1. Shared CareShared Care
Design ofDesign of a Quality Pilot Projecta Quality Pilot Project
Carol Gray, Service Excellence Project ManagerCarol Gray, Service Excellence Project Manager
January 13, 2009January 13, 2009
2. Meeting LogisticsMeeting Logistics
• Facilitator, Carol GrayFacilitator, Carol Gray
• Leader, Sue GronostajskiLeader, Sue Gronostajski
• Design Team, All of UsDesign Team, All of Us
• Clinical Directors, Staff ManagersClinical Directors, Staff Managers
• Meet Once / WeekMeet Once / Week
• Decisions Made – Discussion / ConsensusDecisions Made – Discussion / Consensus
• Be Here…Cells & BBs – Vibrate, SilentBe Here…Cells & BBs – Vibrate, Silent
3. AgendaAgenda
• Project / Meeting ObjectivesProject / Meeting Objectives
• Information SharingInformation Sharing
• Expected OutcomesExpected Outcomes
– Pilot TeamsPilot Teams
– ProjectProject
• Questions / Next StepsQuestions / Next Steps
4. Project ObjectivesProject Objectives
• Design a Pilot Team ProjectDesign a Pilot Team Project
• Duration - 3 MonthsDuration - 3 Months
• Produce 2 Pilot Teams in New HanoverProduce 2 Pilot Teams in New Hanover
• Achieve OutcomesAchieve Outcomes
– Determined by Design TeamDetermined by Design Team
• Begin Late Spring 2009Begin Late Spring 2009
5. Meeting ObjectivesMeeting Objectives
• Share InformationShare Information
– Definition of Shared CareDefinition of Shared Care
– Purpose and Value of Shared CarePurpose and Value of Shared Care
• Determine Expectations ofDetermine Expectations of
– Pilot TeamsPilot Teams
– Pilot ProjectPilot Project
• Answer QuestionsAnswer Questions
6. HistoryHistory
• Senior Leaders Questioned Current Care ModelSenior Leaders Questioned Current Care Model
• Heard Great Success of Shared CareHeard Great Success of Shared Care
7. Hospice Surveys
• Hospice Care of Boulder & Broomfield
Counties – Boulder, CO
• San Diego Hospice & Palliative Care - CA
• Capital Hospice – Washington DC
• Hospice of the Western Reserve –
Cleveland, OH
• Hosparus – Louisville, KY
8. LCFH Types of CareLCFH Types of Care
• Adult Home CareAdult Home Care
• InpatientInpatient
• Routine Home CareRoutine Home Care
• Nursing Home CareNursing Home Care
• On CallOn Call
• Continuous CareContinuous Care
• Extended careExtended care
• Routine Home CareRoutine Home Care
• Adult Home CareAdult Home Care
• Nursing Home CareNursing Home Care
Shared Care
9. Purpose of Shared CarePurpose of Shared Care
• Better Hospice CareBetter Hospice Care
• Nursing ShortageNursing Shortage
10. What is Shared Care?What is Shared Care?
• Interdisciplinary Care NotInterdisciplinary Care Not
Multidisciplinary CareMultidisciplinary Care
• All Team Members Equally Aware Of Pt’sAll Team Members Equally Aware Of Pt’s
Physical, Emotional, & Spiritual StatusPhysical, Emotional, & Spiritual Status
• Increase Focus On Patient NeedsIncrease Focus On Patient Needs
– WHAT IS PT/FAMILY’S GOAL, WISH,WHAT IS PT/FAMILY’S GOAL, WISH,
IMPORTANT?IMPORTANT?
11. What is Shared Care?What is Shared Care?
• Workload Shared Among All TeamWorkload Shared Among All Team
MembersMembers
• Response To Pt & Family Needs IsResponse To Pt & Family Needs Is
Shared By All Team MembersShared By All Team Members
• Emphasis On Team Support Rather ThanEmphasis On Team Support Rather Than
Individual Team Member’s DisciplineIndividual Team Member’s Discipline
12. What is Shared Care?What is Shared Care?
• Team Schedules & Makes Admission VisitTeam Schedules & Makes Admission Visit
TogetherTogether
• Admission Tasks SharedAdmission Tasks Shared
• Discipline-Specific Assessments CompleteDiscipline-Specific Assessments Complete
• Admission Visit Takes 1.5 HoursAdmission Visit Takes 1.5 Hours
• Half the Time of Our Admission VisitHalf the Time of Our Admission Visit
13. What is Shared Care?What is Shared Care?
• Allows Each Discipline New OpportunitiesAllows Each Discipline New Opportunities
• Shift in ResponsibilitiesShift in Responsibilities
– 4 P’s4 P’s
– Case CoordinationCase Coordination
• Enable Disciplines to Utilize ImprovedEnable Disciplines to Utilize Improved
SkillsSkills
• Builds Pt / Family RapportBuilds Pt / Family Rapport
14. What is Shared Care?What is Shared Care?
• Each Hospice CareEach Hospice Care
TeamTeam
– 1 Social Worker (SW)1 Social Worker (SW)
– 1 Registered Nurse1 Registered Nurse
(RN)(RN)
– ½ Chaplain (CP)½ Chaplain (CP)
– 1 Hospice Aide (HA)1 Hospice Aide (HA)
– ~18 Patients~18 Patients
• Visit LengthVisit Length
– 45-60 minutes45-60 minutes
– 45-60 minutes45-60 minutes
– 45-60 minutes45-60 minutes
– > 1 Hour> 1 Hour
15. 4 P’s – Most Common Concerns4 P’s – Most Common Concerns
• PainPain
• PoopPoop
• PillsPills
• ProductsProducts
16. 4 P’s4 P’s
• AT EVERY VISIT, EACH TEAMAT EVERY VISIT, EACH TEAM
MEMBER WILL ASSESS THE 4 P’s BYMEMBER WILL ASSESS THE 4 P’s BY
ASKING THESE 4 QUESTIONS:ASKING THESE 4 QUESTIONS:
1.1. HOW IS YOUR PAIN?HOW IS YOUR PAIN?
2.2. DO YOU NEED ANY MED REFILLS?DO YOU NEED ANY MED REFILLS?
3.3. HOW ARE YOUR BOWELS?HOW ARE YOUR BOWELS?
4.4. DO YOU NEED ANY SUPPLIES?DO YOU NEED ANY SUPPLIES?
17. Day to DayDay to Day
• Team Roles RotateTeam Roles Rotate
– Point Person of the Day (PPD)Point Person of the Day (PPD)
– FacilitatorFacilitator
– TimekeeperTimekeeper
• Care Coordination Meetings (CCM) &Care Coordination Meetings (CCM) &
Comprehensive AssessmentsComprehensive Assessments
18. PPDPPD
• Designated For Each Day At The CCMDesignated For Each Day At The CCM
• Responds To Incoming Phone Calls ToResponds To Incoming Phone Calls To
Team That Day To CoordinateTeam That Day To Coordinate
Communication For The Patient AmongCommunication For The Patient Among
All DisciplinesAll Disciplines
– Transfers/Changes in POCTransfers/Changes in POC
– Pain/Symptom AssessmentPain/Symptom Assessment
– DME & SuppliesDME & Supplies
19. Weekly MeetingsWeekly Meetings
• IDT: Doctor, Director, BereavementIDT: Doctor, Director, Bereavement
Present; Status & POC Updated. Half ofPresent; Status & POC Updated. Half of
Patients Discussed.Patients Discussed.
• Care Coordination: Planning This Week-Care Coordination: Planning This Week-
New Admissions, Team Assessments ofNew Admissions, Team Assessments of
Patients’ NeedsPatients’ Needs
– ““Who needs to be seen today and who needsWho needs to be seen today and who needs
to go?”to go?”
20. Care Coordination MeetingCare Coordination Meeting
• 1 Team Only1 Team Only
• Required - RN, SW, CP, HARequired - RN, SW, CP, HA
• Rotating Roles Of Facilitator & TimeRotating Roles Of Facilitator & Time
Keeper Named Each MeetingKeeper Named Each Meeting
• The PPD For That Day Should Not Be TheThe PPD For That Day Should Not Be The
Facilitator Or TimekeeperFacilitator Or Timekeeper
21. Initial VisitInitial Visit
• Admissions RN Will Complete:Admissions RN Will Complete:
– Admissions PaperworkAdmissions Paperwork
– Nursing AssessmentNursing Assessment
– (Not Psychosocial Or Spiritual(Not Psychosocial Or Spiritual
Assessments)Assessments)
• Admissions RN Then Contacts PPD AndAdmissions RN Then Contacts PPD And
Reports Key Issues For PatientReports Key Issues For Patient
22. Initial VisitInitial Visit
• PPD Then Contacts Pt/Family To Set UpPPD Then Contacts Pt/Family To Set Up
A Time For The Team To VisitA Time For The Team To Visit
• This Is The “Family Visit / ComprehensiveThis Is The “Family Visit / Comprehensive
Assessment ”Assessment ”
– Done Jointly By SW, RN, & CPDone Jointly By SW, RN, & CP
• All Three Visit Together If At All Possible;All Three Visit Together If At All Possible;
At Least Two RequiredAt Least Two Required
23. Pilot TeamsPilot Teams
• Member TraitsMember Traits
– Clinically SoundClinically Sound
– Open MindedOpen Minded
– Not NegativeNot Negative
– Not Afraid of ErrorsNot Afraid of Errors
– Not Afraid of Giving/Receiving FeedbackNot Afraid of Giving/Receiving Feedback
24. Benefits of Shared CareBenefits of Shared Care
• ImprovedImproved
– Coordination/CommunicationCoordination/Communication
– Clinical CareClinical Care
– System EfficiencySystem Efficiency
– Customer SatisfactionCustomer Satisfaction
– Employee SatisfactionEmployee Satisfaction
• Increased Utilization of SWs & CPs inIncreased Utilization of SWs & CPs in
Appropriate SituationsAppropriate Situations
25. Anticipated OutcomesAnticipated Outcomes
• Improve Quality of Care DeliveredImprove Quality of Care Delivered
• Address Clinical Issues of StaffAddress Clinical Issues of Staff
– # Interruptions During the Day# Interruptions During the Day
– Resolving Patient/Family CrisesResolving Patient/Family Crises
– Waiting to Hear From / Inability to Reach aWaiting to Hear From / Inability to Reach a
Team MemberTeam Member
• Improve Employee SatisfactionImprove Employee Satisfaction
