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A physicians perspective on the Accountable Care Unit and Seniors Home Visit program

21-Jun-2016

A Q&A with Dr. Andrew Kielly

The pilot project is now at its mid-point. What are the benefits you’re seeing as a physician?

People go into medicine for a whole variety of reasons, but one underlying reason is to meet a desire to help and be there for people and provide their medical care. You have in your mind the way you think that will unfold. Because of the many different things that happen in the ACU, a lot of those lofty ideals that I had are being met here. It’s a fabulous place to practice medicine, because we are doing medicine the way it (philosophically) should be done, and we are involved with a different delivery mechanism which is both exciting and challenging and really rewarding. The way we interact with all our colleagues – nurses, pharmacy, social work, dietitians, physiotherapists – is really something else, and then to be able to have patients and their families involved in the patient’s care on the unit, with their team, have their care needs met and their questions answered- it’s just incredible.

You get that positive feedback from patients and their families about how appreciative they are, how happy they are with the care and service that’s being provided, but you also get that professional satisfaction of being able to work with other like-minded physicians, being able to work in a more efficient way with other physicians outside of our department, and then the interactions and ability to bond with the care team.

There are other Hospitalist jobs available in Canada, but there is not another unit that is set up like this.

 

What kinds of challenges have you encountered thus far?

 

Surprisingly few. The biggest challenge as a health care professional is that you’re asking people to really change the way they do things. The medicine isn’t changing, but the way we go about our daily routines have changed a lot, including how we interact with patients, their families, other physicians and support staff. That’s involved huge change.

 

The nursing staff people have brought about incredible changes in order to make this work smoothly and efficiently. It’s really something to see people be willing to make those changes. Change is really hard and that has been a challenge, but I can say universally that every one of the people that are involved, despite the challenge of change and reluctance or hesitancy at the start, is seeing the benefits from this way of doing things. I don’t think I know of anyone that says they would want to go back to the way we used to do things, it’s that profound of change. Once we see what happened, it’s been a challenge that’s well worth it. And actually, because we can see how we rose to meet those challenges and the positive change that came out of that, we are more open to trying more changes in different ways to keep improving the program and the unit.

Do you think this model of care could be applied to other facets of health care?

Without a doubt. Hospitals, other institutions, long-term care facilities, any place where you have the potential for a collaborative, teamwork approach could apply this model of care. It’s a way of doing things that allows us to work together collegially, efficiently, get information to patients and their families and provide better care to them in a way that has little to do with medicine, and more about how we prioritize and communicate and focus our efforts. Those things are applicable across all health care fields.

My one caution would be that I hope that those considering embarking on such a venture approach the changes in a logical, proper way where they are not attempting to bring about too much change too quickly. In our experience, it is prudent to do it sensibly, in a well thought out manner and have people involved in the process of change so they are educated and really buy into what they are trying to achieve. Hopefully our unit will serve as an example to encourage others that want to adopt that change, as well.

Patients are saying that they actually feel themselves getting better faster, as a result of the care they receive on the unit. Do you feel like you’re contributing to that as a physician?

I would hope so. I think it’s just because of the strategies that we employ. Because we do a multi-disciplinary care model, there are lots of opportunities for all the individuals providing care to be there and communicate with each other. The likelihood of missing things about that patient’s care is greatly diminished. With any hospitalized patient, there are numerous things that we are both trying to achieve and prevent and we are working actively as a team to succeed in doing this. Patients and their families are informed about what we’re doing and what we are trying to achieve as a group involved in their care and I think that this makes a big difference.

Already we’re already seeing things like a higher turnover in our patient flow, decreases in infection rates and other possible complicating factors that we sometimes see in the hospital. This is largely due to our quality control efforts and the unique way we’re interacting with the different care providers, and the patients and their families to make sure that we aren’t overlooking things and that we are doing everything in the best way we possibly can.

How important is the data capture in this pilot to you?

Data is critical as a physician. We get lots of testimonials from patients and their families about their degree of happiness and comfort, but really, when it comes down to it, we also need other information, like length of stay in hospital , number of complications etc. It’s critical for us to use this information to gauge our performance, but for other people within the hospital to be able to determine their performance as well.

The cost of health care is a very real thing that we also have to be aware of. If we can show the people that are involved in administration that what we’re doing is making people healthier, happier, that we’re saving people time in the hospital, preventing infections and complications, then we’re ultimately saving our system money that can in turn be invested in other areas and help to expand other programs and provide other services that we haven’t been able to provide in the past.


Any final thoughts?

We’re still early in the program, but the initial data is showing we’re making improvements and from a patient care side of things, the feedback is very encouraging and convincing. The way staff are working together and the happiness you see on the unit is really something. We often have patients and their families comment about their care, but they often comment about how happy everyone seems to be, smiling, enjoying their work. To be a part of this unit and see all of these positive changes particularly at this time when there’s lots of concerns about what’s happening within health care, is really something.

I can honestly say that the type of care that we’re providing, the feedback we’re getting, the value we’re providing, are exactly the reasons why I went into medicine. This is feel-good medicine at its best.