The 90 Days of Innovation: Ready Every Day Information and Decision Support team has been focused on:  “Creating a system that proactively predicts and supports current and future patient demand.” Their project list is as follows:

What is off-servicing?
This happens when a patient receives services other than those designated for that unit bed example a surgical patient in a general medicine unit.
What is a master rotation?
A schedule of all positions and hours of work for staff within an service area, designed to best meet the needs of patients while respecting collective agreements.

Proactively manage demand based on best practice models – the team has developed a forecasting methodology to predict demand at a 90 per cent degree of accuracy, including best practices from other regions. The team has also implemented a regional data mart (repository), which extracts key information from various Region systems so the information can be provided in one place and can more readily populate information dashboards for staff. An on-line snapshot of key metrics for the current and previous day, and a seven-day forecast for admissions and discharges by site was created, providing a clear view of overcapacity and off-servicing metrics by site and unit. Their next steps are to imbed the staffing projection into the daily snapshot and information dashboard, develop and implement service and unit level information dashboards, and establish standard work for reviewing and managing quarterly forecasts to better manager capacity.

Improve management accountability through leaders’ standard work, including daily cascading information sharing huddles (where one level of the organization meets and reports any concerns or question up to the next level) and visibility walls (a board on the wall where teams gather that contains information the team needs to make daily decisions). Additionally, improvement events have been held to develop a manager education model, expectations of a manager’s role has been clarified, and a patient-first management system for managers is being developed. Up next, the team will focus on completing the patient-first management system, hold an improvement event to design the future state of a manager’s day.

Match staffing to demand and develop a decentralized manager support system – The team is trialing a number of improved manager supports in three pilot units at Royal University Hospital. Some examples include developing updated and optimized master rotations, and embedding human resource support staff in the units to assist with resource demand and scheduling. The team has established regional staffing principles and launched an assessment of the impact of staff bank days (facility-wide planned day off every three weeks) on patients. Up next, the team will be providing support for managers on the new processes for hand-off and follow-on, replicating programs at St. Paul’s Hospital, and providing recommendations on how best to address the impacts of bank days.

Bed Capacity and capacity alignment to service demand – The team has reviewed all adult beds and identified inappropriate beds by unit, as well as potential additional beds, evaluated bed capacity by service compared to historical utilization, and engaged physicians, leaders and staff on the plan to eliminate off-servicing.  Next, they will be working with three physicians to develop two possible options for realigning beds, presenting the options to a cross-functional stakeholder group, and developing a plan for realignment, and complete the closure of all inappropriate spaces.

Working on this 90-day cycle has enabled the team members of Information and Decision Support to complete years’ worth of work in a very condensed period of time and move several other projects significantly forward. Team 3 has engaged hundreds of staff and physicians in their work.

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