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Home Hospital Accelerator: Spreading Acute Care at Home

 

Ariadne Labs logoImproving patient outcomes has always been the top priority for medical professionals and healthcare systems. But the world of healthcare is a notoriously siloed one. This means incorporating lessons learned, leading practices, and innovations across healthcare systems can be as vexing and complex as modern medicine itself. 

What happens if these siloes remain? The ability for healthcare systems to effectively build from shared knowledge is limited at best. So we’re left with uneven pockets of innovation and improvement. 

Ariadne Labs hopes to save lives and reduce suffering by breaking through barriers like these. The first-of-its-kind center for health systems innovation was created by Brigham & Women’s Hospital and the Harvard T.H. Chan School of Public Health. 

One of Ariadne’s latest initiatives is to bring together and accelerate hospitals and health partners who are either preparing to or have just begun delivering acute care at home as a substitute for the traditional hospital. The goal is as important as it is ambitious. Ariadne believes the Scrum framework can help them achieve that goal. 

Scrum Inc. is proud to contribute to this effort by providing pro-bono training and support.

The Need for Hospital-Level Care in a New Setting

Hospitals were overcrowded and care was expensive long before the pandemic. Anyone who has made a trip to an Emergency Room can attest to these as fact. 

But there can be other issues with hospitalizations as well like unintended clinical consequences. “Believe it or not, 20% of older adults become delirious during hospitalizations,” says Dr. David Levine, “one-in-three lose functional status that’s never regained.” 

Levine, a primary care physician and investigator at Brigham & Women’s Hospital and Harvard Medical School, also notes that the potential risks of hospitalization aren’t limited to a particular age group. “On average one-in-ten patients admitted to an American hospital will have something go wrong during their stay.” This can range from a medication error or an adverse event such as a fall or infection. 

“If we knew we had a one-in-ten chance of something going wrong every time we walk on an airplane,” Levine states plainly, “we’d never fly again. Yet we walk into hospitals all the time.” 

Creating a program that allows some patients to receive acute hospital-level care at home is one way to alleviate these risks and improve the patient experience. A growing number of hospitals and healthcare systems are rolling out these programs. The theory is that many of these hospitals could more optimally provide acute care at home if they collaborate and share knowledge and practices. 

So, in collaboration with CaroNova, Ariadne Labs launched the Home Hospital Early Adopters Accelerator Program to provide expertise in designing and managing home hospital programs via a network of hospitals that collectively learn, create, and implement together as a community. 

The Home Hospital Accelerator’s Product

21 organizations from around the world have joined CaraNova and Ariadne Lab’s Home Hospital Accelerator. They will collaborate to create 20 ‘knowledge products’ in 40 weeks. 

What is a knowledge product? “It’s a purposely vague term,” explains Dr. Levine, who is the Product Owner of the accelerator. The purpose of the initiative is to create the tools, clinical protocols, and workflows needed to enable home hospital programs to provide acute hospital-level care away from a physical hospital. The needs of hospitals and healthcare systems will likely change over the length of the accelerator. 

Ariadne utilizes quick feedback loops with participants to capture, prioritize, or reprioritize the needs of the participating organizations. The accelerator will be able to quickly pivot to meet changing or emerging needs. As Dr. Levine states, “we want each product to be what the hospitals need them to be.” 

Scrum and the Accelerator

The makeup of this accelerator provides several advantages. The number of participating organizations creates access to a deep pool of specialists and other subject matter experts. There is also a regional mix of healthcare systems that provides insights into different approaches, different patient populations, and a diversity of needs. 

There are, however, many challenges that must be overcome. The team launch video conference highlighted what is arguably the most significant; a number of the individual participants joined from a clinical setting - some wearing full personal protective equipment. 

Many of the individual Scrum Team members are taking part in the accelerator and providing care to patients daily.

Ariadne and Levine believe that the Scrum framework can and will create the flexibility required in such a situation while still empowering teams to collaborate and drive work to done. To work effectively, efficiently, and collaboratively in the midst of an interrupt-driven environment. 

The Scrum Teams in the accelerator work in one-week Sprints. Their goal is to deliver a completed ‘knowledge product’ every two Sprints. 

Not every patient or case is a good candidate for a home hospital program. Establishing state-of-the-art clinical inclusion or exclusion criteria has been identified by hospitals and healthcare systems as their top priority. This first knowledge product was completed in the very first Sprint. Twice the work in half the time indeed. 

Congratulations Ariadne, CaroNova, and the Home Hospital Early Adopters Accelerator! Scrum Inc. is proud to support efforts like this which seek to change the world in positive and meaningful ways.

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