Leadership

Executive Training for Research Application (EXTRA)

Trish Bergal

Extra Fellow, 2006–2008: Trish Bergal, RN, MN

Current position: Regional Director, Utilization, Winnipeg Regional Health Authority

Current job role:

• Working with regional and facility staff to develop and promote a Regional Utilization Framework
• Deploying a regional clinical decision support system to improve patient flow and reduce length of stay.

Intervention project: An Evidence Base Approach to Improving Hospital Patient Flow
           
Health-care organizations throughout the Western world are always striving to improve hospital utilization. Moving patients into, through and out of the acute care system (described as “flow”) in a timely and efficient fashion is necessary to balance demand with capacity.

The Winnipeg Regional Health Authority has a long-standing interest in alleviating overcrowding in emergency departments. With the support of Manitoba Health, the Winnipeg Regional Health Authority has invested in several initiatives to increase accessibility to care, including an initiative to provide alternative settings of care for hospitalized patients. The last step in this initiative was to tackle moving in-patients through their plan of care.

A utilization management system was acquired for use in acute care hospitals in Winnipeg to assist hospital administrators in setting goals, arranging care planning and tracking discharge delays and to help health-care teams to identify actions required to move patients forward in their plan of care. Following implementation of the utilization management system, there was little evidence from data on length of stay to indicate how the system had contributed to improving movement of in-patients through their plan of care.

A literature review showed that patient flow is a complex entity; it is influenced by leadership direction and expectations and by organizational goals related to patient flow. The literature on flow, change and sustainability helped shape the design of the intervention, which was focused on adopting and implementing the utilization management system.

EXTRA benefits:

My participation in the EXTRA program has provided numerous career benefits for me and many associated benefits for my organization. My personal capacity related to knowledge use and application has been advanced. In addition, my ability and confidence to encourage others within my organization to examine issues from an evidence-based and best-practice perspective has developed considerably.

Most significant skills acquired through EXTRA:

I developed a number of important skills by participating in the EXTRA program. The skill sets I use most frequently in my daily practice include the following: formulating an appropriate question of inquiry, searching and appraising the literature and applying the literature related to change management and sustainability to my work. My personal information-management skills also have grown as a result of my participation in the EXTRA program.