COUNT: COPD Opportunity Map

Special thanks to Kim Erwin, Jennifer Sculley and Dr. Jerry Krishnan

This project was with the COPD Wellness Committee to improve COPD (Chronic Obstructive Pulmonary Disorder) care at Institute of Healthcare Delivery Design for UI health. The aim of this project was to help the Committee identify the different problems happening across silos in the care system and make them visible to further create an opportunity map for them. It involved creating a process map that tracked patient experience from emergency department all the way to the out-patient setting.

I led this project conducting;

  • Primary research (interview, observations and shadowing) in both in-patient and out-patient setting at UI health. Working within a health setting provided me direct contact with the patients and the clinicians. 

  • Developing tools and methods to support interview with the professionals and synthesising the information provided.

  • Looking across silos at the workflow and roles of different stakeholders to then create a root cause analysis.

  • Co-conducting a participatory workshop with the clinicians. Designing methods and developing tools to support many exercises.

  • Creating an opportunity map and presenting it to the COPD Wellness Committee

Current COPD patient pathway...
Current COPD patient pathway...
It looks like a linear process but it's not...

EMERGENCY DEPARTMENT

HOME

OUT PATIENT SETTING

Effective H2h loop

Re-hospitalization loop

HOSPITAL

COPD patient pathway over time
'After discharge, 10% to 20% of COPD patients are readmitted within 30 days'
- COPD Foundation
'Ideal cycle'  Doctors and administrators want the patient to fall in this cycle for better management of COPD
Patients are trapped in the loop of re-admission due to poor management of their condition
PHASE 1
Understanding the context
Primary research participants...
Clinical Pharmacist
Interview
Hospitalist
Interview
Outpatient pulmonologist
Interview
MoPhE team
shadowing
Respiratory
Therapist
Interview
Pulmonologist
Hospital Tour
COPD wellness committee
Workshop
Clinical Pharmacist + hospitalist
Workshop debrief
Clinical Pharmacist
Shadowing
Respiratory
Therapist
Shadowing
Patient journey pathway...
Current discharge material given to the patient.
Identifying different stages of COPD care at the hospital including the channel and level of communication with the patient and amongst the multidisciplinary staff at UI Health.
Detailing the entire process COPD care at UI health...
Yellow columns; Identifying moments where the patient is idle and waiting.
A thorough journey map of the COPD patient at UI health. Capturing onstage and backstage work including communication between different stakeholder, activity levels, means of communications and patient engagement.
High problem area. Eg, Capturing where the speed of communication doesn't match the speed of information in the system.
PHASE 2
Validating what we know
Co-conducting the workshop for clinicians in COPD care journey. The objective of the workshop was for the clinicians to step out of their silos and look at the system as a whole.
Helping them understand the role of the other stakeholders in the care delivery
Helping the medical practitioners look at the holistic view in the continuum of care 
Understanding the problems in the system through someone else's experience and using different tools to capture that.
PHASE 2
Root Cause Analysis
Synthesis + Creating an opportunity map
Abrupt hand-off amongst the different stakeholders causes a ripple effect in care continuum.
Exploring the problem area to identify the it's repercussions in someone else's role.
PHASE 3
Opportunity map + Recommendations
3 gaps in COPD patient service 
1  Process transparency
A
Repeat processes during ED handoff may reduce confidence in care team.
B
Medication procedures may lead to resistance + confusion.
C
Hard-to-execute follow-up
appointments create barriers to patient care.
2  Patient education + supports
A
Patients education materials don’t reflect changing patient needs.
B
Educational materials across touchpoints are inadequate, inconsistent, or non-existent.
C
Educational materials are used as handouts rather than conversation supports.
3  Guidelines + coordination
A
Practice variation + lack of coordination presents conflicting messages to patients.
B

Practice variation may lead to under or misused resources.

C

Discharge coordination can omit important input from care team members  

1  Process transparency
2  Patient education + support
3  Guidelines + coordination
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