Patient Flow Collaborative Action Learning Session No 2

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Patient Flow CollaborativeAction Learning
Session No 2

• November 11th
• Royal Melbourne Hospital
• Chair for the day Megan Bumpstead

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Welcome

• Today is an opportunity for further
• Learning
• Networking
• Challenging yourselves and each other

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Housekeeping

• Mobile phones to silent/vibrate
• Delegate packs
• Lunch will be served (1200 1245)
• Rest rooms

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Housekeeping

• Take your belongings with you during the day
• Work in partnership no one knows all the
  answers

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Agenda

• 10.00 11.00 LaTrobe Regional Hospital
  Wendy Bazzina
• experience
• 11.00 12.00 Melbourne Health Di
  Collins Sub acute experience
• 12.00 12.45 Lunch
• 12.45 - 13.45 Templating
• Demonstration from Ballarat Rowena Clift
• Discussion and practice Rochelle Condon

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Agenda

• 13.45 14.15 Project Plans Wendy
  Tomlinson
• 14.15 14.30 Designing systems Lee
  Martin
• 14.30 14.45 Communication plans Jannie
  Selvidge
• 14.45 15.45 High Impact changes Lee
  Martin
• 15.45 16.00 Web Tracker Wendy Tomlinson
• Demonstration
• 16.00 16.15 Whole System Thinking Rochelle
  Condon Quiz

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The LaTrobe Regional Hospital experience

• November 11th
• Latrobe Regional Hospital
• Wendy Bazzina
• Latrobe Regional Hospital
• Patient Flow Facilitator

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Patient Flow Collaborative
The LRH Experience
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Bed Allocation from ED to Ward

• Issues
• Transfer from ED to Ward, once bed is
  allocated, is spanning 3 to 6 hours
• Improvement Strategies
• Breakdown of categorys for Bed Allocation
  constraints
• Aim to set goal for All patients admitted
  within 1 hour of the decision to admit

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12 hour Waits in ED

• Diagnostics performed
• ED Hourly data tracking performed for every
  patient
• Collected manually onto A3 tracking tool.
• Data analysed monthly to identify constraints.
• Improvement Strategies
• Focus on utilisation of SSU
• Category breakdown of 12hr violations
• Analysis of Bed Allocation delays

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12 hour Waits in ED
ED 12 hours waits
of ED attendances waiting 12 hrs
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Bed Waiting

• Issues
• Long Acute LOS with GEM patients waiting for
  transfer to Sub Acute
• Lost GEM bed days causing lost revenue
• Improvement Strategies
• Established Bed Manager Role
• Established Community Bed Register
• Networked with Social Workers
• Triaged GEM patients for bed allocation
• Implemented GEM Functional Maintenance Program
• Currently working on Event Driven Discharges
• About to launch Fusion Sheets for Issue
  resolution by ward staff

Contact Wen Bezzina, Project Coordinator,
wbezzina_at_lrh.com.au [phone]
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Questions
?
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Access to Sub acute ServicesMelbourne Health

• November 11th
• Royal Melbourne Hospital
• Di Collins
• Patient Flow Collaborative Clinical Lead
• Access to sub acute services

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Patient Flow Collaborative
Acute Sub Acute
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Diagnostics Undertaken

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Major finding

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Intermediate Steps

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Intermediate Steps

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Intermediate Steps

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Measurement

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Lessons learnt

• Need to come back to the basic principles
• Sometimes there needs to be a whole system change
• Resistance to change is usually based in fear,
  which leads to defensiveness

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Desired Impact

• Model of care for the aged person admitted to
  Melbourne Health
• Intermediate term
• Reduced length of stay in the sub acute
• A tailoring of MH residential care facilities to
  meet our patients needs
• Increased use of sub acute ambulatory services
• Transparent communication between the acute and
  sub acute
• Integrated bed management system across the acute
  and sub acute

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RESULT SO FAR
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What has led to our success
What does culture change mean? What leads to
success? Why do some things work? What sustains
change? Is it systems changes? Is it changes in
peoples attitudes? Is it changes in
leadership? Is it an alignment of the planets?
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• Questions

?
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Lunch meet us back here at 12.45
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Patient Flow Collaborative
Process TemplatingRowena CliftMick
KirbyBallarat Health Services
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Background

• Presentation by Helen Bevan NHS Modernization
  Agency
• Use of Process Templating in 10 High Impact
  Changes
• BHS similar scenarios
• Dialysis
• Oncology
• Fact not Fiction

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Dialysis

• New Department
• Different work practices bigger dept
• Perception of being busier
• Request increase EFT
• No supporting evidence

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Old Unit
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Dialysis 2004
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Process

• Met with staff developed templates
• Scheduling
• Patient types
• Data review

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Dialysis Treatments
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Dialysis Data Collection
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Dialysis
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Process

• Reviewed Template with staff
• Identified needs
• Variety Staffing options
• Clerical
• Technician / Ward Assistant
• Volunteers
• Shift Changes
• Update

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Outcomes

• Employed new staff
• Patient Services Attendant
• Clerical
• Technician
• Volunteers
• Recommended review of rosters
• Early Evaluation

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Outcomes

• Service Provision Changes
• New department
• Co located OPD
• Increased clinic numbers
• New Oncologists

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Day Oncology (Background)

• Perceived Increased workload
• No evidence of increased throughput
• Requested Clerical Assistance

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Day Oncology Process Template
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Day Oncology Attendances
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Process
Oncology Time line1.xls
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Staff Process Template
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Outpatient Activity Data
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Process

• Gathered Info
• Identify core business / activity
• Observation
• Staff Input
• Templated
• Reviewed by staff
• Recommendations

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Outcomes

• Templating
• Scheduling issues
• Non core business activity
• Inappropriate staff mix
• Data analysis
• Evidence of non core activity
• Staff focus groups
• System and process issues
• Drop ins, protocols, work practice issues

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Outcomes (cont.)

• Recommendations
• Clerical assistance
• Review scheduling
• Develop new work practices
• Internally
• With other departments

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Recommendations alternate scheduling and
rostering
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Learnings

• Staff buy in
• Information must come from them
• Use data
• Templates
• Allow visualisation
• More to learn
• Different scenarios need different approaches
• Whiteboard!!

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• Questions

?
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High impact change 9

• Optimise patient flow through service bottlenecks
  using process templates

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Step 1 create a template based on what happens
80 of the time
The colour bars represent the time required at
each step as performed by one person, in one
place at one time
Prepare Bowel
Scope L bowel
Recover balance
Write notes
Prepare patient
patient
nurse
gastroenterologist/surgeon
gastroenterologist /surgeon
patient
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Instructions
Step two create the schedule background
9.00
8.00 p.m.
Step three create the schedule
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Step 4 consider available resources

• 2 toilets for preparation
• 1 nurse for preparing patient
• 1 theatre for scoping
• 1 doctor for scoping
• the doctor writes the notes
• 4 recovery chairs for recovering balance

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Typical questions

• What is the constraint?
• What is your solution to the constraint ?
• how did you increase the throughput (activity)?
• What were your assumptions ?
• What time did the department open?
• How long was the session?
• What would you chose the constraint to be ?
• What are the appointment intervals for the
  patients?
• 1st patient should arrive at?
• 2nd patient should arrive at?
• 3rd patient should arrive at?

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Step 5 line up the templates to match the
resources
30 minutes
Only 2 toilets
Gaps when doctor, theatre and nurse not used
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High Impact Change 9Optimise patient flow
through the service bottlenecks using process
templates

• What might we aim for locally?
• Organisations should consider using process
  templates prior to investment in additional
  capacity to ensure that the investment is
  required. This should become standard practice
  at the level of a single bottleneck (i.e.
  Endoscopy, chemotherapy or radiotherapy unit).
• Combine this with a reduction in the number of
  queues (high impact change 8) to get much more
  dramatic capacity gains

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Project Planning

• November 11th
• Royal Melbourne Hospital
• Wendy Tomlinson
• Patient Flow Collaborative Project Facilitator
• Melbourne Health

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Project Phases

• Project Creation Planning
• Project Control
• Project termination

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Creation, Planning Scheduling

• Define an appropriate project goal
• Determine the major stages
• Break into a series of separate tasks
• Determine the sequence of the tasks
• Assign suitable resources
• Set up a task schedule
• Review the project plan

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Defining the goal

• Endorsed, approved by the client specifics are
  clear
• Purpose scope
• Any constraints cost, time, facilities
• Contingency plans if runs over time or not within
  budget
• Criteria by which to measure success.

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Major Stages

• No more than about ten major stages
• Important in top - down planning

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Separate tasks

• Milestones to mark the completion of each stage
• Tasks need to be
• Well defined with a clear purpose
• Manageable
• Each task has associated activities that have a
  definite beginning end

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Sequence of tasks

• Decide which tasks need to be completed before
  other can start.
• Define any constraints that will effect the
  sequence.

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Resources

• People
• Equipment
• Facilities
• Materials

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Schedule

• Calendar
• Realistic
• Clearly communicated

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Review

• Verify accuracy
• Circulate copies of plan for review

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Management

• Meeting schedules
• Agendas
• Clear actions communicated
• Planner
• ACTION LIST 051104.doc
• PFC Project Plan 2004-05.xls

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Designing systems

• November 11th
• Royal Melbourne Hospital
• Lee Martin
• Manager Clinical Innovations Agency

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Have You Heard Whats Happening?

• Communication Plans
• Patient Flow Collaborative
• Jannie Selvidge,
• Barwon Health

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This Presentation Aims To

• Provide a framework to review the patient flow
  collaborative communication plans
• Revisit the communication plan components
• Outline the principles of effective communication
  plans
• Engage the audience with an activity to evaluate
  their own communication plan.

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Evaluation Criteria

• Did the message reach its intended audience?
• Was the message distributed through the planned
  channels?
• Did the output reach the intended audiences on
  schedule?
• Was the distribution effective?
• Did the message address the information
  requirements of the target audience?
• Did the public believe the message?

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Have You Implemented a Pull Strategy?

• How often is the audience asking your
  stakeholders and clinical teams how the
  collaborative is going?
• Are people inundating you with their insights and
  brilliant ideas?

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Framework for communication Plan

• 1.       Determine goal(s)
• 2.       Identify target audiences
• 3.       Finalise key messages
• 4.       Determine strategies
• 5.       Determine activities
• 6.       Determine evaluation mechanisms.

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Guidelines

• Project name
• List of stakeholders
• Information needs
• Communication methods
• Credible communicator
• Time and dates
• Feedback mechanism

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Communication Plan Example
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Communication Opportunities
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Principles of Effective Communication

• Credibility approach/communicators
• To involve, not just inform
• Trusted and respected communicators
• Visible management support
• Face to face communication
• Avoid information overload
• Consistent messages

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Principles of effective communication

• To repeat messages and vary mechanisms
• To create demand encourage team to pull for
  info, rather than management push
• Tailor communication to audience needs, and
  wants, not what you want to tell
• Central co-ordination
• Manage expectation
• Listen and act on feedback.

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• The Patient Flow Collaborative objectives,
  successes and failures are not hush-hush
• By now all the hospitals are buzzing with
  discussion about the revolution of Victorian
  health services are they?

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How effective is your communication plan

• Looking your existing communication plan,
  consider the effectiveness of the plan using the
  following criteria

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Evaluation Criteria

• Did the message reach its intended audience?
• Was the message distributed through the planned
  channels?
• Did the output reach the intended audiences on
  schedule?
• Was the distribution effective?
• Did the message address the information
  requirements of the target audience?
• Did the public believe the message?

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• Questions

?
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• Jannie Selvidge
• Barwon Health
• Jannies_at_barwonhealth.org.au
• Telephone [phone]

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High Impact Changes

• November 11th
• Royal Melbourne Hospital
• Lee Martin
• Manager Clinical Innovations Agency

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Demonstration Web delay tracker

• November 11th
• Royal Melbourne Hospital
• Wendy Tomlinson
• Patient Flow Collaborative Project Facilitator
• Melbourne Health

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Whole system thinking quiz