Have you ever been on a ward team that had patients on multiple units? Have you ever wondered if there could be a better approach to efficiency, teamwork, and accountability?
In January 2019 we re-designed our ward structures at University Hospital around a geographic ward model that co-locates providers on a single unit to achieve the following goals:
|Instead of…||…Imagine if|
Little or no connection between team members
Personal connections between team members
Lack of interprofessional teamwork
Daily interprofessional team huddles/meetings
Waste in travel time between units
Economy of movement on one unit
Lack of defined leadership presence
Effective and well-known unit-based leadership
Lack of improvement infrastructure
Improvement in daily milieu
Lack of team specific data
Unit-based data to drive team performance
Idiosyncratic rounding strategies
Structured interdisciplinary bedside rounding
Emphasis on process
Emphasis on outcomes
We are not afraid to tackle difficult problems, and we have seen both early successes and challenges with geographic wards. Changes like this are considered complex service interventions requiring many iterations to get right.
The geographic teams have new opportunities to get to know nurses better and have in person discussions with consultants on rounds. We are now in the process of creating standard practice for interdisciplinary communication and workflow and handoffs.
Feedback from residents and faculty have already driven driven major improvements to our initial model and residents are part of a geographic wards steering committee and multiple subcommittees to lead these efforts.
As a part of these groups, you will learn about and work on processes involved with bed assignment, flow through the hospital, and minimizing unnecessary handoffs. You will help determine which data best captures patient safety and experience in our new system, help trial and implement the new interdisciplinary communication huddles on our geographic teams, and identify new quality improvement projects through our quality improvement subcommittee.You will be able to participate in efforts to maximize educational experience through creation of needs assessments and curriculum development as part of our education subcommittee.You will be able to promote wellness and learn to advocate for system change in the wellness subcommittee.
You will also have the opportunity to help shape geographic wards and inpatient education for the residency.The opportunities are endless but here are some goals for the future:
- Create an infrastructure for residents to participate in and lead new inpatient quality improvement projects
- Develop a system for residents to receive data related to their patient care outcomes
- Create an acute care track for residents that includes built in time for quality improvement, education related to specific inpatient systems-based care topics, and mentorship
- Revamp the day float elective to provide an opportunity for residents to gain knowledge and experience in hospital medicine