Care Coordination - New Model

The hospital identified an opportunity to improve its discharge planning process to allow more time to be spent with patients and reduce duplication of duties within the case management and social work department. Utilization reviews were performed for case managers, social workers and clerical staff. These observations revealed in time increments indirect care, direct care and waste. The goals were to find where standard work could improve processes and to identify duties that could be more appropriately performed by another discipline.

The hospital identified an opportunity to improve its discharge planning process to allow more time to be spent with patients and reduce duplication of duties within the case management and social work department. Utilization reviews were performed for case managers, social workers and clerical staff. These observations revealed in time increments indirect care, direct care and waste. The goals were to find where standard work could improve processes and to identify duties that could be more appropriately performed by another discipline.

A new model of care coordination was created from the roles of the case management and social work department. Standard work was created for all positions in care coordination along with identified training needs. Administration and clinical staff used Lean tools such as A3s, Kaizen Events, 3P and others to guide them through the change. The new model impacted the hospital by allowing patients and families to be seen daily, documentation to be completed daily, more time at patients' bedsides to educate them and their families on discharge plans and seven-day-a-week coverage.

This case study is part of the Illinois Health and Hospital Association's annual Quality Excellence Achievement Awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals and health systems in continually improving and transforming health care in the state. These organizations are improving health by striving to achieve the Triple Aim—improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care—and the Institute of Medicine's six aims for improvement—safe, effective, patient centered, timely, efficient, and equitable. To learn more, visit https://www.ihaqualityawards.org/javascript-ui/IHAQualityAward/

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