Review of Clinical Information Service & Registration & Admission Processes

This review, conducted in a mental health setting, had central goals regarding the data process within the organization. The review began with key informant interviews. Findings from this phase contributed to direct observation, and interviews in the reviews of clinical information services and registration and admission. These specific reviews resulted in detailed findings and associated recommendations aimed at the central data process goals, as well as the clients’ areas of interest regarding the current organization of process, internal capacity, and organizational challenges.

Work Flow Analysis for a Community Health Centre

A team conducted a workflow analysis aimed at facilitating change to current clinical administrative systems. This project took place in a highly complex setting, where client privacy must be sensitively respected.  As well, the client must remain consistent with best practice in their clinical service areas. A redesign of the administrative structure was presented in text and visual format, and supported by quantitative results from work flow studies and in-depth key informant interviews.

Future of Healthcare in Canada

This is a massive opinion leader study based on in-depth personal interviews with 80 of the most influential people in healthcare today, as nominated by their peers.  Participants include deputy ministers, academics, hospital executives, healthcare practitioners and other qualified parties.  The aim is to identify how healthcare will develop over the next 5-10 years and why this will happen.  Royal Bank of Canada and Manulife Financial are sponsoring the work.  The study includes a special report on funding & financing issues for RBC, as well as a special report on insurance & benefits for Manulife Financial.  Link to Overview of Findings. 

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- Analysis of Care Systems
- Data, Detail & Decisions  

National Infrastructure For Electronic Health Records

Electronic Health Records (EHR) are increasingly part of our health care system, but access to them remains in the paper based paradigm. What would be the impact of an infrastructure creating a comprehensive EHR system on a national scale -- not as a replacement for local systems but as a central repository for information on patient care of all kinds? This study looks at the economic and social impact of this kind of system for representative groups of patients. Expert reviews of information flow and patient care are compared, before and after creating a comprehensive system. We look at the use of information across the health care system when dealing with a patient episode and the kinds of benefits that would accrue from better access to a wide range of reliable information. Concerns of data integrity and privacy are also part of the discussion. Expert opinion establishes both the economic value and the quality of care benefits that are likely to follow from this kind of system.

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- Information Management

Review & Future Plans for Quality and Utilization Management Programs

The Quality and Utilization Management Program at a large community hospital was felt to be an important influence on patient care management processes. It has been cited as a benchmark program for external facilities as an example of successful approaches to managing resources and patient access to hospital services. In light of the changes within the hospital and in the external community, a project was initiated to conduct a review to determine future plans for this program within the hospital.
Through consultation with various internal stakeholders, various goals were identified for the review. A confidential, semi-structured interview process was utilized with all stakeholder groups. The final report was structured around the goals, identified common themes and specific key concerns identified in the review process, and included recommendations regarding new structures, adapted processes, and valued elements to retain. Click here to see a Brief Overview.

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- Data, Detail, & Decisions
- Utilization Management

Therapy Service Delivery Model Project

A community based multidisciplinary care organization is engaged in developing an overview of major client groups, along with consistent therapy service models across all clients and service sites. In addition to the clear picture of major client groups, the key stakeholders in the project group have also identified critical junctures in the client journey. Development of flow charts of the clients’ experiences for the basis of related care management tools. The project management plans take into account the organization’s steps in integrating learning organization processes and attitudes.

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- Analysis of Care Systems
- Utilization Management

Patient Registration, Booking and Registry Project

The Brondesbury Group produced a report, documenting their findings of the Registration, Booking and Bed Registry environment review in a large multi-site community hospital. The report included suggested recommendations for improvement and supporting business cases as well as implementation plans.
The objective of this project was to gain a complete and thorough understanding of the processes and workflows within the Registration, Booking, and Bed Registry environments, such that the efficiencies and inefficiencies were clearly understood and documented. The review involved in-depth analysis of staff and process at both the larger facilities and a sample of community based clinics. Click here to see a Brief Overview.

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- Information Management
- Data, Detail & Decisions

Design of Survey Instruments – Provincial Study of Primary Care Processes

In order to effectively move primary care record-keeping to an electronic environment, one needs to understand the critical information flows. As part of a larger study for a provincial government, we created survey instruments to track communications flows related to primary care. The instruments identified the source and destination of communications, their nature, the information conveyed and the priority level of information exchanged. Instruments were designed to identify both frequency and importance of information, so that a system geared to both considerations could be developed.

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- Information Management

Using Decision Support Feedback for Care Management Planning

A clinical team in a large teaching hospital had excellent decision support information to support their ongoing clinical and utilization management. An initial meeting with the core team members set the goals and framework for their ongoing process. This was followed by the facilitation of an initial full team meeting. Team members were supported in the important steps of depersonalizing the message, and working step by step in isolating key information to guide the selection of areas of success and challenge. An action plan from that meeting was provided, and the team continued the meeting process independently.

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- Data, Detail & Decisions

Decision Support Framework for a Multi-Site Community Hospital

A large multi-site community hospital used a stakeholder driven process to identify key areas to support with a decision support department. The framework built on skills of data analysis from health records, patient care management from utilization management and pathways processes, and program evaluation processes to support both ongoing hospital program development and the formative evaluation and development of the new department. Challenges included meeting the needs of administrators for decision support when data were not yet available, and developing ways of collecting and communicating information about the data flow, the data message, target patient groups, and summary messages.

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- Data, Detail, & Decisions
- Utilization Management

Patient Flow Project

Hospitals, Emergency Rooms, and clinics are busy and complex places. One way to understand inefficiencies and improve the timeliness of care is to follow the patient through a typical care encounter, and identify bottlenecks and inefficiencies. It is important to have all key stakeholders involved in this exercise, however, as changes made in one part of the system without full consultation may increase inefficiencies in another part of the organization. This project combined the perceptions and experiences of a wide variety of caregivers from all sites within a multi-site care facility to provide a detailed flow chart of patient flow through the system in a typical encounter. This allowed the identification of bottlenecks and inefficiencies from multiple points of view. Management of this project included facilitating the design of the process, the set up of the sessions (with appropriate neutral outside facilitators), analysis of the session output, creation of the flow charts, and identification of action plans and implementation strategies. Follow-up to the project included ongoing formative evaluation of activities, and identification of activities still needed.

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- Analysis of Care Systems

Maintenance Program for Utilization Management Process

In addition to daily patient acuity review activities, strategies for targeting patient groups for rotating audits were developed. Feedback processes to physicians at both individual and group level were developed and adapted as the nature of utilization challenges changed due to the impact of the program. A training program in utilization management for patient care facilitators was also developed. The program was based on a scan of the organization for enablers and blocks, as well as the strategic understanding of the organizations issues and goals, industry and government standards and benchmarks. A gap analysis was used as a starting point in planning content. Finally, the development and delivery of both self-learning material and workshops on “ALC” (Alternated Level of Care), addressed strategic utilization issues where knowledge gaps were identified.

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- Utilization Management
- Data, Detail, & Decisions