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Supporting province-wide implementation at scale: The Alberta Health Services Acute Care Bundle Improvement initiative

September 24, 2022

Alberta Health Services (AHS)’ Acute Care Bundle Improvement (ACBI) initiative is based on a vision of excellent care for “every patient, every time” to improve quality outcomes for patients, for providers, and for the system. It aims to improve patients’ experience and quality of life by focusing hospital-based care on those services that need to be delivered in the hospital, with all other care shifting to a more appropriate setting. It addresses key stakeholder feedback regarding multiple (and similar) hospital-based acute care processes, pathways and initiatives that were competing for attention, limiting successful implementation, and impacting transition of care to the most appropriate setting. AHS has prioritized ACBI implementation, with executive, zone and site leadership support. ACBI, currently being implemented at 14 major acute care hospitals across the province, is being customized to reflect the local context, needs, and priorities at each site. This evidence-based implementation approach is grounded in knowledge translation and implementation science (IS) as well as change management principles.

ACBI consolidates several strategies intended to improve patient outcomes into evidence-based “bundles” – one for medicine, one for surgery with a goal of reducing LOS and ALC rates. These acute care bundles form a consistent and predictable approach for routine care activities in daily workflows and transitions that aligns with the patient’s journey from admission, through daily care, and finally discharge back to community/primary healthcare. Collectively, these strategies will optimize the utilization of inpatient beds, improve patient flow and reduce costs. This will ultimately create more inpatient capacity for other priorities, including surge capacity for managing post pandemic recovery (e.g., Surgical Waiting Lists) or future needs related to growth and ageing.

Grounded by AbSPORU’s unique mandate to support health-system transformation by enabling and sustaining evidence-based change, the Learning Health System (LHS) and Patient Engagement (PE)teams have and continue to make vital contributions to this initiative by combining their network of relationships, expertise in implementation science, and resources for building research capacity:

The LHS team was well-positioned to support AHS staff because of key relationships brokered by our health-system lead. We have worked closely with specific programs and the participating sites, integrating their organizational and practice-context knowledge with our IS expertise and experience (e.g., assessing barriers and facilitators to change and addressing them using targeted strategies), thereby building IS capacity.
Eleven patient engagement researchers were supported to take the PaCER program, with part of their training focus being on both the medicine/ surgery foundational bundles, particularly the component of Hospital to Home to Hospital transition (H2H2H) initiative, to help inform implementation from a patient and family perspective.

For 2022-2023, the LHS team will continue to support the ACBI implementation processes, including evaluation. By helping to build and mobilize IS capacity in AHS, we will help strengthen AHS’ learning health system’s ability to apply IS principles and methods as the organization works toward the critical goal of providing the right care to the right patient in the right location.

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Land Acknowledgment

The Alberta SPOR SUPPORT Unit operates on and acknowledges the lands that are the traditional and ancestral territory of many peoples, presently subject to Treaties 6, 7, and 8. Namely: the Blackfoot Confederacy – Kainai, Piikani, and Siksika – the Cree, Dene, Saulteaux, Nakota Sioux, Stoney Nakoda, and the Tsuu T’ina Nation and the Métis People of Alberta. This includes the Métis Settlements and the Métis Nation of Alberta. We acknowledge the many First Nations, Métis and Inuit who have lived in and cared for these lands for generations. We make this acknowledgment as a reaffirmation of our shared commitment towards reconciliation, and as part of AbSPORU’s mandate towards fostering health system transformation.