Download - Unintended Consequences and WTMS Workshop on Waiting Time Management Strategies for Scheduled Health care Ottawa March 28, 2012 Marie-Pascale Pomey, MD,

Unintended Consequences and WTMS

Workshop on Waiting Time Management Strategies for

Scheduled Health care

OttawaMarch 28, 2012

Marie-Pascale Pomey, MD, PhDJuan Carlos Sabogal, MD, MHA (c)

OUTLINE OF THE SESSION

1.Research project

2.Concept of Unintended Consequences

3.Individual task

4.Audience discussion

Unintended ConsequencesUnintended Consequences

Project 4: What Seems to Be Working (or not)?

• Objective: What are the determinants that can explain why a waiting time management strategies (WTMS) for total joint replacement (TJR) surgeries to respect federal benchmark in Canada is sustainable or not?

• Sub-objective: What are the potential Unintended Consequences of implementing those WTMS?


DEFINITION

“Unintended consequence refers to a particular effect of purposive action

which is different from what was wanted at the moment of carrying out the act, and the want of which was a reason for carrying it out”.

(Baert, 1991)


INTENDED vs. UNINTENDED CONSEQUENCES

INTENDED: Purpose and intention of actionGoals of any event (positive consequences)• Improved WT• Increase patients’ satisfaction

UNINTENDED: Lack of intention and purposefulness(positive and negative consequences)• Select non complex cases• Increase team innovation culture


DESIRABLE vs. UNDESIRABLE

CONSEQUENCESDESIRABLE CONSEQUENCES (Positive)* Improved WT• Work team• No increase in nosocomial infections

UNDESIRABLE CONSEQUENCES (Negative)* Increase in other WTs (neurosurgery, general

surgery)* Increase in medical complications


DIRECT vs. INDIRECTCONSEQUENCES

DIRECT: Changes that occur in immediate response to an event ( Rogers, 1995)

• Improved OR time for hip and knee surgeries.

INDIRECT: Consequence caused by a chain of events (Bloomrosen, 2011) “Consequences of consequences” (Rogers, 1995)

• Increase in OR time in other specialitiesUnintended ConsequencesUnintended Consequences

ANTICIPATED vs. UNANTICIPATED CONSEQUENCES

ANTICIPATED: Ability to forecast (positive or negative)

• Stress on staff• Tension among surgeons

UNANTICIPATED: Inability to forecast (positive or negative)

• Increase OR time for other surgeries• Role model of the program


ATTRIBUTES OF UNINTENDED CONSEQUENCES (Rogers, 1995; Bloomrosen et al. 2011)


DEFINITIONS

• Anticipated and desirable consequences: “Goals”: Objectives of a WTMS – Reduction in WT / WL

• Anticipated and undesirable consequences: “Trade-offs”: We accept that there are some likelihood effects in exchange for a greater good - Stress on staff.

• Unanticipated and desirable consequences: “Serendipities”: Happy surprises - Team cohesion.

• Unanticipated and undesirable consequences: Negative consequences that are not anticipated or expected (negative side effects) - Increase in WT for a surgeon consultation


THREE DIFFERENT LEVELS OF CONSEQUENCES


CONSEQUENCES AT THE FEDERAL/PROVINCIAL HEALTH CARE

SYSTEM LEVELExamples:

Budget: * Less budget for other areas (-) * No funding to sustain WT strategies in

the long term (-)

Waiting time: * Increased WTs in other specialities (-)

Health policies: * Less attention to other WTs, for example, neurosurgery,

general surgery, paediatric surgery (-)

* Used the same policy as a role model for different subjects (+

or -) Unintended ConsequencesUnintended Consequences

ORGANIZATIONAL LEVEL

REHABILITATIONSURGERYREFERRAL PROCESS


CONSEQUENCES AT THE ORGANIZATIONAL LEVEL

Examples:Pre-hospital: * Lack of knowledge of the

referral process by GPs (-) * Patients better informed

(+)

Hospital: * Team work in OR (+) * Decrease in OR time for

other specialties (-)

Post-hospital: * Lack of follow-up in the rehabilitation process (-)

* Patients' satisfaction (-/+)


CONSEQUENCES AT THE INDIVIDUAL LEVEL

Examples:Managers: * Increase personal and

professional Motivation (+)

Health Professionals: * Tension among surgeons (-)

* Stress on staff (-)

Patients: * Decrease in patients’ satisfaction (-)


WORKSHOP: Task

From your own experience, and based on the framework presented, can you share with us some examples of UCs in terms of:Could you fill in the worksheet

with some examples of…Trade-offs

SerendipitiesNegative UC


TIME CONSTRAINTS

Individual brainstorming : 10 min.

Audience discussion: 15 min.


WORKSHEET

ANTICIPATED AND DESIRABLE

“INTENDED or Goals”

ANTICIPATED AND UNDESIRABLE

“Trade-offs”

UNANTICIPATED AND DESIRABLE =

“Serendipities”

UNANTICIPATED AND UNDESIRABLE“UNINTENDEDor Negative”


THANK THANK YOUYOU

THANK THANK YOUYOUUnintended ConsequencesUnintended Consequences

Download - Unintended Consequences and WTMS Workshop on Waiting Time Management Strategies for Scheduled Health care Ottawa March 28, 2012 Marie-Pascale Pomey, MD,

Top Related