Since February 2007, ThedaCare has used its propriety care model — Collaborative Care — to change the way inpatient hospital care is delivered to patients. Collaborative Care has not only improved care and lowered costs; it has also led to higher satisfaction rates among patients and staff members.
Hospitals have provided care the same way for decades despite technology advances and a greater emphasis on creating the best possible customer experience. At the same time, employee satisfaction and retention among nurses remains a challenge for hospitals as nurses struggle to care for more patients and provide them with a higher quality of care.
Facing these challenges, ThedaCare's Appleton Medical Center and 12 other pilot hospitals in the nation were chosen to participate in the Institute for Healthcare Improvement's Transforming Care at the Bedside initiative. In 2006, ThedaCare, an integrated health system in northeast Wisconsin, utilized its ThedaCare Improvement System to develop a new way to deliver inpatient hospital care. With the goal of improving patient care while cutting waste and cost, a team of ThedaCare employees met to discuss what attributes they would want in the ideal hospital room and the ideal patient care model. The result was Collaborative Care, a customer-driven interdisciplinary collaborative model of care that delivers exceptional patient care.
In Collaborative Care, a trio of providers — a physician, a registered nurse and a pharmacist — meets with each patient within 90 minutes of admission. The providers then receive the same information at the same time. After meeting with the patient, the trio develops a plan of care, which is shared with the patient. By bringing together all three disciplines, a balanced plan of care is created and all staff members know and understand the plan of care.
The use of the trio cuts down on waste since patients or their families don't have to repeat the same information to the doctor, nurse and pharmacist. With all three providers working together from the beginning, communication among the different disciplines is more open and improved.
Collaborative Care rooms are also designed differently. There is a computer at the bedside so providers can look up the patient's medical records immediately or review any tests. Additionally, medications and supplies have been moved to the bedside making it easier for the nursing staff to access what they need. As a result, the unit has not had a single medication error. The system has slashed documentation time in half, enabling nurses to increase the time they spend with patients by 70 percent.
Patients are also more satisfied with their treatment and leaving the hospital sooner. In the first year of operation, the average stay of a patient in the Collaborative Care wing decreased 20 percent. At the end of 2007, 87 percent of patients gave the unit a 4 or 5 on a scale of 1 to 5. In 2008, that percent rose to 90 percent.
Patients aren't the only ones satisfied with Collaborative Care. Using the same 1 to 5 scale regarding job satisfaction, nursing staff members had an average of 3.72 in 2007. In 2008, satisfaction levels rose to 4.37.
Delivering Collaborative Care requires an environment not found in many hospitals. The standard wing design of a central nursing station was eliminated and replaced with smaller work stations closer to the patient rooms. Patient rooms were also remodeled to not only be safer, but also to include in-room storage for the most used items, which cuts down on the number of steps staff members need to take to get what they need. A color indicator system on the wall also lets other staff members know who is in a patient's room (for example an RN, a CNA or another health professional).
Along the way, Collaborative Care team continues to look at ways to improve its care model. Employees use the ThedaCare Improvement System to identify processes needing improvement and then develop ways to make what they're doing even better.
Following the success of the pilot program, ThedaCare officials decided to take Collaborative Care system-wide and are currently remodeling Theda Clark Medical Center in Neenah and building a new bed tower at Appleton Medical Center to accommodate the room design necessary for Collaborative Care to succeed. (At the Appleton hospital, the new bed tower will replace rooms in the original part of the hospital which cannot be remodeled to accommodate the new care delivery system.)
Through Collaborative Care, ThedaCare is creating a new model of patient care that does not exist in today's healthcare environment.
Additional Resources:Radical RedesignEfficiency is the Cure: ThedaCare's Appleton center refined patient care as it raised productivityAdmission Medication Reconciliation Standard Work
