
is essential for best
outcomes
• Additional pulmonary
rehabilitation
programme into the
community
• Otara
• Pukekohe
Plan
Do
•
•
•
•
•
•
Identify & secure venues
Supply equipment
Design programme
Engage Community
Identify patients
Arrange staffing &
speakers
• Start programme
Measures Summary
•
Outcome Measures
– The number of patients enrolled in each community Better
Breathing programme
– The number of unplanned hospital admissions
•
Process Measures
– The number of referrals to Better Breathing
– The number of participants who start Better Breathing
– The number of participants completing the programme
– The change in distance walked on 6 minute walk test
– The change in health related quality of life questionnaire
scores
Implementation
Implementation
Areas
Changes to Support
Implementation
Standardisation Developing Process Map
Programme Guidelines
PDSA cycles
Developed Otara, To some
extent tested in Pukekohe
Documentation Plan to create a franchise
“options” document giving
examples as case studies
Training
Measurement
Resourcing
Developing training materials Testing on new staff
Produce and monitor
guideline measures, covering
clinical outcomes, patient
drop out and completions
targets.
Information on ideal venue,
staffing and equipment in
Franchise document.
Adapted from “The Improvement Guide. A Practical Approach to Enhancing Organizational Performance” Gerald Langley et al., 2009, p180.
Highlights and Lowlights
Highlights
- Accessibility – patients report they are now able to attend a
programme
- Patients feel safe and supported in a familiar environment
which is in the heart of their community
- As a whole, the pulmonary rehabilitation service is able to offer
an increased number places on the programme (240 – 450)
- Increased profile of pulmonary rehabilitation in South Auckland
Lowlights
- Recruitment of staff
- Practise nurse involvement in Otara
- Pukekohe site size and availability
Achievements to date
Moving Pulmonary Rehabilitation to the community
Venues, equipment, programme, speakers, referrals,
assessments, staff, speakers, advertising, patient information,
cultural support
Starting the Better Breathing Programme in Otara (running for 7
months)
Starting the Better Breathing Programme in Pukekohe. (4 intakes)
Testing and refining everything while we are doing it.
Learning from the patients and the community
Co-ordinating all the various groups, departments, stakeholders and
people.
Thank you to everybody that has been involved
20,000 Days Campaign Storyboard
Learning Session 3, 11-12 March 2013
Better Breathing
Clinical Pathway
Clinical Leads: Fiona Horwood, Richard Hulme
Team: Katie Coulter, Nicola Corna, Diana Hart,
Sue Beaumont-Orr, Michelle Mills, Ta-Mera Rolland, Richard Small
Project Manager: Alison Howitt
Improvement Advisor: Prem Kumar
Decision Support: Tanesha Patel
Aim
• The overall aim of the Better Breathing Collaborative is
to work together with the Counties Manukau Community
to help people with breathing problems to manage their
condition well in the community.
• This will be accomplished by
•Providing community based pulmonary rehabilitation, for
250 in Otara and Pukekohe.
•Introducing a COPD care bundle for patients with a primary
diagnosis of COPD patients in Middlemore Hospital.
•Increasing the numbers of COPD patients, identified in
primary care and by piloting the introduction of an “early
diagnosis primary care bundle.”
Driver Diagram
- Include Collaborative Driver Diagram
Primary Care Change Packages
2o Drivers
Change Ideas Tested
Describe Process
(Theory of
change)
Early
Primary Care Bundle
Diagnosis
The receptionist gives a CAT survey to
a patient who is 40y+, is a smoker or
ex-smoker & doesn’t have known
asthma. The CAT survey has been
incorporated into a decision support
tool in the GP Patient Management
System. GP act on the information
provided by the patient
Clinical
Pathway
Roll out CME course developed by
Clinical Pathway Group and ProCare.
Focus on spirometry and WOF.
Primary Care COPD
Pathway CME
Primary and Secondary
Change Ideas to be tested
2o Drivers
Change Ideas
(describe process)
(Theory of
change)
Secondary care bundle has been
developed and tested, using the “pink”
form
Winter warrant of fitness for target
patients
Options for spirometry in the community
•
•
•
•
Practices/Shared Group of Practices
Locality Hub
Alongside Better Breathing Programme
Huff and Puff Bus
Evidence
Further
evidence is
required
Most Successful PDSA Cycles?
Based on UK
developed
Care Bundle
Tested Resp
Ward
Re-think and
Simplify
Tested Resp
Ward
Order changed
Y/N added
Tested Resp
Ward
One box
removed, not
enough patients
to test
Tested Resp
Ward & Gen
Ward
Further info
added for non
Resp wards
Tested on Gen
Ward
Referral Check
box, sign & date
added
Tested Resp &
Gen Ward
Testing
continues and we’ve
learn’t a lot
Measures Summary
-
Measures related to Aim
Graphs of key measures
Which of your run charts would you give to senior leadership to use?
Include Collaborative Dashboard
Measures Summary
Outcome Measure
• Unplanned admissions to Middlemore Hospital
• Length of Stay in Middlemore
• Readmission rate
Process Measures
• Numbers of patients identified with COPD in primary care.
• Numbers of patients receiving all or parts of early diagnosis primary
care bundle.
• Numbers of patients offered, attending and completing community
based pulmonary.
• Numbers of patients receiving discharge care bundle.
• COPD patients by localities
Highlights and Lowlights
-
Highlights
- Working across primary and secondary care.
- Forming, what has become the COPD Team to work on the
secondary care bundle.
- Having the opportunity to review best practices, adapting
and testing them for our patients and community.
- Partnering with Auckland & Waitemata DHB’s for the COPD
primary care pathway.
- Sharing ideas and learning’s with Northland DHB and
Canterbury
-
Lowlights
- The challenges of testing when there are no patients.
- Finding a meeting time that everybody can attend.