Hamilton Health Sciences

1

• Hamilton Health Sciences
• Henderson Site Patient Flow Innovation and
  Learning Site
• Improving Bed Management Meetings Through de
  Bonos Six Thinking Hats

HHS Change and Quality Improvement Model
Define
Plan
Do
Study
Act
2
Team Members

• Susan Taylor, Senior Consultant, Quality, Patient
  Safety Clinical Resource Management (QPSCRM)
  (Co-lead, Henderson Patient Flow Innovation and
  Learning Site Initiative)
• Nancy Henderson, Quality Specialist, QPSCRM
• Ivan Yuen, Quality Specialist, QPSCRM
• ... and all members of the Henderson Site Bed
  Management Committee

3
What are we trying to accomplish?

• To create a transparent work-plan from daily bed
  management meetings in which there are clear
  conclusions
• To enable clear discussion/follow-up at
  subsequent bed management meetings

Previously
Target
They expect to have 5 discharges by 1700hrs
We expect to have 5 discharges by 1700hrs
We have 4 confirmed discharges, 3 potentials, and
of those, 2 look strong and 1 looks weak
So how many discharges will they have??
4
How will we know a change is an improvement?

• Outcome Measures
• Increased efficiency of daily bed management
  meetings, as measured by number of bed management
  meetings held per day
• Increased percentage of daily bed management
  meetings in which a work-plan is developed with
  clear conclusions
• Process Measures
• Utilization of a single number per unit for
  discussing discharges

5
What changes can we make that will result in an
improvement?

• Using a parallel thinking technique known as de
  Bonos Six Thinking Hats, the Henderson Site Bed
  Management Committee discussed the merits of
  eliminating the many discharge terms
  (Potential, Weak Potential, Strong
  Potential, Confirmed) used in bed management
  meetings
• De Bonos Six Thinking Hats
• White hat facts, information
• Green hat alternatives, ideas
• Yellow hat positives, benefits
• Black hat negatives, caution
• Red hat emotions, intuition
• Blue hat process control

6
Study Phase (PDSA) Achieved Outcomes

• Confirmed and potential discharges are no
  longer used during bed management meetings, and a
  single number for discharges is consistently
  communicated by each unit
• Enabled the development of a formula to predict
  the number of expected discharges per unit within
  a time frame of 6-8 hours
• Enabled the development of a Site Status
  Communication Tool to summarize the conclusions
  and work-plan made during daily bed management
  meetings
• Site status, with summarized work-plan, is
  consistently communicated to site clinical
  managers and directors across all sites
• Clear work-plan reduced need for subsequent bed
  management meetings on green days

7
Study Phase (PDSA) Key Success Factors/Enablers

• Henderson Site Patient Flow Innovation and
  Learning bundles multiple patient flow
  improvement initiatives together, building
  support and generating enthusiasm for change and
  improvement
• De Bonos Six Thinking Hat technique allows
  participants to dissent and provide opposing
  opinions due to the different hats worn during
  session
• HHS Change and Quality Improvement Model (Define
  PDSA - adapted from the IHI Model for
  Improvement) also enabled the outcome of
  discussion (i.e. use of one number for discharges
  at bed management) to initiate further
  improvements

8
Study Phase (PDSA) Actual and Potential Barriers

• Actual barriers experienced by HHS
• Initial lack of understanding of the format for
  de Bonos Six Thinking Hats on the part of
  participants
• A few participants did not have the chance to
  speak during certain rounds due to the time limit
  imposed on each round
• Potential barriers that may be encountered
• Engagement and willingness to participate
• Participants thinking in a different hat than
  others (i.e. not everyone thinking in the same
  hat at the same time)

9
Study Phase (PDSA) Lessons Learned

• De Bonos Six Thinking Hats is a novel parallel
  thinking technique that requires participants to
  understand how it is conducted, in order to
  facilitate open discussion
• Participants should be given a quick tutorial
  about the technique ahead of using it in a
  discussion
• Based on the number of participants, the length
  of time for each round of de Bonos Six Thinking
  Hats may need to be adjusted to allow
  participants enough time to provide their input

10
Study Phase (PDSA) Next Steps Taken

• Members of the Quality, Patient Safety Clinical
  Resource Management program met with other sites
  to discuss the process used to establish one
  number for discharges communicated at Henderson
  Sites daily bed management meetings
• To sustain the change at Henderson Site, the
  improvement was also built into other improvement
  initiatives
• Bed assignment tool day-ahead planning tool to
  synchronize admissions, discharges, and transfers
• Reliably predicting discharges
• Site Status Communication Tool

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Take Away Thoughts

• Applicability to your problem or opportunity
• Do you have an idea that you want to implement
  that requires that support of a group of people
  with diverse views?
• Do you have an issue within an initiative in
  which team members have entrenched perspectives
  that may have been difficult to change in the
  past?
• Do you want to engage in the creativity of your
  team through a thinking technique besides
  brainstorming?

12
Contact Information

• Ivan Yuen
• Quality Specialist
• Quality, Patient Safety Clinical Resource
  Management (QPSCRM)
• Hamilton Health Sciences Henderson Site
• 711 Concession Street
• Hamilton, ON L8V 1C3
• 905-521-2100 x43954
• yuen_at_hhsc.ca

13
Appendix de Bonos Six Thinking Hats in Action!

• The following statement was used to promote
  discussion using de Bonos Six Thinking Hats
  technique
• We need to STOP talking about
• Actual Discharges
• and Potential Discharges,
• then Strong Potentials
• and Weak Potentials.
• EITHER we predict the patient will go home (and
  we plan for that bed) OR we predict that he
  wont. This shift in mindset will help us to
  flow patients so that we will have a bed for
  those in ED, in OR, in community. We might not
  always be right, but if we can be good at
  predicting well have that much more clarity in
  our planning.
• Source Taylor, S. Henderson Site Bed Management
  PowerPoint Presentation. Presented on March
  18, 2008.