Implementation strategies
Identification of the patient population in need
Through its ongoing relationship with the hospitals in Ontario the Total Joint Network identifies orthopaedic patient populations where system change could improve the outcomes for the patients and/or the system. System change is then created by bringing all the organizations together to implement the changes necessary to ensure the best outcomes for the patient.
Best Practice
Best Practice is identified for each patient population through:
- accessing clinical experts in all relevant professions
- using findings from a comprehensive literature review
- working with local data collected through a research or pilot project
Developing system goals
Once the patient population is identified the Total Joint Network works with the healthcare organizations to set realistic and achievable system goals for each organization to strive towards in order to meet the needs of the identified patient population. Goals may include reducing overall length of stay or increasing the availability of rehabilitation for patients, or even increasing the capacity of the healthcare system to care for additional patient. Other goals include patient goals such as improvements in physical and mental functioning.
System change
The Total Joint Network is working with the partnering organizations to facilitate change by working on the following areas:
Committee Structure
The Total Joint Networks creates a committee structure that meets the needs of the Project Initiative and supports the project goals. This structure differs for each project however is designed to allow input from all organizations through the planning and decision making processes as well as supports problem solving within each sector and between sectors.
Education
Education is key to improving clinical practice. Each project requires both formal education and continued reinforcement of best practice through ongoing informal education sessions. Education is provided through identified clinical leaders in each of the professions affected by the change eg. surgeons, physiatrist, physiotherapists, nursing etc.
Follow up support
Change management occurs over a number of months and needs ongoing support to ensure each organization is able to facilitate the discussions necessary to identify and implement the necessary change.
Results
The results from each of the organizations are collected and analysed by the Total Joint Network on a monthly basis. This information is reported to the partnership and is used by the organization to make decisions on the need for further improvement strategies
Unilateral Hip and Knee replacement
During the implementation of the elective hip and knee replacement project the hospitals were required to implement through the following stages:
- Phase 1 – Introduction
- Phase 2 – Process design
- Phase 3 – Implementation
- Phase 4 – Process improvement
- Phase 5 – Data Collection for the evaluation
This system allowed each organization to develop a strategy to implement change and to move ahead within its own timelines.
Hip Fracture Project
The hip fracture project is using a modified Rapid Cycle approach to the implementation. The original cycle was completed through a pilot project at Toronto Rehabilitation Institute, Hillcrest site. The role out schedule for each organization will be defined by each organizations ability to meet the agreed upon needs of the patient population. An internal Steering committee at each hospital will be accountable to move ahead with the change process.
Care Maps
The Total Joint Network supports the standardization of care through the use of care maps. Through the partnering organizations care maps are created for acute care, in patient rehab and CCAC to identify best practice. The Care Maps are designed to link together to provide a seamless approach of care for all patients through the transition points until discharge.
Transition between acute care and rehabilitation
For successful transition to between acute care and rehabilitation hospitals it is important that the patient receives the ongoing care they require to successfully complete their rehabilitation. The Total Joint Network therefore works with the partnering organizations to develop appropriate documentation and guidelines on care through this important transition.
Performance Indicators
In order to measure performance improvement the Total Joint Network uses 3 types of indicators:
- data tracked by the Total Joint Network on the implementation status of the project
- data on the specific indicators that demonstrate system change which are provided monthly to the TJN, amalgamated and reported back to the parternship
- clinical and operational change indicators to be collected and used individual by each partnering organizations.
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