Patient Flow Collaborative Learning Session 2

1
Patient Flow Collaborative Learning Session 2
Welcome 5TH October 2004 Melbourne Convention
Centre
2
Patient Flow Collaborative Learning Session 2
Dr Jenny Bartlett Chief Clinical Advisor 5TH
October 2004
3
Welcome

• Challenge each other to improve patient care
• Promote team work
• Plan to spread
• Lots to share
• Have fun

4
Victorian Travelling Fellowship Program

• Strategically drawn together to underpin the
  Patient Flow Collaborative innovations
• Story boards on display highlighting
• Who
• Where
• When
• Major learnings

5
Housekeeping

• Mobile phones to silent/vibrate
• Delegate Packs on tables
• Lunch will be served in the foyer (1200
  1245)
• Rest rooms
• Fire alarms and exits

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Housekeeping

• Take your belongings with you during the day
  room configuration will change
• Work in partnership no one knows all the
  answers
• Support people Clinical Innovations Team
  Planning Group Members (red badges)

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Story Board Voting

• Each team has been given a sticker to allocate to
  the storyboard they think is the best
• Criteria includes
• Achievements
• Team development
• Impact for communication
• Deadline for voting is 1430hrs
• Winner announced at the end
• of the day

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Agenda

• 9.10 10.30 Where are we and whats next? Lee
  Martin
• 10.30 10.45 Morning Tea
• 10.45 12.00 First Concurrent Session
• Team Presentations
• 12.00 12.45 Lunch

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Second Concurrent Session12.45 2.00

• How to encourage a culture of innovation Cathy
  Balding and Mary Mitchelhill
• Outpatient department toolkit Veronica
  Strachan and Kim Moyes
• Communication strategies Julian Murphy and
  Sharon Neal
• Advanced project management Ruth Smith and
  Claire Mackinlay
• Managing variation, elective emergency Lee
  Martin and Bernadette McDonald
  and Marcus Kennedy

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Agenda

2.00 2.30 Afternoon tea 2.30 3.15 Team
planning time 3.15 - 4.30 Healthsmart Anthony
Bibby Update web delay tracker Marcus
Kennedy Paper based delay tracker Peter
Wright 4.30 4.45 Update Melbourne
Health Melbourne Health Next steps and
close Marcus Kennedy
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To change the results, we need to change the
paradigm
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Hospital Demand Management Performance
Kathryn Cook Director Metropolitan Health Service
Relations 5 October 2004
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Hospital Bypass
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Percentage of time spent on bypass by hospital
September 2004
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Patients spending longer than 24 hours in the ED
16
Patients spending longer than 24 hours in the ED
by hospital
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Patients spending longer than 48 hours in the ED
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Patients spending longer than 48 hours in the ED
by hospital
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Mental Health Patients spending longer than 24
hours in the ED
20
Mental Health Patients spending longer than 24
hours in the ED by hospital
21
Percentage of elective patients postponed before
admission grouped by postponement reason by
hospital
22
Patient Flow
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Where are we and whats next?
Lee Martin Collaborative Director 5 October 2004
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Resource pack
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Orientation ?Learning session 1

• Masterclass series
• 12 weeks of rigorous diagnostics
• Whole system overview
• Social networks
• Breaking the myths

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Learning session 1

• Formed innovation teams
• Constraint diagnostics
• Started improvements
• Utilisation of the first draft toolkits
• Building on the excellent work done already
• Formed communication plans

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Individual constraint areas

• Bed management
• OPD
• LOS
• Elective stream
• Theatres
• Radiology
• Emergency Care
• Sub-acute

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Stickers
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Individual constraint areas
Bed Mgt
OPD
Elect
LOS
Radiology
Sub Acute
ED
OR
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Voting

• The answer is NO
• disruptive
• pointless
• vote the right/best way

• The answer is YES
• progressive
• helpful
• moving in right direction

• The answer is
• AMBIGUOUS
• results are mixed
• pros and cons
• good in parts

• The answer is
• HARD TO DETERMINE
• not enough data
• not clear, not sure
• need to investigate
• hard to make sense of

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Voting time
From the Collaborative work so far, do you feel
you have identified the true constraint areas?
No
Yes
Ambiguous
Hard to determine
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Organisational view
?
?

• Building whole care view
• Removing key constraint area
• Practiced improvement tools and creating new ones
• Building on appreciation in our organisation
  (Can
  do this task!)
• Starting to look at sustainability?

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Sustainability planning
Sustainability assessment toolkit
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Next challenge

• Once removed major constraint, what next?
• Remove constraint ?
• Understand and manage capacity and demand
• Manage flow with pull systems (no delays in
  process)
• Build new ways to treat patients
• Develop your modernisation plan

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Voting time
Would establishing capacity and demand management
with scheduling systems help to build effective
organisational flow?
No
Yes
Ambiguous
Hard to determine
36
Analysing variation and manage capacity and
demand

• Ward

Speciality
Divisional
Organisational
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Emergency Admissions
Range between the process limits is 20-55 Average
is 38
38
Elective Admissions
Range between the process limits is 4-50 Average
is 27
39
Understanding EL/EM Variation
Which has the greater variation Emergency or
Elective
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Admissions
Range between the process limits is 19-95 Average
is 57
41
Discharges
Range between the process limits is 5-107 Average
is 56
42
Understanding Adm/Disch Variation
Which has the greater variation Admissions or
Discharges
43
Variation in Inpatient Processes
44
Predicting Emergency Admissions
45
Variation in Admissions and Discharges/Deaths
46
Variation in Bed Usage
47
Murphys law
Problem will occur at the worst point, the worst
time and when you least expect it.
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Simple pull system for managing inpatient delays

Front page
Back page
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Hot topic call
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Managing capacity and demand
Elective Increase day surgery
Remove delays in length of stay
ED Capacity and Demand Remove through Chronic
Disease Management
Length of stay Decrease repeat tests, examinations
Eliminate not ready for care, cancellations on
day of admission
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NHS 10 High Impact Changes
Further information
52
Postcards
Right now, what is the one service improvement
program that is your priority to deal with flow
constraints?
53
Concurrent Session 1Team Presentations

• Bellarine Room 1
• Ballarat Health Service
• Goulburn Valley Health
• Western Health
• Royal Children's Hospital
• Felicity Topp and Rochelle Condon

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Concurrent Session 1Team Presentations

• Bellarine Room 2
• Royal Womens Hospital
• Southern Health Monash Medical Centre
• Peter MacCallum Cancer Centre
• Maroondah Hospital
• Calvary Health Care
• David Langton and Mary Mitchelhill

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Concurrent Session 1Team Presentations

• Bellarine Room 3
• Northeast Health - Wangaratta
• Bendigo Healthcare Group
• Southern Health Dandenong Hospital
• Peninsula Health
• Box Hill Hospital
• Melanie Hendrata and Kim Moyes

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Concurrent Session 1Team Presentations

• Bellarine Room 4
• LaTrobe Regional Hospital
• St Vincents Health
• Northern Health
• Angliss Hospital
• Bayside Health
• Tony Snell and Prue Beams

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Concurrent Session 1Team Presentations

• Bellarine Room 5
• Royal Victorian Eye and Ear Hospital
• Melbourne Health
• Barwon Health
• Austin Health
• Peter Bradford and Ruth Smith

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Morning Tea
Meet us in the concurrent sessions at 10.45
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Team Planning Time

• Lee Martin
• Manager Clinical Innovation Agency
• 5H October 2004

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Team Planning

• Share the knowledge and ideas you have gained
  today
• Use sustainability tool results in planning
• Work through the planner and develop your
  strategic approach

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Ask yourselves

• Will our plans help us make a significant
  improvement in our program measures?
• What other clinical areas would benefit from
  learning about the improvements we have made?
• Who are the expressive team members that can help
  us engage with other departments and disciplines?
• Does our communication plan support spread of our
  improvements?
• Do we have all the key people involved in our
  innovation work that we need?

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Task List

• Share today's learnings
• Develop the project plan
• Use the laptops and CDs for further ideas
• Review and update communication plans
• Use results of sustainability tools

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Health SMART
Anthony Bibby Portfolio Manager Patient and
Client Management Systems Office of Health
Information Systems
Department of Human Services
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Agenda

• The HealthSMART program
• The Governance Structure
• Status of Projects
• Finance Materials Management
• Patient Client Management
• Clinical Systems
• Shared ICT Services

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HealthSMART The Strategy

• Replace obsolete, unsupported core systems with
  capable, industry-standard ones
• Introduce new systems capable of supporting the
  transformation of health care
• Refresh and develop the ICT infrastructure
• Develop a strategic program management structure
• Deliver ICT services through Shared ICT Services
  using accredited (panel) products

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HealthSMART a 4 year Program -Three project
streams

• Resource Management Systems
• Finance and materials
• Human resources
• Clinical Systems
• Medication management (e-prescribing)
• Investigative services ordering and results
  reporting

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HealthSMART a 4 year Program -Three project
streams

• Patient / Client Management Systems
• Hospitals (deliverable)
• Primary and Community Health Services
  (deliverable)
• Mental Health (integration)
• Ambulance (VACIS project)
• Dental (EXACT project)

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• Governance

Department of Human Services
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HealthSMART program structureAgency
participation the partnership
Board of Health Information Systems Chair
Patricia Faulkner
Clinical SystemsSteering Committee Chair
Brendan Murphy
Resource Management Steering Committee Chair
Kathy Byrne
Patient Client ManagementSteering
Committee Chair Sherene Devanesen
Financial Management Group Supply Chain Group
Inpatient Management Group Ambulatory Services
Group Client Management Group Health Info Mgmt
Group
Medication Management Group Orders Results Group
Office of Health Information Systems
Chief Information Officer Group
Policy/Legislative Change Groups
Technical Expert GroupsDevelop and implement
technical design and standards
Health Service Implementation
Health Service Implementation
Health Service Implementation
Health Service Staff
Vendor
Health Service Staff
Vendor
Health Service Staff
Vendor
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System-wide Approach

• Lead Agency approach
• Funding provided to all Health Services to
  support participation in Program
• Single product evaluation and selection processes
  (Panels)
• Standard baseline of core products across all
  agencies
• All implementations will use defined standards
  and project methodologies
• Single program with multiple projects

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Guiding principles

• Maximum leverage will be derived from existing
  investments
• Buy not build Internal development, if any,
  will be minimised
• Purchasing power will be maximised
• Financial support conditional on adopting the
  HealthSMART strategic approach and principles
• DHS provides majority funding (70 - 80) to
  implement panel products, agencies contribute to
  projects and carry recurrent

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OHIS functions
The Office will provide a number of core
competencies, functions and services supporting
delivery of the Health ICT Strategy
Health Systems Development
Program Management
Strategy Policy
Technical Services
Engages other departments including state and
regulatory representation on strategy
development, healthcare system design and
innovation, and policy and standards creation.
Comprises portfolios of Resource Management
Systems, Patient Client Management Systems, and
Clinical Systems. Works with stakeholder groups
to provide direction on all stages of product
life cycle management - development, procurement,
implementation, maintenance and support.
System architecture and design. Technical
architecture and design. Development and
implementation of standards. Establishment of
essential hardware and software infrastructure,
development of shared services capability.
Design and implementation of integration
technologies. Provides expertise to portfolio
managers and health services to insure
infrastructure, technical services and
underpinning integration supports systems
delivery.
Methodologies and tools to ensure consistency and
accountability across projects in the areas of
procurement, implementation, project management,,
financial, risk, quality and change management,
governance, benefits realisation and outcome
evaluation.
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Shared ICT Services
Department of Human Services
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Shared ICT services - Scope

• Data centres
• Communications (agencies ?? data centres)
• Technology platforms to support core applications
• Database administration
• Specialist application support (2nd level)
• Redundancy

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Shared ICT Services - Status

• Technology refresh funding 2004
• Acute 20M
• Community 2M
• HealthWAN
• Southern Region commenced
• Conceptual design complete
• Shared ICT Services
• Work plan developed
• Work to design entity commenced
• Architectural design commenced
• FMIS infrastructure ordered
• Interim arrangements through Bayside Health

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• Resource Management Systems

Department of Human Services
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Current StatusFinance Materials Management

• Lead Agencies Bendigo, Eastern, Peninsula
• Contract let with Oracle February 2004
• Implementation Planning Studies commenced 1 March
  2004 recently signed off
• Design of common system configuration complete
  (involved all health services NOT just lead
  agencies)
• Issues
• Request for scope creep (Discoverer, report
  writer)
• Difficulty in establishing business cases with
  costs of Shared ICT Services not available
• 20 contribution by sector

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Current StatusHuman Resource Management

• Allegiance sale to Mantrack (and subsequent
  dispute with SAP) finalised
• Advisory Group established
• Consultants appointed to facilitate development
  of common requirements (agencies and DHS) and
  business case.
• Workshops held - gt150 agency staff participated
• Issues
• Agencies will need to commit to participate (or
  not) to allow business case to be developed
  accurately
• Not clear that there is a common commitment to
  progressing with functional HR management systems
  as compared to doing little more than payroll
  management

79

• Patient Client Management Systems

Department of Human Services
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Current StatusPatient Client Management

• Lead Agencies Peninsula, Gippsland, Melbourne,
  Southern, Northern, Western, Mercy, SWARH,
  Womens, MonashLink, Inner South, Western Region
  and Bendigo
• RFT released 6th August
• Tender closed 23 September
• Pre implementation project funding allocated
  (250k)
• Issues
• Media aggravation - Probity issues
• Enormous amount of effort required for evaluation
  pressure on staff
• Difficult getting and retaining Community sector
  involvement

Note Grampians have been removed from Lead
Agency group as they entered into a contract with
a vendor to replace their patient management
systems
81

• Clinical Systems

Department of Human Services
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Current StatusClinical Systems

• Lead Agencies Barwon, St Vincents, Bayside,
  Childrens, PMCI, RVEEH, Hume, Austin
• RFT released late September 2004
• Pre-implementation project funding allocated
  (250k)
• Issues
• Difficulty attracting staff to the project
• Most difficult to define and manage scope

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OHIS HealthSMART Contact details

• Office of Health Information SystemsTelephone
  03 9616 2787
• EmailOHIS.GeneralEnquiry_at_dhs.vic.gov.auOHIS.Vend
  orEnquiry_at_dhs.vic.gov.au
• OHIS websitehttp//www.dhs.vic.gov.au/ahs/healthi
  t
• HealthSMART website http//www.health.vic.gov.au/
  healthsmart

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Victorias Whole-of-Health ICT Strategy
Department of Human Services
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Royal Melbourne HospitalWeb Delay Tracker

• Dr Marcus Kennedy
• Clinical Lead
• Patient Flow Collaborative

An initiative of the Patient Flow Collaborative,
E.D. R.M.H., Melbourne Health
86
Introduction

• Monitoring Patient Flow through the Emergency
  Department, R.M.H. via a Web Browser.
• This will help in identifying bottlenecks in
  patient flow through the Emergency Department to
  the Wards, and other Depts.
• Accessible on the hospital intranet

87
Outline

• Accessing the Web browser
• Web Browser appearance
• Significance of colours
• How to update the Status of a Patient
• Who updates the Status of the Patient
• Action Sheets

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Overview

• Emergency Departments through out Victoria are
  facing a dilemma with Patient Flow through the
  Department.
• The Patient Flow Web Browser has been developed
  by Melbourne Health I.T. Dept., in conjunction
  with the Patient Flow Collaborative, Emergency
  Dept. R.M.H. to help identify the bottlenecks
  associated with Patient Flow through the E.D.
• These bottlenecks will be addressed by Action
  Sheets which have been developed to tackle the
  respective bottleneck.

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Accessing the Web Browser

• On the Desktop of the designated PCs there is an
  icon

• Click on the icon the Patient Flow Display
  will open.

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(No Transcript)
91
Patient Flow Display
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Patient Flow Display - detail
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Significance of the Colours
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Updating the Patient Status
Under the Status column, click on the Drop Down
arrow
to display the list of Delay Reasons
Select the appropriate Delay Reason to update the
Status of the Patient.
Once updated, the time since the last update
reverts to 0 m
95
Who Updates the Status?

• Senior Staff on duty for each shift are
  responsible for updating the Status of the
  Patients i.e. Clinical Coordinator in Charge
  Consultant in Charge.
• The Status should be updated every 60 minutes
  (second hourly overnight)

96
Action Sheets

• Action Sheets have been developed in association
  with the Delay Reason, these Actions Sheets will
  guide the next step to take in rectifying the
  Delay.
• Action sheets refer to actions that will be taken
  in ED, wards, at exec level, in service
  departments etc in response to specific
  situations. They are policy driven.

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LaTrobe Regional HospitalPatient Delay Tracker

• Peter Wright
• Emergency Care Director
• Latrobe Regional Hospital

98
Manual Hourly ED Tracking

• Why we embarked on manual tracking
• Detailed analysis of ED patient flow
• Simple
• Well accepted by ED staff
• Highly visible
• Highlighted key constraints

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Initial hourly tracking template
100
Codes used
101
Completed day sample
102
Refinement of hourly tracking
103
Refinement of hourly tracking
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Desired Impact

• Our expected impact will be
• Bed allocation time reduced to an hour for all
  stable patients
• Refinement of hourly patient tracking will
  determine new action plans

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• Questions
• Wendy Bezzina
• PFC Coordinator
• wbezzina_at_lrh.com.au
• [phone]

?
106
Melbourne Health team update

• Access Subacute services
• Bed Management
• Workforce Communication
• Access Theatres
• Access Radiology
• Emergency Department

107
Next Steps

• 16 weeks take us to the week before Learning
  Session 3
• Plan to make a significant change to your program
  measures
• Test all your changes carefully before spreading
• Next site visit with the Executive Sponsor
• and project facilitator only

108
Next Steps

• Involve the Collaborative management team
• Use your planning group members and each other as
  resources
• Connect to the Travel Fellows and the test bed
  work

109
Remember

• Urgency out of Emergency conference Le
  Meridien 19th 0ctober
• Web casts, see sheet or website
• Project Coordinators training day 2 Melbourne
  Health 11th November
• Hot Topic Call
• Simple Length of stay management
• Call 1800 063 705 pin number 4405 173
• Wed 3rd November 2.30-3.30 pm

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Project Coordinator Training Day Number 2

• November 11th
• Royal Melbourne Hospital
• Registration pack will be out shortly

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Best Storyboard Competition

• As voted by you
• The winner is.

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Evaluation forms

• Fill out the evaluation forms
• Safe trip home
• Thanks for a great day ,see you in February next
  year!

113
Conclusion
Marcus Kennedy Clinical Lead (Flow) 5 October
2004
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Access Block
115
Improvement / Change
116
The "Triple A" approach