Calling time on the ‘dance of the blind reflex’: how collaborative working reduced older persons ’length of stay in acute care and increased home discharge

Background: A practice development project was undertaken with nurses from acute, older persons, primary care and rehabilitation services across two counties in the north east of the Republic of Ireland over a 12-month period in 2018-19. For acute hospital patients aged over 65 years, the average length of stay in 2017 was 44.44 days; for medical patients it was 55.69 days. The average length of stay on the pre-discharge unit was 36.5 days, after which 54% of patients transferred to nursing homes, 14% to rehabilitation services and 18% to home. Aims and objectives: The objectives were to provide a more person-centred, integrated approach to care across the services, to facilitate patient and family involvement in care planning and to understand why so few patients transferred home, with the aims of reducing lengths of stay in the acute hospital and increasing the number of patients going home. Methods: Person-centred and Lean Six Sigma approaches were combined. Lean Six Sigma provided the framework for data collection, analysis, planning and scheduling, while engagement within the team and with other colleagues, patients and their families was underpinned by person-centred principles. Results: The project resulted in an average reduction in length of stay on the pre-discharge unit of 16 days. More than 47% of patients are now being discharged home compared with 18% in 2017. Conclusion: A combination of Lean Six Sigma and person-centred approaches was used to shift from the status quo and transform care by implementing process changes that promoted better communication and facilitated a smoother transition for patients through the services. This combination was effective in promoting a culture that supports patients and their families to determine and achieve their preferred health outcomes. Implications for practice: Understanding culture and context within healthcare organisations is an essential part of practice development, especially in cross-service initiatives Creating a shared vision across all services that puts the patient at the centre of care supports patients and families to choose and achieve their care preferences Lean Six Sigma and person-centredness can be used in combination to design person-centred improvements that benefit staff, patients and their families