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:
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 saw early successes with geographic wards. Teams had new opportunities to get to know nurses better and have in person discussions with consultants on rounds. We also developed standardized interdisciplinary communication and workflow including daily interprofessional team huddles.
We also experienced significant challenges in work, including an increased amount of patient handoffs in the initial months.
However, we are not afraid to tackle difficult problems. Changes like this are considered complex service
interventions requiring continuous use of improvement science to get it right.
If you are interested in more detail in how we improve, watch the videos below, parts of a grand rounds given by our Geographic Wards leader and associate program director Danielle Weber:
You will be encouraged to join our improvement groups to learn and contribute teams and system science.
For example, in the Bedflow committee you will learn about and work on processes involved with bed assignment and flow through the hospital. In the Huddle committee you will work to improve upon the huddle process and discuss huddle script changes to align with other QI work. You will also have the opportunity to help shape geographic wards and inpatient processes for the residency.
The opportunities are endless but here are some goals for the future:
Improve interdisciplinary communication related to patients not on our geographic wards (“rover patients”)
Develop a system for residents to receive data related to ongoing quality improvement projects
Create an acute care track for residents that includes education related to specific inpatient systems-based care topics