Patient Flow Collaborative Learning Session 3

1
Patient Flow Collaborative Learning Session 3
WHOLE SYSTEM ACCESS Bellarine Room 4 Marcus
Kennedy and Prue Beams
2
Breakout session 4Bellarine Room 4 9.40 10.35
A whole system approach to acute care management
Siva Sivarajah Executive Director Rosebud
Hospital, RAPCS, Allied HealthExecutive
Sponsor Peninsula Health PFC, Peninsula
Health 9th February, 2005
3
Presentation

• A WHOLE SYSTEM APPROACH TO PATIENT FLOW
  MANAGEMENT

4
Aims

• How we got started
• Challenges to date and in the future
• Key strategies
• Early achievements activities to date
• Lessons learned
• Next steps

5
How we got startedThe first six months

• Key stakeholders chosen from the quality area
• Multiple collaboratives underway at same time
• Facilitator could not provide a focussed effort
  due to workload commitments
• Minimal communication about the PFC
• Brainstorming sessions across Peninsula Health
• Small project focussed

6
How we got startedThe second six months

• Change in key stakeholders
• Executive Sponsor Vision Major Change
  Initiative
• A facilitator that could provide a focussed
  effort
• Increased co-ordination communication
• Regular meetings with new PFC Executive Team
• Multiple project teams built
• Gained increased PH Executive support

7
How we got started - The first six months

• Who was involved?
• Peninsula Health wide brainstorming
• Patients
• Frontline staff
• Departmental Managers
• Reactions?
• Have done it before
• Good, lets get this right

8
How we got started - The second six months

• Collation of Brainstorming results into Priority
  Areas
• Identifying Priority Area Leaders
• Refining Priority Areas
• Re-aligning Priority Area Leaders to Priority
  Areas
• Turning major trends into projects
• Linking into work already done for quick wins
• Submerge PFC into Day to Day Business

9
Peninsula Health PFC Executive Team

• Executive Sponsor - Siva Sivarajah
• Facilitator - Eddie Dunn
• Priority Area Leaders (PALs)
• Priority Area 1 - Dr Susan Sdrinis Shamala
  Jones
• Priority Area 2 - Jane Poxon Robert Barker
• Priority Area 3 - Di Jamieson Kate MacRae
• Priority Area 4 - Jan Child Lyn Jamieson

10
Priority Areas

• Optimise patient flow from the Emergency
  Department
• Eliminate delays for patients awaiting surgery
• Optimise bed utilisation across all sites
• Facilitate consistent systems and processes
  across Peninsula Health

11
Whole System Approach
12
Whole System Approach
13
Guiding Statement

• A delay in the discharge of
• one patient means a delayed
• admission for another.

14
Guiding Principles

• Patient focussed
• Improved patient outcomes
• Right patient, place, resource, time and
  clinician
• Prompt access
• Optimal flow
• Enhance professional networks and relationships
• Efficiency

15
Key Strategies Co-ordination

• Have a vision
• Build an Executive Team from multiple disciplines
  
• Agree on a direction and Priority Areas
• Meet regularly and empower PALs
• Encourage accountability through regular reporting

16
Challenges Co-ordination

• Needed to bring all PFC info to date together
• Needed to provide up to date information
• Needed to develop consistent tools for all to use
• Needed to Pinch with Pride and share

17
Key Strategies Co-ordination

• Have a central point for all information and make
  available all information from all projects
• Disseminate information
• Format tools that could be used across multiple
  projects
• Communicate, communicate, communicate

18
Challenges -Communication

• Needed a co-ordinated approach
• Needed to use the same language
• Needed a signature / design
• Needed to be simple, understandable effective
• Needed to be targeted
• Needed to be planned

19
Key Strategies -Communication

• Develop a Public Folder for all PFC
  Teams/participants
• Executive Sponsor Paving the way for success
• Standing Item on Operational Executives meeting
• Fortnightly PAL meetings
• Engaged Peninsula Healths Public Relations Unit
• Quarterly four page newsletter and monthly update

20
Next steps -Communication

• Develop a PFC Intranet site with a Score Chart
• Update Internet site
• Road show
• Maintain the central point of documented evidence
• Orientation programme presentation

21
Communication

• This is bureaucratic gobbledegook to
  clinicians. I have NO IDEA what a patient flow
  collaborative is, something to do with Urology
  perhaps?
• (Peninsula Health Medical Officer December 2004)

22
Early Achievements

• Focus on quick wins
• Identified established work that could link with
  PFC
• Targeted projects from Brainstorming Analysis
• High Level Executive Support
• Team approach

23
Activities to date

• ED / Radiology
• Emergency Streaming
• Direct RAPCS admissions from ED
• Allied Health Pre-discharge Home Visits
• Patient Transfers and Transport

24
Activities to date

• LOS and Early Discharge
• Volunteers
• Incident Management
• Theatre Utilisation Project

25
Future Activities

• Communication and referral processes between ED
  and Inpatient Units
• Orthopaedic Streaming
• Neuro Streaming
• Weekend Discharges

26
Future Activities

• Multiple patient assessments
• High Risk follow up
• Transfer of Medical Records across sites
• Ward Clerk and PSA roles

27
Lessons learned

• Quick wins are important!
• Independent project facilitators support success
• Involve frontline staff at beginning of process
• Pressure test regularly with front end users
• Provide increased education
• An analysis of one problem often identifies
  other issues, which will need to be addressed.

28
Lessons learned

• Quick wins are important!
• Processes and decisions to be patient focussed
• Strategies to support accountability to be put in
  place early
• Communication and co-ordination required for
  success
• NHS Sustainability Tool is effective

29
Lessons learned

• An analysis of one problem often identifies
  other issues, which will need to be addressed.
• Provide increased education
• Need motivators involved in projects
• Best project leaders may come from front end user
  group
• Communicate, communicate, communicate

30
Future Challenges

• Gaining participation of medical officers
• How to involve more frontline staff in the
  process
• Keeping staff motivated
• Managing the growth of activity

31
Critical to Success

• High level management support
• Clinicians fully engaged
• Clinical Leadership
• Team work
• Communication mass involvement of staff and
  healthcare partner organisations
• Improvements must involve structures, processes
  patterns

32

• Questions

?
33
Morning Tea

• Meet us back here for
• Workforce strategy development
• at 10.50

34
Breakout session 4 Bellarine Room 4 10.50
11.45
Workforce strategy developmentRight People,
Right SkillsDHS workforce design strategy
Jennifer Colbert Workforce Strategy and
Regulation, DHS 9th February, 2005
35
Right People, Right SkillsDHS workforce design
strategy
Jennifer Colbert Service Workforce Planning
36
Human services workforce Key challenges

• Factors impacting workforce supply
• Changing workforce demographics
• Changing working patterns mobility
• Shrinking pool of workforce entrants
• Increasing specialisation entrenched
  professional silos lead to fragmentation of
  care
• Factors influencing workforce demand
• Increasing service demand
• Changing technology and evolving models of care
• Increasing client complexity

37
Human services workforce Enablers for change

• Getting national/state/local approaches
  outcomes
• Engaging with the VET, tertiary post tertiary
  education sectors
• Overcoming professional/industrial legacies
• Adjusting workforce expectations
• Acceptance of learning from overseas
• Getting investment in workforce development
• Willingness to embrace change

38
National workforcestrategic framework

• Established to guide national investment in
  health workforce
• Allows better identification of workforce
  priorities that would benefit from national
  approaches
• Provides capacity to promote collaboration
  between jurisdictions and reduce duplication
• Work plan for 2004-05 includes
• Nationally consistent medical registration
  project
• AMWAC Studies in surgical specialties
• Alternative workforce planning approaches
• Improving workforce data

39
Developing a Victorian action plan

• Key areas to be progressed include
• Increase workforce supply
• Improve workforce distribution
• Improve workforce data analysis
• Explore opportunities for role redesign
• Combination of short, medium and long term
  strategies required

40
Health workforceStrategies solutions
Short term
Medium term
Long term
Attract locally trained international students
Improve
Supplement existing overseas recruitment
strategies
workforce
Expand strategies to encourage re
-
entry
supply
Increase funding for clinical placements
E
C
R
Fund growth in early graduate positions
O
F
Improve
K
Establish alternative approaches to management

R
workforce
O
allocation of early graduate

vocational training positions
distribution
W

H
Expand recruitment

retention strategies in priority services

occupations
T
L
A
E
Fund projects to design
influence curriculum
H
Redesign
Support skills mix projects
the
Expand training utilisation of certificate
trained staff
workforce
Fund local workforce innovation projects which
pilot
work roles /or design
41
Workforce StrategiesIntegration
42
Role review designPrinciples

• All role changes should improve the patient
  journey through the health care system
• Ideally, follow on from service review
• Allow professional staff to work at their
  training level delegate technical and
  irrelevant work
• Expand use of trained support staff
• Maintain safety and quality

43
Role review designEducation training

• Improve liaison with higher education VET
  sectors tailor curricula to roles
• Explore alternative education models deliver
  skilled workers more efficiently
• Encourage articulation between VET higher ed
  career paths and career flexibility

44
Role review designSkills mix projects

• Undertake statewide pilots to identify effective
  approaches and tools
• Support local innovation, existing and proposed
• Priorities for 2004-05
•          Extended roles for allied health
  assistants
•          Support roles in acute care
•          Support roles in rehabilitation
•          Extended roles in eye care (building on
  the VictorianOphthalmology Services Service
  Planning Framework
•          Support and professional roles in
  mental health
•          Extended allied health professional
  roles.

45
Role review designMethodology
46
Role review designGovernance
47
Role review designGoing forward

• More information please forums, visits to
  services
• Call for expression of interest from health
  services for redesign pilots
• Communication, consultation ongoing liaison
  with stakeholders
• Formation of reference groups teams
• Development of redesign tools

48
DHS workforce design strategyInterested?
Questions?
Contact Email jennifer.colbert_at_dhs.vic.gov.au Ph
one 03 9616 7872
49
Team Presentations11.45 1.00

• Prues Cluster Bellarine Room 4
• Peter MacCallum Cancer Centre
• Northern Health
• Bendigo Healthcare Group
• Western Health
• Box Hill Hospital

50
Tabletop presentations

• The aim of this session is to
• Promote discussion
• Share Peer to Peer practical experiences of
  innovation
• Increase energy for change and shared learning
• Spread ideas between teams

51
Session format

• 2 teams per table
• Team A has 10 minutes to share experiences with
  team B
• Whistle blows
• Team B has 10 minutes to share experiences with
  team A
• Rotation 1
• Continued.

52
Session format
53
Session format
54
Lunch

• Meet us back here for
• How to successfully engage VMOs
• at 2.00

55
Breakout session 4 Bellarine Room 4 2.00-2.45
How to successfully engage Visiting Medical
Officers
Susan Noome NUM, Murwillumbah Hospital Mary
Mitchelhill National Medication and Safety
Breakthrough Collaborative Service Improvement
Lead
56
Objectives

• At the end of this session you will have shared
  ideas and developed an understanding of how to
• establish relationships with VMOs
• attract VMO Participation
• best use VMOs availability and role within your
  organisation
• engage and sustain VMO involvement

57
The Relationship

• As in any relationship building exercise there
  are crucial steps that need to be followed
• finding the desirable targets,
• developing interest
• maintaining the interest long enough to move into
  the
• commitment factor then onto the hard work of
• maintaining the relationship.

58
Desirable Targets

• Good bed partners, positive attitude, lots of
  energy that will help bring it home
• Accommodate, especially for the necessary evils
  for some things to work and have a future,
  certain key people need to be involved
• Reliable workers, doers not procrastinators

59
Developing Interest

• Promote the concept to the selected key
  stakeholders, dont try and sell the whole
  package first up
• Start with the positive drivers and influential
  players and move on to others later
• A particular individual may be your hardest
  conquest but could have the greatest influence
  once on board

60
Developing interestcont.

• However, restrict time wasting on intractable
  people, get some runs on the board

61
Developing interestscont.

• Modes of communication
• Corridor conversations, element of surprise, keep
  it short and sweet
• Their committee meetings, take the idea to them
  and present it yourself. They wont have time to
  come to you
• Emails ????? Easily deleted
• Mail, hardcopy ????? Are they read?

62
Exercise 5 minutes

• Discuss modes of communication you have used when
  working with VMOs?
• Which of these was most effective?

63
Maintaining the interest

• Run with the idea when its hot. Dont put it out
  there then wait for months before you move on it
• Do some ground work and follow up on the corridor
  conversations. It shows you listened to what they
  had to say even if you are now presenting
  evidence to dispute it
• Dont start a committee until youre ready to do
  the work

64
Maintaining the interest..cont

• Give the desired participants, including the
  evils, the choice- be on the committee or be a
  liaison consultant for the group.
• Not participating is not to be offered as an
  option

65
Maintaining the interest..cont

• Pat feathers dont ruffle themnot yet

66
Commitment factor

• We NEED them and what they can offer
• Be prepared to do the leg work, feed it back, via
  the corridor, their meetings, grand rounds, even
  via your own committee meetings (the one theyre
  members of)
• Set short, concise, realistic time frames

67
Commitment factor cont.

• Common rules for committee meetings
• Meeting time is set around their availability
• They may need feeding
• Have an agenda with a timeline attached and
  person responsible
• Ensure everyone gets their agenda early
• Have a ruthless chairperson who wont allow you
  to gabble on
• Set outcomes, dont defer anything to the next
  meeting

68
Commitment factor ..cont.

• Misconceptions
• Give them a job and they have to be involved
• Everyone is busy, we all have the same available
  time
• If someone is prepared to do all the work then we
  should let them

69
Maintaining the relationship

• Promote the outcomes via breakfast trolley during
  grand rounds etc
• Book a time slot at their monthly/bi-monthly
  meetings but keep it short
• Keep them up to date with any changes in person,
  as well as via email or internal mail
• They are happy to be reminded, so .

70
Maintaining the relationship ..cont

• Nag, Nag, Nag, Nag, Nag, after all, this is a
  valued relationship and they always appreciate a
  gentle reminder

71
Exercise 10 minutes

• Spend a couple of minutes listing ideas and
  solutions you have heard today.
• At your table, share the ideas about how you can
  develop and maintain VMO involvement?
• What would most suit your type and size of
  organisation?

72
In Summary

• VMOs are integral team members
• Attracting, establishing and maintaining
  relationships are key to effective team
  participation
• Find the right communication mode and dont waste
  time or opportunities
• Get them involved and keep up reminders

73

• Questions

?
74
Afternoon Tea

• Meet us back in the Plenary for
• Statewide strategic innovation
• at 3.00