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Project Submission: Residential Respite Essay

The major users of the Residential Respite Beds are caregivers who care for people 75 years of age and older. Trends and statistics show that this population will increase to 20% of the overall population (Fraser Health, 2006). This population is going to require support in the community from caregivers who will require residential respite. Cost of healthcare will continue to increase thus it is important to utilize current respite beds to full capacity before purchasing additional beds. The problem is the Case Managers cannot view all available respite beds while sitting at their computers as they speak with the caregiver. This results in multiple calls back and forth between the caregiver, the Case Manager and the Residential Services Clerk. The result is an expression of frustration by the staff and caregivers and an inefficient use of time.

Case Managers complain about the amount of time it takes to book a respite bed and the lack of availability of beds. Caregivers complain about poor availability of beds and the difficulty in accessing beds. Case Managers and caregivers are requesting an increase in the number of respite beds. Upon review it was discovered that overall utilization of existing beds is 80% (Fraser

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Health, 2006). The Residential Respite Bed Booking Project is a technology based process improvement initiative that will through the use of newly developed software similar to that used by hotels increase the utilization of existing respite beds.

The current utilization rate for the 50 authority wide respite beds is 80% which means that 20% of the time these beds are not being utilized. Each day 10 respite beds are vacant, which translates to 3650 lost bed days. At the cost of $130 per bed per day the total loss per year is $475,500. Assuming an occupancy improvement by four beds per day multiplied by 365 days times $130 the net gain will be $189,800.

The improvement of four beds is conservative; the actual improvement will likely be higher. The investment required for the project is $167,200. The software will also provide reports on utilization rates per bed which can be used to support future planning. This project will be a cost effective solution to the identified problem if the included change management plan is utilized during the planning and implementation processes.

Organizational Overview Fraser Health is a nonprofit organization that receives funding from the Provincial Government to provide healthcare to the 1.5 million individuals who live within the boundaries of Burnaby through Hope. The organization manages 12 acute hospitals, maintains 7000 residential beds, and provides many community programs. Approximately 22,000 staff work directly for Fraser Health and another 10, 000 work in health agencies contracted by Fraser Health. Approximately 2,000 doctors are affiliated with the organization. Fraser Health manages a budget of 1.7 billion dollars (Fraser Health, 2003).

Pearce and Robinson (2005) state an organizational vision is developed to “express the aspirations of the executive leadership.” The vision statement’s intent the authors’ state is to focus the organization’s resources on achieving the desired envisioned future. Fraser Health has a strategic plan that was developed in October of 2003 at which time the vision of “Better Health, Best in Health Care” was developed. The mission of the organization is to improve the health and the quality of life of the people it serves by acting as a single, integrated organization that focuses on providing care that meets the needs of clients at the right time, in the right place.

The mission includes ensuring programs delivered will be the result of finding new solutions, creating new ways of providing health care services, and developing programs to maintain and improve access to services. Through investment in technology and redesign of how services are delivered, Fraser Health expects to make considerable gains in productivity. Fraser Health’s values statement is “respect, caring and trust characterize our relationships.” The organization is committed to being passionate in its pursuit of quality and safe healthcare and committed to inspiring individual and collective contribution. Fraser Health is focused on evidenced based outcomes, new ideas and innovation. (Fraser Health, 2003).

This paper will describe a change management plan that through the use of technology and process improvements will improve the efficiency of the use of residential respite beds in Fraser Health. Residential respite beds are available to support caregivers who are caring for family or friends in the community. Access to respite beds is through Home Health staff called Case Managers. It is the job of the Case Manager to determine a client’s eligibility for this service. Eligibility is assessed based on set criteria. The objective is to provide a break to caregivers from providing care to individuals who live in the same home and to whom they provide care. A caregiver may book a respite bed for a minimum of three days to a maximum of 30 days. Twenty four hour healthcare is provided to the client while their caregiver is resting at home or away on vacation.

This paper will; provide an analysis of business requirements; present a technology project plan; review the models and theories of change; look at application of change models; provide recommendations for leading and sustaining change; consider systems thinking and change management evaluation and provide a conclusion that sums up all the recommendations Business Requirements Analysis This section will describe two business requirements for Fraser Health and reasons for selection. The use cases that an IT department would need to know about in order to analyze and design technology solutions for the requirements will be included.

 

The current process starts with a call from a caregiver requesting access to a residential respite bed. The Home Health Case Manager determines eligibility for service. The Home Health Case Manager asks the caregiver for the dates he or she is requiring and calls the applicable Residential Services Office. Residential Services are geographically split into North, South and East. North encompasses Burnaby, New Westminster, Tri Cities, and Maple Ridge/Pitt Meadows. South covers Surrey, White Rock, Delta and Cloverdale. The East covers Mission, Abbotsford, Chilliwack and Hope.

The clerk in the applicable office has an excel sheet that she or he reviews and lets the Case Manager know if the requested dates are available. The clerk can only view and book respite beds in the geographical area she or he covers. A Case Manager may need to contact three different clerks before a bed is located. If the requested dates are unavailable, the Case Manager must contact the caregiver and start the process over again with new dates. If the dates are available, the clerk books the respite bed and sends a fax to the respite facility regarding the booking. The Case Manager faxes the facility the most recent client assessment.

On the day of admission, the facility will send a fax notifying the applicable Residential Office of the admission. On the day of discharge, the facility sends the same office a fax stating the client has been discharged. If the caregiver wants to cancel the respite bed, the caregiver must call the Case Manager who in turn informs the clerk. The clerk calls the facility to cancel the bed and deletes the booking on the excel sheet (Fraser Health, 2005).

Justification for Selection Case Managers complain about the amount of time it takes to book a respite bed and the lack of availability of beds. Caregivers complain about poor availability of beds and the difficulty in accessing beds. Case Managers and caregivers are requesting an increase in the number of respite beds. Upon review it was discovered that overall utilization of existing beds is 80% (Fraser

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Health, 2006).

The major users of the Residential Respite Program are caregivers who care for people 75 years of age and older. Trends and statistics show that this population will increase to 20% of the overall population (Fraser Health, 2006). This population is going to require support in the community from caregivers who will require respite. Cost of healthcare will continue to increase thus it is important to utilize current respite beds to full capacity before purchasing additional beds. The problem is the Case Managers cannot view all available respite beds while sitting at their computers as they speak with the caregiver. This results in multiple calls back and forth between the caregiver, the Case Manager and the Residential Services Clerk. The result is an expression of frustration by the staff and caregivers and an inefficient use of time.

A technology that integrates the respite beds available through Fraser Health by creating a centralized booking system that Case Managers from across Fraser Health can access from their offices would be an improvement. Additions and deletions to the booking system will occur in real time thus ensuring Case Managers have timely and accurate information. The Case Manager can discuss the availability of beds with the caregiver when the caregiver calls and review alternatives available if the bed requested is unavailable or the date requested is unavailable. Case Managers as a result of this change will spend less time looking for respite beds thus increasing productivity as they can use time saved to complete other required activities.

The belief that Fraser Health holds is that use of respite services will delay admission to permanent residential services and this delay is a cost saving to the healthcare system. A process that is streamlined and user friendly will attract repeat customers. Increasing the number of repeat customers will maintain clients at home for longer thus saving the system money. A computerized respite-booking program that allows the Case Manager to view availability for all respite beds within Fraser Health and book the bed electronically would be a process improvement. Currently manual calculation regarding utilization rates is done which takes staff time and may be prone to human errors.

The computerized system will generate reports on utilization rates which will support future planning. This software would be similar to the software hotel clients and staff use for booking hotel rooms. Due to the fact that eligibility has to be determined by a Home Health Case Manager prior to a client having access to a respite bed, at this time direct booking by a client’s caregiver would not occur, Case Managers would be the stakeholder group using the software to book clients. It is important that a project is aligned with the organization’s strategic plan. This project is clearly aligned with the mission and strategic direction for Fraser Health as it will use technology to integrate the respite beds available through Fraser Health thus improving efficient use of staff time and easier access to clients and their caregivers.

Applicable Use Cases Atkins (2003) states that failure to accurately define requirements can lead to problems in system design and development. She states it is important for the customer and the supplier to spend time on the IT requirements identification process. Inadequate attention to Software Requirements Analysis at the beginning of the project can lead to the end application not performing the intended tasks thus it is important to spend time and resources in identifying how the application will integrate with business processes (outsource2india.com) The list below is based on the writer’s knowledge of the process and therefore may not be complete. The plan would be to meet with stakeholders and identify a complete list of requirements through process mapping.

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