In August 2014, Monash began to think more deeply about their extended stay patients. Long stay patients represent only 2% of clients, but use 25% of hospital bed days. So, minimizing long stay has significant value for any hospital system. Since few people want to spend any time at all in the hospital, it has clear value for patients as well. Data, overall, illustrates that each additional day stay tends to have less medical efficacy and it produces more stress in the patient and for the staff. The Monash team began by drafting a four page design brief to layout their objectives. Though they had no idea what was causing the long stays, the hope was to halve the number of people in Monash Hospitals staying longer than 21 days. The team members immerse themselves in information about the experience of long stay patients. Conducting extensive interviews and pouring over patient's real life descriptions of their needs. It was face to face ethnography. The team also spoke to frontline medical staff to understand the obstacles to delivering care. All these conversations lead to an intention that the team elected to formalize. The Long-Stay management system ensures that patients at high risk to an extended stay receive appropriate, high-quality, safe and waste free care in partnership between patients and caregivers. Despite looking at all the data, one key insight was that each case was unlike any other long stay case, patterns were difficult, maybe impossible to find. Another insight was that patients loved being asked how they were. That basic ethnography, that simple human connection, helped both the patient's emotional and their physical states. Busy clinicians needed an easy and intuitive way to track and monitor patients with elevated long state potential. Which the team arbitrarily decided was six days. What could staff learn between that sixth day and between discharge. Brainstorming led to a napkin pitch that resonated with awe. An app that could be used with an iPad or other mobile device. Something where front line caregivers could quickly and easily record long-stay risk factors like infection or emotional states. Besides predicting long-stay risk, the information could support doctor patient decision making, and allow staff to track issues as they arose. Because with an iPad in hand, staff was always mobile. They could collect, record and examine all the data at each patient's bedside while talking with him and his family. The app titled, No Wasted Days, would also enable clinicians to request assistance with patients stuck due to hospital processes or administrative foul ups. And it will capture follow up conversations for future research and iteration, except for development cost. No wasted days, sounds like a win, win, win. The team built wire frames to prototype the app and began training nurses in using it, even though it was just a prototype. To convey what the future under the new approach might look like, they created a journey map that traced, day by day, the new and improved experience of their persona Larry Longstay. They iterated through four learning launches, based heavily on clinicians feedback, improving the idea time and time again. Once satisfied with the concept, they opened bidding for writing the app and sought the $25,000 to get it developed. Here's an interesting point, just preparing for the app, apparently changed behavior, and, therefore, altered the hospitals bottom line. When the Longstay project began, Monash had 15 patients lingering longer than 21 days. And when the app went out for development, the hospital system was down to two, two patients. Of course, there could be every reasons for the dramatic decline. But some of it can be attributed to two concepts. One, that just being the center of attention improves patient health, not just patient experiences. And the other is what researchers call the Hawthorne Effect. That the focus required for any study affects the results and usually in a positive way. Humans, caregivers, in this case, subconsciously think that if we're measuring, we should pay attention to it. Developing the app idea, figuring out what information to collect, for example, help caregivers pay attention to long stays and, most likely, patients begin receiving more rather than less attention the longer they stayed. Certainly, after the team's arbitrary six day threshold.
