Hemodialysis re-design wins 3M quality award

VANCOUVER – The hemodialysis team at St. Paul’s Hospital has won a prestigious national award for a care model redesign that improved patient care and saved close to $700,000. The Canadian College of Health Leaders recognized the team for undertaking the transformational redesign with the 3M Health Care Quality Team Award (Acute Services Category) in Charlottetown, PEI.

The redesign involved completely rethinking the way care is provided on the unit. The unit’s traditional model of care consisted of three patients to one nurse (3:1) regardless of patient needs or acuity. Instead, the team co-located patients with similar needs (based on an acuity scale), allowing the team to support a 2:1 ratio for higher acuity patients, while patients with fewer needs could receive a 3.5:1 ratio. As a result, the team could better personalize patient care.

“These changes allowed us to address patients’ needs more quickly, and with a more personalized approach,” said Michele Trask, Operations Leader for the unit. “We wanted to find a way to allow patients to become more involved in their care.”

The transformation resulted in the following improved outcomes and cost savings:

•  Patients’ self-reported monitoring of their vascular access increased to 70 percent, up from 48 per cent, over the course of one year.
•  A decrease in Emergency Department visits and hospital admissions for patients. The median visit rate dropped to one visit per month for every eight patients, down from one in five patients previously.
•  Combined cost savings of $688,242.80 from staffing efficiencies and cost avoidance related to a reduction in overtime spending.
•  Improved staff engagement and morale.

The design touched every part of the unit. Using Lean methodologies and Time-in-Motion studies, the team redesigned everything right down to supply carts, along the way restructuring every role including nurses, social workers, renal technicians and unit coordinators, while also adjusting the rotations for almost 90 nursing staff members. This allowed the team to better match nursing shifts to the care that patients required.

A portion of the savings was reinvested to create a patient navigator role that helps patients determine the right level of treatment (e.g. peritoneal, home, community or hospital hemodialysis) and education they require.

The role of nurses also evolved as they became more focused on being mentors, coaches and educators. This has brought a new job satisfaction, as people get a new sense of joy from seeing their patients grow and progress.

“We strive to create environments where people can take risks and form ideas in a way that is focused on improving the care of the people we serve. It’s inspiring to see our staff challenge the status quo and question whether the care they provide can be improved,” said Dianne Doyle (pictured), President and CEO of Providence Health Care. “Because hemodialysis patients come to our hospital multiple times a week, this project represents a great opportunity to improve care and find cost-savings. This transformation is proof that we can accomplish both.”

The team created an orientation system and a new patient pathway that assisted patients with goal identification (e.g. return to work, plan a vacation, overall better sense of wellness), which is then used as a way to engage the patient in their care. The care area was divided into pods – involved care, complex care, short stay, and general population. The team also improved transition points from one nurse to another, including documentation, handovers, and doctor and nurse rotations.

The 3M award is an annual award, recognizing three important elements: innovation, quality and teamwork. 3M Canada Company encourages institutions and healthcare providers to embrace quality management by developing innovative approaches that bring about sustainable improvement.

“It is well-known that the more involved a patient and their family are in the care process, the better the outcomes,” said Warren Hart, Renal Program Director. “Having patients partner with their care providers is a strategic priority of Providence Health Care and exemplifies our vision and values of patient and family centered care.”

St. Paul’s Hospital houses a 46-station hemodialysis unit serving 300 patients, on average, three times per week. Hemodialysis filters wastes, salts and fluid from the blood of patients with advanced kidney failure.

The award was presented at the National Health Leadership Conference in June 2015. The conference is the largest national gathering of healthcare leaders in Canada and provides a forum for questions, debate and sharing strategies and solutions to the most pressing health system challenges. It is presented by the Canadian College of Health Leaders in partnership with the Canadian Healthcare Association.

About Providence Health Care (PHC)

Providence Health Care (PHC) is one of Canada’s largest faith-based healthcare organizations, operating 16 healthcare facilities in Greater Vancouver. PHC operates one of two adult academic health science centres in the province – St. Paul’s Hospital – performs cutting-edge research in more than 30 clinical specialties, and focuses its services on six “populations of emphasis”: cardio-pulmonary risks and illnesses, HIV/AIDS, mental health, renal risks and illness, specialized needs in aging and urban health and is home to the B.C. Centre for Excellence in HIV/AIDS. Please visit www.providencehealthcare.org.