Failing fast to succeed boldly: COPD insider case study
No matter what your initiative is, one thing is vital: fail fast. Discover how failing fast can lead you to succeed boldly with this insider case study.
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You’ve been here before. Rising COPD readmission rates wreaking havoc on your institution—costing time, money, and valuable resources. While you try your best to set each patient up for sustainable success, change is difficult and demanding. And with change comes the risk of failure. So, what do you do? Whether it’s making changes to a current COPD readmissions program or implementing a new one, insider Keith T. Kanel, MD, MHCM, FACP, says that in order to succeed boldly, you need to fail fast. Read on to discover how various failures during the creation and implementation of his COPD readmissions reduction program ultimately led to big success.
Contributors
Keith T. Kanel, MD, MHCM, FACP
Clinical Associate Professor of Medicine University of Pittsburgh
Immediate observation: Readmissions reduction was minimal
Kanel helped establish a COPD readmissions reduction program where nurse case managers met with COPD patients in the hospital, one by one. The program seemed like a valid plan at first, but as it unfolded the COPD readmissions results they were expecting just weren’t there. The impact was minimal, payers were taking notice, and the program was not sustainable. A big change was needed—and needed fast.
Immediate observation: Readmissions reduction was minimal
Kanel helped establish a COPD readmissions reduction program where nurse case managers met with COPD patients in the hospital, one by one. The program seemed like a valid plan at first, but as it unfolded the COPD readmissions results they were expecting just weren’t there. The impact was minimal, payers were taking notice, and the program was not sustainable. A big change was needed—and needed fast.
Speedy solution: Rapidly reframe the program to be more patient-centric
Once Kanel realized the initial program was failing, he quickly gathered his team, brainstormed, and immediately developed a new model that was more patient-centric, known as the Primary Care Resource Center. Staffed with specially trained nurses and pharmacists, the beginning stages of this program focused solely on extending care beyond the hospital and into patients’ homes. This helped them form COPD care plans that covered the entire continuum of care.
COPD insider tip #1:
Establish program goals immediately.
If goals are not being reached, identify what areas need to be changed and how you can optimize them by:
Maximizing the contributions of staff members
Adapting workflow to meet the needs of your program and each patient’s COPD care plan
Getting the funding you need for sustainable success
Although the new program was in place, extending care beyond the hospital was still not enough. Additional challenges arose, and Kanel needed to adapt the program even further.
Immediate observation: Comorbidities complicated the treatment process
Initially, the Primary Care Resource Center focused solely on COPD management, but there was a problem. With COPD comes a plethora of comorbidities, which were not factored into the program.
Immediate observation: Comorbidities complicated the treatment process
Initially, the Primary Care Resource Center focused solely on COPD management, but there was a problem. With COPD comes a plethora of comorbidities, which were not factored into the program.
Speedy solution: Expand the disease management scope right away
In order to meet the needs of more patients, Kanel immediately expanded the scope of disease management beyond just COPD. Now, the COPD readmissions reduction program was able to help treat COPD patients who also suffered from heart failure and myocardial infarctions.
COPD insider tip #2:
Don’t sit back—be proactive.
Look for opportunities to expand the breadth of your newly establish program by identifying:
Common comorbidities in COPD patients who are continuously readmitted
Staff members who can be cross-trained to treat the whole patient
The patient-centric approach was in place. The scope of disease management was taking shape. The COPD readmissions reduction program seemed to be operating efficiently, but one final issue arose—medication management.
We ended up coming across numerous patients with comorbidities we did not account for in our original scope, and needed to adapt quickly."
Keith T. Kanel, MD, MHCM, FACP
Clinical Associate Professor of Medicine University of Pittsburgh
Immediate observation: Medication management was suffering
As the scope of disease management was bigger than ever, the management of medication became an issue. A key care team member responsible for ensuring that patients received the medication they needed, when they needed it, was unaccounted for. This could have been a critical oversight, but Kanel adapted quickly.
Immediate observation: Medication management was suffering
As the scope of disease management was bigger than ever, the management of medication became an issue. A key care team member responsible for ensuring that patients received the medication they needed, when they needed it, was unaccounted for. This could have been a critical oversight, but Kanel adapted quickly.
Speedy solution:
Promptly hire full-time pharmacists
Kanel acted fast, adding a full-time pharmacist to the Primary Care Resource Center team. Immediately hiring and training a pharmacist specifically for COPD allowed the program to have a dedicated team member to ease the transition of patients from hospital to home. Now, as a part of their COPD care plan, each patient had the medication they needed when they were discharged and understood how adherence could change the course of their care.
COPD insider tip #3:
Deeply invest in training staff members in:
Look for opportunities to expand the breadth of your newly establish program by identifying:
Quality improvement—to learn how to create data flow charts and value stream maps, as well as track their own performance
Disease management—to understand the complexities that are specific to COPD
Motivational interviewing—to understand each patient on a deeper level, and how they can set them up for sustainable success
Our investment in people really helped us do a broad project and not have to worry about every single detail. They drove themselves and that's why we saw the results we did."
Keith T. Kanel, MD, MHCM, FACP
Clinical Associate Professor of Medicine University of Pittsburgh
Results that speak for themselves
Once Kanel was able to fail fast, the Primary Care Resource Center succeeded boldly. The final prototype allowed for them to compete and win a large grant. And, with the same prototype, Kanel was able to open six additional health centers that achieved staggering results during the three years they ran.
7 centers
14,000 patients with three disease targets seen
40,000 telephone calls made
30,000 inpatient contacts
53 nurses, pharmacists, and additional staff specially trained in COPD
30-day all-cause readmissions rate dropped by 25%
Several thousands of dollars saved per each 90-day period
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Further reading
COPD insider
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