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Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and Quality Outcomes at Northwest Hospital

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Page 1: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Leveraging the Accountable Care

Unit Model to create a culture of

Shared Accountability

How we improved Patient Safety and Quality

Outcomes at Northwest Hospital

Page 2: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Our Journey to Shared Accountability

•Implementation process and outcomes of the ACU model

•Move to culture of Shared Accountability and Outcomes

•Lessons Learned

•Next Steps

Page 3: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

•Implementation process and outcomes of the ACU model

•Move to culture of Shared Accountability and Outcomes

•Lessons Learned

•Next Steps

Our Journey to Shared Accountability

Page 4: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Northwest Hospital will rank among the state’s

BEST in Quality and Patient Satisfaction.

Quest to be the Best

Page 5: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

“Clinicians and institutions should

actively collaborate and

communicate to ensure an

appropriate exchange of

information and coordination of

care.”

2001 Institute of Medicine report:

High Quality Healthcare in US

Page 6: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Healthcare Silos

Skilled Nursing

Facilities

Pharmacy

Outpatient

Services

Emergency

Department

Inpatient Care

Office Based

Provider

Page 7: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Hospital Care Silos

Nursing

Attending

Provider

Case

Management

Resource

Teams

Consultant

Services

Ancillary Service

Teams

Page 8: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Asynchronous Care

RN with Patient

at 8AM

121

2

3

6

9

4

57

8

10

11

Page 9: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Asynchronous Care

Provider with Patient

at 12pm

121

2

3

6

9

4

57

8

10

11

Page 10: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Asynchronous Care

Care Manager/SW with

Patient at 2pm

121

2

3

6

9

4

57

8

10

11

Page 11: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Team Based Patient Care

Nursing

Attending

Provider

Ancillary

Support Team

Case

Management

Resource Team

Consultant Services

Page 12: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Accountable Care Unit Model

Page 13: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

• Unit level Provider and Nursing Co-leadership

• Unit based teams

• Unit level performance reporting

• Interdisciplinary bedside rounds

Accountable Care Unit Model

Page 14: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

ACU Pilot Unit at Northwest

Insert Picture of team here

Page 15: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Length of Stay (LOS)

Benefits of ACU Pilot:

Improved Communication

1.0

2.0

3.0

4.0

5.0

Avg

2015

March

2015

April

2015

5.0

4.09

3.46

Start of

Rounds

Nu

mb

er

of

Da

ys

Page 16: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Benefits of ACU Pilot:

Improved Accountability

76

84

7480 82

43

77

48 47

0

10

20

30

40

50

60

70

80

90

Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15

4D Indwelling Catheter Days 2014-2015

Foley Days Linear (Foley Days)

Start of Rounds

Page 17: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Benefit of ACU Pilot:

Improved Patient Experience

0.0%

50.0%

25.0%

46.2%50.0%

75.0%

61.5%

30.0%

71.4%75.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15

4D Scores

4D Scores Linear (4D Scores)

Start of Rounds

Page 18: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Benefits of ACU Pilot:

Improved Team Satisfaction

5.0

Quality PI reps Care

Management

3.64

4.42

Sc

ore

Providers

3.87

4.58

3.79

4.56

3.75

4.56

Internal Stakeholder survey pre and post ACU model initiation

Goal 4.5

1.0

2.0

3.0

4.0

Page 19: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Unexpected Benefit of ACU Pilot

5.0

Perception of

Staffing Resources

2.54

3.47

Sc

ore

3.87

4.58

3.79

4.56

3.75

4.56Goal 4.5

1.0

2.0

3.0

4.0

Question:

I have appropriate

staffing to provide

the best quality care

to my patients.

Page 20: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

OBSPCU

ICU/IMC

Med/Surg

ACU Co-Leadership Teams

Med/Surg

Med/Surg

ED

Page 21: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Structured Interdisciplinary Bedside Rounds

Page 22: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Our Journey to Shared Accountability

•Implementation process and outcomes of the ACU model

•Move to culture of Shared Accountability and Outcomes

•Lessons Learned

•Next Steps

Page 23: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Patient Safety and Quality Checklist

Page 24: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

ACU Team Members

Provider Partner Nurse Manager

Nursing team Zoned

Hospitalist

Quality,

Infection

Prevention,

Educators

Care

Management

Page 25: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

• Quality

• Infection Prevention

• Educators/CNS

Unit Resource Team

Page 26: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

ACU Co-Leadership Team Meetings

CLABSI

CAUTI

Telemetry

ProtocolFamily

Communication

C diff

Challenging

Patient/FamiliesFalls

Handoff

Communication

Page 27: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

ACU Co-Leadership Team Meetings

OBS

PCU

IMC/ICU

Med/Surg

Med/Surg

Med/Surg

ED

Page 28: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Benefits of Shared Accountability:

Improved Hospital Acquired Infection Rates

Page 29: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Benefits of Shared Accountability:

Decrease in Patient Falls

Page 30: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Benefits of Shared Accountability:

Increased Event Reporting

Page 31: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

System Based Patient Care

Nursing

Attending

Provider

Ancillary

Support Team

Case

Management

Resource Team

Consultant Services

Page 32: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Shared Accountability Approach: MHAC

Page 33: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

•MHAC

•Readmissions

•Mortality

•Others

Shared Accountability:

Readmissions and Mortality

Page 34: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

•Implementation process and outcomes of the ACU model

•Move to culture of Shared Accountability and Outcomes

•Lessons Learned

•Next Steps

Our Journey to Shared Accountability

Page 35: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Critical to Success: Time Investment

ACU Timeline

Nov 2014 March 2017

Page 36: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Critical to Success: Leadership Support

OBS

PCU

IMC/ICU

Med/Surg

Med/Surg

Med/Surg

ED

Page 37: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

Critical to Success: Development

OBS PCU

Med/Surg

Med/Surg

ICU

Med/Surg

ED

Page 38: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

What we would have done differently had

we known….

Communication plan around ACU and Shared Accountability

Visibility of ACU Co-Leadership in cross departmental settings

Implement Ground Rules of Rounds earlier in ACU development

Better incorporation of night teams into ACU structure

Build the ACU framework into onboarding of all new team-members

Page 39: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

•Implementation process and outcomes of the ACU model

•Move to culture of Shared Accountability and Outcomes

•Lessons Learned

•Next Steps

Our Journey to Shared Accountability

Page 40: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

• Private Attendings and Consultants into Model

• Challenging Conversations with Patients and

families

The Journey Continues…

Page 41: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

We are the Accountable Care Units of Northwest Hospital

Page 42: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

We are the Accountable Care Units of Northwest Hospital

Page 43: Leveraging the Accountable Care Unit Model to create a ...Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and

We are the Accountable Care Units of Northwest Hospital


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