Case Studies

We pride our work on real results from reliable sources. The case studies below describe actual improved team processes and even some improved clinical outcomes after implementing the Siebens Domain Management Model™.

 

SDMM™ Dissemination in multiple rehabilitation hospital team conferences

The Chief Medical Officer, Dexanne Clohan MD, of HealthSouth (a large corporation that included over 100 rehabilitation hospitals), supervised the incorporated of the SDMM into inpatient rehabilitation team conferences. She summarized the process at a national rehabilitation conference in 2014.

In 2009, her leadership team and she were looking into standardizing the rehabilitation team conference format since there was no uniform structure to these meetings. They recognized that the right kind of standardization could yield benefits to patients, physicians, staff, and the hospitals. They realized they needed a model that was simple, comprehensive, interdisciplinary, flexible (“like cake frosting: not too stiff but not too runny”), outcome oriented, and compatible with other documentation approaches. Also, any change had to be easy to teach, outcomes and feedback from staff would be important, as would sustainability and model expansion to new facilities.

Dr. Clohan had heard of the SDMM in a prior presentation by Dr. Siebens. She later learned that it had been successfully incorporated into team conferences at the University of Virginia’s affiliated HealthSouth rehabilitation hospital. On discussion with Dr. Siebens in 2010, a decision was made to add the SDMM to a standardized template for team conferences. Teams were instructed to discuss patients’ care in the order of the SDMM’s 4 domains and focus on barriers to discharge.

In her 2014 presentation Dr. Clohan shared that there had been no clinician push back during the roll-out and that the overall assessment of the HealthSouth leadership team was that this specific standardization was beneficial.

See details of improved outcomes at University of Miami-affiliated hospital by Dr. David S. Kushner.
See more annotated citations of
Dr. Kushner’s publications.

 

The SDMM and Inpatient Rehabilitation Team Conferences

Being consistently well-organized can save time and money.

Using the SDMM, Dr. David Kushner and colleagues at the University of Miami Miller School of Medicine, Department of Physical Medicine and Rehabilitation, reported significant benefits.  

In their inpatient rehabilitation hospital team conferences, they:

  1. applied the SDMM to re-organize discussions

  2. focused on barriers to home discharge

As result, reported benefits included:

  1. team members became more engaged and real problems were solved

  2. patients were discharged with better function

  3. more patients were discharged home

  4. lengths of stay were shorter

  5. for the stroke group, fewer patients returned back to the acute hospital

Possible explanations for why these improvements occurred included:

  1. team conferences were more interactive and,

  2. there were changes in how physicians co-led team conferences and in items discussed based on the 4 domains and on barriers to discharge.

See details of improved outcomes at University of Miami-affiliated hospital by Dr. David S. Kushner.
See more annotated citations of
Dr. Kushner’s publications.

 

Outpatient Care of Seniors - Program of All Inclusive Care of the Elderly (PACE)

This client had a challenge in their brief outpatient team conferences that addressed the urgent needs of the program’s participants. Discussions were unfocused, at times tangential. There was no consistent way to talk about participants.

Under the leadership of the Medical Director, who was familiar with the SDMM, the client requested a site visit. After observing a team conference and a few telephone conferences, the SDMM was integrated into a new conference template. From one successful pilot team its use expanded to four teams.

During a second site visit three months later, pilot team staff, outpatient providers and the program’s Transitions Team, all heard the SDMM Overview presentation by Dr. Siebens. Because the qualitative feedback was all positive, the SDMM was continued in the expansion to another four outpatient teams and to the Transitions Team’s documentation. They suggested that a video of the presentation be made to show even more of their staff and for use in training new hires.  

The qualitative outcomes within one year include:

  • leadership/staff agreement that the SDMM makes communication more consistent, participant-focused, and decreases the risk of missing critical elements

  • SDMM has been supportive of the program’s growth

  • agreement that the four domains kept the focus on their participants without taking more time

  • health risks that were being missed in the past no longer are

The Medical Director and Executive Director reported that the SDMM was there to stay. The director of Social Services reported, “The SDMM is the bright spot of our new conference format.”

In addition, they reported that during a Centers for Medicare and Medicaid Services (CMS) Audit, the auditors agreed that the SDMM was a solution to the client’s prior deficiency that medical concerns were not getting sufficient focus.



 

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