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Leveraging the Accountable Care
Unit Model to create a culture of
Shared Accountability
How we improved Patient Safety and Quality
Outcomes at Northwest Hospital
Our Journey to Shared Accountability
•Implementation process and outcomes of the ACU model
•Move to culture of Shared Accountability and Outcomes
•Lessons Learned
•Next Steps
•Implementation process and outcomes of the ACU model
•Move to culture of Shared Accountability and Outcomes
•Lessons Learned
•Next Steps
Our Journey to Shared Accountability
Northwest Hospital will rank among the state’s
BEST in Quality and Patient Satisfaction.
Quest to be the Best
“Clinicians and institutions should
actively collaborate and
communicate to ensure an
appropriate exchange of
information and coordination of
care.”
2001 Institute of Medicine report:
High Quality Healthcare in US
Healthcare Silos
Skilled Nursing
Facilities
Pharmacy
Outpatient
Services
Emergency
Department
Inpatient Care
Office Based
Provider
Hospital Care Silos
Nursing
Attending
Provider
Case
Management
Resource
Teams
Consultant
Services
Ancillary Service
Teams
Asynchronous Care
RN with Patient
at 8AM
121
2
3
6
9
4
57
8
10
11
Asynchronous Care
Provider with Patient
at 12pm
121
2
3
6
9
4
57
8
10
11
Asynchronous Care
Care Manager/SW with
Patient at 2pm
121
2
3
6
9
4
57
8
10
11
Team Based Patient Care
Nursing
Attending
Provider
Ancillary
Support Team
Case
Management
Resource Team
Consultant Services
Accountable Care Unit Model
• Unit level Provider and Nursing Co-leadership
• Unit based teams
• Unit level performance reporting
• Interdisciplinary bedside rounds
Accountable Care Unit Model
ACU Pilot Unit at Northwest
Insert Picture of team here
Length of Stay (LOS)
Benefits of ACU Pilot:
Improved Communication
1.0
2.0
3.0
4.0
5.0
Avg
2015
March
2015
April
2015
5.0
4.09
3.46
Start of
Rounds
Nu
mb
er
of
Da
ys
Benefits of ACU Pilot:
Improved Accountability
76
84
7480 82
43
77
48 47
0
10
20
30
40
50
60
70
80
90
Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15
4D Indwelling Catheter Days 2014-2015
Foley Days Linear (Foley Days)
Start of Rounds
Benefit of ACU Pilot:
Improved Patient Experience
0.0%
50.0%
25.0%
46.2%50.0%
75.0%
61.5%
30.0%
71.4%75.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15
4D Scores
4D Scores Linear (4D Scores)
Start of Rounds
Benefits of ACU Pilot:
Improved Team Satisfaction
5.0
Quality PI reps Care
Management
3.64
4.42
Sc
ore
Providers
3.87
4.58
3.79
4.56
3.75
4.56
Internal Stakeholder survey pre and post ACU model initiation
Goal 4.5
1.0
2.0
3.0
4.0
Unexpected Benefit of ACU Pilot
5.0
Perception of
Staffing Resources
2.54
3.47
Sc
ore
3.87
4.58
3.79
4.56
3.75
4.56Goal 4.5
1.0
2.0
3.0
4.0
Question:
I have appropriate
staffing to provide
the best quality care
to my patients.
OBSPCU
ICU/IMC
Med/Surg
ACU Co-Leadership Teams
Med/Surg
Med/Surg
ED
Structured Interdisciplinary Bedside Rounds
Our Journey to Shared Accountability
•Implementation process and outcomes of the ACU model
•Move to culture of Shared Accountability and Outcomes
•Lessons Learned
•Next Steps
Patient Safety and Quality Checklist
ACU Team Members
Provider Partner Nurse Manager
Nursing team Zoned
Hospitalist
Quality,
Infection
Prevention,
Educators
Care
Management
• Quality
• Infection Prevention
• Educators/CNS
Unit Resource Team
ACU Co-Leadership Team Meetings
CLABSI
CAUTI
Telemetry
ProtocolFamily
Communication
C diff
Challenging
Patient/FamiliesFalls
Handoff
Communication
ACU Co-Leadership Team Meetings
OBS
PCU
IMC/ICU
Med/Surg
Med/Surg
Med/Surg
ED
Benefits of Shared Accountability:
Improved Hospital Acquired Infection Rates
Benefits of Shared Accountability:
Decrease in Patient Falls
Benefits of Shared Accountability:
Increased Event Reporting
System Based Patient Care
Nursing
Attending
Provider
Ancillary
Support Team
Case
Management
Resource Team
Consultant Services
Shared Accountability Approach: MHAC
•MHAC
•Readmissions
•Mortality
•Others
Shared Accountability:
Readmissions and Mortality
•Implementation process and outcomes of the ACU model
•Move to culture of Shared Accountability and Outcomes
•Lessons Learned
•Next Steps
Our Journey to Shared Accountability
Critical to Success: Time Investment
ACU Timeline
Nov 2014 March 2017
Critical to Success: Leadership Support
OBS
PCU
IMC/ICU
Med/Surg
Med/Surg
Med/Surg
ED
Critical to Success: Development
OBS PCU
Med/Surg
Med/Surg
ICU
Med/Surg
ED
What we would have done differently had
we known….
Communication plan around ACU and Shared Accountability
Visibility of ACU Co-Leadership in cross departmental settings
Implement Ground Rules of Rounds earlier in ACU development
Better incorporation of night teams into ACU structure
Build the ACU framework into onboarding of all new team-members
•Implementation process and outcomes of the ACU model
•Move to culture of Shared Accountability and Outcomes
•Lessons Learned
•Next Steps
Our Journey to Shared Accountability
• Private Attendings and Consultants into Model
• Challenging Conversations with Patients and
families
The Journey Continues…
We are the Accountable Care Units of Northwest Hospital
We are the Accountable Care Units of Northwest Hospital
We are the Accountable Care Units of Northwest Hospital
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