AUTONOMOUS COLLABORATIVE CARE DELIVERY MODEL Bonnie Hall and Marie - - PowerPoint PPT Presentation

AUTONOMOUS COLLABORATIVE CARE DELIVERY MODEL

Bonnie Hall and Marie Marques National Healthcare Leadership Conference Toronto ON June 12th, 2007

Overview of Presentation

• Provide an overview of an

innovative care delivery model

• Discuss the implementation
• Evaluation
• Lessons learned

Patient- Centered Care Nursing Professional Practice Model Autonomous Collaborative Care Delivery Model SCO Health Service Philosophy of patient care Nursing Governance Nursing Advisory Committee Nursing Care Delivery Model

Vision for Patient Care & System Effectiveness

Care Delivery Model

Autonomous-Collaborative Care Model

Patients and Families

Registered Nurse Registered Practical Nurse Personal Care Attendant

Interdisciplinary Team

Definitions of Terms

• Autonomous

– Freedom to act on what you know, to make independent clinical decisions that exceed standard nursing practice, in the best interest of the patient.

• Collaboration

– Collaborative Nursing Practice means sharing in planning, decision-making, problem solving and goal setting.

General Principles Guiding the Autonomous – Collaborative Care Model

• Provides for the highest level of

continuity of care

• Provides for smallest number of

different categories of workers assigned to a patient on any given shift

• Ensures highest level of autonomy for

the care provider

• Ensures the right category of care

provider

Guiding Principles

• Knowledge
• Caring

– Continuity of Care – Therapeutic Relationship

• Collaboration
• Patient-Centered Care
• Healthy Work Environment

Role Expectations- RN, RPN, PCA

Implementation

Communication plan:

– Nursing Advisory Committee – Medical Advisory Committee – Professional Advisory Committee – Management Team – Unit specific sessions – all shifts

• Collaboration:

– Nursing Resource Team and Managers – Evaluation

Evaluation

Evaluation direct observation and focus groups

• RNs

– assigned to most complex patients – assigned to all new admissions until a plan of care is in place

• RPNs

– family conferences and team rounds – contacting the physician when patients’ conditions change – working autonomously when caring for stable and predictable patients – performing an increased number of nursing skills based on knowledge, skills and judgment and policies revised to enable full scope of practice

• PCAs

– no longer assigned responsibility for overall care of patient but rather, to aspect of personal and basis care

Evaluation: Number of Care Providers

10.9 10.9 13.6

• Audit (random sample 10%-week) number of times

a different care provider was assigned

• Lower the score, that is, the least number of

different care providers, the better the outcome

• 3 individual (21.4%)

Post T2 (18 months) Post T1(6 months) Pre # Different Care Providers Total (x/21)

Right Category of Care Provider

18.0 17.4 12. 1 5.7 6.8 4.4 5.8 5.25 6.2 6.2 5.8 3.6 CCCP

Right category of care provider assigned to appropriate type of patient Complexity, stability and predictability Audit patient care assignment patterns 57.6% to 85.7 % (48.7% improvement)

Pos t T2 Pos t T1 Pre Pos t T2 Pos t T1 Pre Pos t T2 Pos t T1 Pre Pos t T2 Pos t T1 Pre # Times Right Care Provider Assigned Total (x/21) # Times Right Care Provider Assigned Night (x/7) # Times Right Care Provider Assigned Eve (x/7) #Times Right Care Provider Assigned Days (x/7) Unit

Lessons Learned

• Leadership
• Courage
• Collaboration
• Supporting staff through all the

phases of the change process

• Communication
• Valuing staff through the journey

The decisions that you make and the actions that you take upon the Earth are the means by which you evolve.

Thank You

Coordinates of Speakers Bonnie Hall RN MScN, GNC(C) Advance Practice Nurse bhall@scohs.on.ca Marie Marques, RN, BA, MPA(c) CRRN Clinical Manager mmarques@scohs.on.ca