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Using creative problem solving for healthcare transformation

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By Lindsay Smylie Smith

Can you imagine the next time you are up against a problem in your organization, bringing all the stakeholders together in one room and leaving with a solution that works for everyone?

That’s exactly what staff at the North Bay Regional Health Centre (NBRHC) have done. By using creative problem solving, staff are able to take challenging situations and turn them into well-defined problems with an action plan—created by and for the stakeholders—in a short time frame. Amazingly, they are able to do all this while also creating buy-in for staff, improving patient care, patient flow, interdisciplinary teamwork and, in some cases, improving the financial well-being of the hospital.

Paul Heinrich, NBRHC President and CEO says he was first introduced to the idea of creative problem solving from Min Basadur, Founder of Basadur Applied Creativity, when Basadur spoke to a class Heinrich was taking at McMaster University. “I thought it was such a simple concept, but so powerful,” Heinrich says.

Basadur teaches creativity is a process that includes the following (in this order)—problem finding, fact finding, problem definition, idea finding, evaluation and selection, plan, acceptance and action. Most people want to jump from problem finding (step 1) to action (step 8), but skipping ahead in the process would mean missing out on identifying the cause of the problem before getting to the solution. Heinrich went on to work with Basadur to use creative problem solving at four different organizations—including NBRHC.

Heinrich admits this way of thinking and problem solving can seem too difficult from the outside. “Divergent and convergent thinking can be very challenging for adults,” he says. “We have learned there is a ‘right’ answer for everything. Over time, we have learned to be uncreative.”

It was at NBRHC that Heinrich decided to try a different approach. “Instead of relying on others to help us solve our problems,” Heinrich says, “We thought ‘why not train our own staff with these skills?’” Heinrich liked the idea of tailoring the tools and tactics specific to a health care audience, while also creating the capacity within the organization to use these methods on an ongoing basis.

So they did just that—training dozens of staff at the Health Centre in the theory of creative problem solving, encouraging them to take them back to their areas and teams, adapting them for the specific problems and audiences.

That’s exactly what two members of the organizations’ Quality Team, Karin Dreany and Kristen Vaughan, did when faced with the task of making improvements to the Health Centre’s clinical documentation processes. This complicated problem involved a number of stakeholders across numerous departments. Essentially, a lack of standardization and incomplete charts meant the Health Centre was potentially missing out on important funds to match the true costs of a patient’s stay. There were additional concerns around turnaround times and a backlog for inputting that required substantial staff overtime to keep up.

Using key elements of creative problem methodology, they tailored the quality improvement to their audience by streamlining the group process from two days to two hours. Once they had everyone in the room—including physicians, frontline administrative and clinical staff, managers and senior leaders—as a group they came up with the top five problems and together brainstormed potential solutions. Subgroups were assigned to each solution, with representatives from physicians, clinical and coding staff on each.

The result? Almost 90% of physicians have adopted the new standardized documentation practices, clinical records has eliminated their overtime, and the turnaround time for chart coding has decreased from 60 days to 23 days. Improved, timely documentation allows the health centre to accurately capture the acuity and treatment of our patients.

Another example of how creative problem solving was used with impressive results is the review of the leave of absence (LOA) process in NBRHC’s Regional Specialized Mental Health Programs.

Laurie Wardell, Director, Mental Health, explains how there was an opportunity early last year to review some of the practises with the discharge process, particularly with respect to how LOA’s were functioning. “We thought there might be a way we could improve how this was executed to help improve our patient flow, better support our patients in their transition to the community and at the same time strengthen our relationships with some of our community partners.”

To accomplish this, as with the Clinical Documentation Project, they needed to get everyone together in one room. This included the psychiatrists, front line staff, health centre leadership and community partners. Groups that weren’t able to attend the session in person were able to remotely participate by Ontario Telemedicine Network (OTN).

“Bringing everyone together and having the ability to engage everyone in the process from the very beginning was so important,” Wardell says. “Everyone had a voice and was able to understand the problem. The session helped us narrow the scope of work and clearly identify the problem we were trying to solve.”

An unexpected benefit was the impact to the relationship with community partners. “They appreciated being involved in the creative problem solving session. It increased their trust in the process and they were able to see for themselves the Health Centre’s level of support for these changes,” Wardell says.

The group was able to improve wait times by reducing the length of the leave of absences by 55%. Wardell credits the group session to the success the group has had with the process change. “Front line staff were a part of the process identifying and creating the solution to the problem – so they were ready to implement it on the units without anyone else having to create buy-in.”

Bringing everyone together in one room is arguably the most important factor in the success these projects have seen. By bringing together everyone who don’t think it can be done or should be done, and by engaging them in the problems solving and allowing them to have a voice–good things are accomplished together.

Lindsay Smylie Smith is a Communications Specialist at North Bay Regional Health Centre.

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