Patient Flow Collaborative Learning Session 4

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Patient Flow Collaborative Learning Session 4
Breakout session 1 Room M7 and M8 Stephen Vale
and Ruth Smith
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Breakout session 1 Room M7 and M8 9.50 10.35
Achieving innovations an executive perspective
Wendy Wood Director of Nursing and General
Manager, Surgical Oncology Peter MacCallum Cancer
Centre 5th May, 2005
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An Executive Perspective

• Critical Success Factors
• Barriers
• Effective Project Management
• Communication
• Managing Resistance
• Ongoing Measurement
• Making Innovation Mainstream

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Critical Success Factors in sustaining
organisational change

• Executive engagement and support is a critical
  success factor in sustained organisational change
• Ownership of the change process
• Facilitation and access to data
• Understanding of resource limitations and
  constraints, no you cant knock down the Admin
  wing

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Barriers

• Getting the team together
• Lack of Information
• Impatience
• Preconceived ideas bad memories (long)
• Negativity of non participating staff
• Lack of resources to test the innovation
• Rushing the change process
• Conflicting goals

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Effective Project Management

• Front line staff own and manage the process and
  the innovation
• Line manager supports the process, organises
  meetings and keeps the team focussed
• Small project team, large reference group
• Executive sponsor is accessible and ensures
  commitment and empowerment of the process
• Scope of project is known at the beginning

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Communication

• Use every tool in the book
• Team meetings
• Written material including hard data
  diagnostics
• Newsletter publication
• Presentation at Executive staff forums
• Sharing Celebration is infectious

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Improving Flow for Combined Modality Patients

• While undergoing Radiotherapy Treatment, test
  results and progress notes are reviewed by the
  Radiation Therapy Team to evaluate the
  therapeutic response to the treatment
• This meant that the medical record was often
  being used in a meeting while the patient was
  waiting to undergo concurrent chemotherapy,
  delaying commencement of infusion.
• If patient histories are required in more than 1
  area simultaneously, e.g. for delivery of
  chemotherapy and for chart review, the area where
  the patient is present will always take priority.

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Managing Resistance

• Do the hard yards up front
• Dont rush any component of the process
• Listen and report back aligned with the specific
  concerns
• Engage the loudest protestors closely
• Address their problems
• Dont be afraid to admit you were wrong

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Ongoing Measurement

• Death by measurement! Or lack there of
• Measurements must be meaningful to the team as
  well as management
• Routine KPI collection and intermittent
  independent audit
• Do the measurements inform future decisions?

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Triage Dermatology Clinic as a Sub Group of the
Skin Melanoma Service

• March 28th. Triage Dermatology Clinic commenced.
• Approximately 30 patients per clinic
• Attended by 2 Senior Dermatologists and a
  registrar. 2 Nursing Staff and 2 Clerical Staff
• 15 referred across to the Plastic Surgeons.
• 27 discharged.
• 4 Radiotherapy.
• 51 Back to the clinic for follow up.
• 1 Melanoma Unit.
• 2 Discharged for treatment elsewhere.
• Advantages Able to accommodate increased number
  of referrals in a more timely manner.
• Treatment options are now
  evidence based.
• Increased number of patients
  appropriately discharged.
• Auditing currently underway to monitor the work
  flow pattern and labour force compatibility in
  the surgical skin unit.

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.Clinic Activity March 2005
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Embedding sustaining the improvements

• Not a project, just what we do to improve the
  patient journey
• Front line staff identified the problems and led
  the process improvement work
• Project officer assisted with data collection
• Adapted the collaborative objectives to Peter Mac
  environment i.e. ambulatory model of care

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Patient Flow Projects 2004/05

• Improve Waiting Times in Skin Melanoma Service
• Surgical Pre-Admission Processes
• Patient Diary Development
• Outpatient Clinics Templates and Staffing Review
• Head Neck Service
• Day Chemotherapy Service
• Combined Chemo Radiotherapy Scheduling
• Care Planning Discharge Management

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Going organisational wide

• Service specific engagement
• Communication and listening
• Hearing the reasoning behind resistance
• Ongoing monitoring of changes to be vigilant of
  potential to relapse
• Revisit processes to ensure they are delivering
  the desired outcome

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Making Innovation Mainstream

• Is the innovation team satisfied with the process
  and the outcome?
• What is the common ground?
• Identify common problems
• Initiate innovations that are transferable to
  other areas and services
• Ensure that innovations are not person dependent
• Share and celebrate noticeable differences from
  the patient and staff perspective

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• Questions

?
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Morning Tea

• Meet us back here for
• Better clinics improving the patient journey
• at 10.55

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Breakout session 2Room M7 and M8 10.55 11.45
Better clinics improving the patient journey
Catherine McCarthy and Ruth Smith Patient Flow
Collaborative 5th May, 2005
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Better clinics improving the patient journey
Catherine McCarthySt. Vincents HealthRuth
SmithClinical Innovation Agency
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Aims

• To share ideas regarding outpatient services
  improvement
• To look at a whole system approach to improving
  outpatient department effectiveness

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Change principles
A Focus on patients journey
B Clinic scheduling
E Make it mainstream
D Appointment systems
C Outpatient effectiveness
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A Step Guide

• Focus on the patient journey

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A Step Guide

• Reviewing outpatient clinic schedules
• - access and treatment rates
• - seasonal variation
• - booking systems

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A Step Guide

• Outpatient Effectiveness
• - FTA Rates
• - Start finish times
• - Productivity profiles
• - Analysis of outcomes
• An example Chesterfield and North Derbyshire
  NHS Trust

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What was the Problem?

• Clinic regularly finished early or started late
• Clinics cancelled at short notice
• Clinic slots reduced through annual leave -
  rescheduling

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Diagnosis

• Clinic Review Form
• Clinic overview
• Newfollow up ratio
• Hospital cancellations
• Patient cancellations
• Unused slots and overbooks
• Issues and actions

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Results

• FTA rates reduced from 10 to 3
• Patient cancellation rates fell from 16 to 10
• Hospital cancellations rates fell from 14 to 3
• Increase in overall attendances from 745 to 88

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A Step Guide

• Appointment Systems
• Booking Systems
• Partial Booking
• Benchmarking against similar health services

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A Step Guide

• Make it mainstream

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Be prepared!

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Better Clinics Improving the patient journey

• Project Overview
• Project Goals
• Project implementation and milestones
• Key Performance Indicators
• Questions?

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Project Overview

• Aims
• The Better Clinics Project Started August 2003
  to
• Improve the effectiveness and efficiency of the
  service offered to patients.
• Improve the process for referring medical
  practitioners.
• Enhance the role of medical, nursing and clerical
  staff working within the department.

CLIF implementation of recommendations
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Project Overview

• Method
• Current processes and practices were reviewed
• Steering committee established
• Design team established
• Drivers group and other committees to drive the
  change
• Interviews with key stakeholders were conducted
• Open forums were conducted and formal submissions
  were requested.
• SWOT analysis
• Communication strategy developed
• Internal strategy
• External strategy

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SWOT Analysis

• Strengths
• Supports health service strategic directions
• Use of change management principles
• Includes a broader cross section of stakeholders

• Weaknesses
• Staged implementation could slow down the process
• Majority of team are not key stakeholders or CIC
  members

• Threats
• Splinter group
• Potential for change in directions
• Unsuccessful
• Loss of Executive support
• Back

• Opportunities
• Pilots provide the opportunity to troubleshoot
  issues before full roll out
• Increased engagement and support for
  implementation
• Professional development

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Project Overview

• Goals
• Recommendations structured around
• Structure
• Strategy
• Systems
• Skills Staffing,
• Style
• Shared Values at St. Vincents Clinics.

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Structure
GOAL Establish a structure that promotes medical
leadership and encourages collaborative efforts
between nurses, clerks and medical staff.
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Structure

• Results
• Heads of Clinic Appointed and operational
• Clinics Business Manager commenced November 2004
• Lead Nurses appointed November January
• Team Leader clerical commenced December 2004
• Team Leader nursing Commenced December 2004
• Position descriptions
• Education packages and workshops
• Staff satisfaction (change management)

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Strategy

• GOAL Establish a strategic profile which
  outlines the vision and commitment of each clinic
  and implement systems to evaluate Clinic
  performance.
• Develop a Clinic Business Model for each
  specialty (Clinic Function, Patient Mix,
  Commitment, Appointment times etc.)
• Develop a Monthly Clinic Report outlining key
  performance indicators (e.g. FTA rates, discharge
  rates, clinic access)

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Strategy

• Results
• Business model template established
• KPIs developed
• Communication strategy
• Getting it out there
• Red and Blue News (Newsletter)
• Meetings
• Mentor Program
• Reports
• Posters
• Patient information brochure

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Clinic Business Model

• Clinic overview
• Leadership and structure
• Patient volume and mix
• General clinic protocols
• Specific protocols (Patient Management and
  discharge)
• Clinic meetings
• Performance Measurement

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Newsletter
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Posters
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Systems

• GOAL Develop the processes to manage the Clinics
  and improve efficiency generally
• Streamline the triage process whereby Lead Nurses
  make initial bookings on the same day as
  referral. (Medical review and alterations of
  bookings conducted retrospectively)
• Implementation of new internal and external
  referral guidelines

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Systems

• Measurements
• Patient and staff survey
• IT changes to support the project overall
• Allied Health contract arrangements
• Referral template distributed
• Triage guidelines (under development)
• Mentor program

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Skills and staffing

• GOAL Develop the capability, skills and
  leadership of staff working within the clinics
• Training program to address Clinic nursing needs
  Process/system/IT needs leadership needs

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Skills and Staffing

• Measurements
• Staff survey
• Staff training program
• Education planner
• Appraisals
• Portfolio development
• Division 2 support role

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Style and values

• GOAL Develop teams and relationships by
  information sharing and collaboration.
• HOCs and Lead Nurses Quarterly Meeting
• Regular meetings for key groups

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Style and values

• Measurements
• Workshops
• Team building exercises
• Code of conduct
• Meetings calendar

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KPIs

• Clinic Appointment activity
• Clinic visits - Numbers of new and review patient
  appointments attended.
• Patient attendance rate of attendance
• Clinic visit duration - Average time between a
  patient appointment and the patients departure
  time.
• Patient discharge rate - Proportion of (new and
  review) patients discharged.
• Dictation turnaround - Average time taken to type
  and dispatch dictated medical correspondence

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KPIs

• Referral activity
• Referral Outcome - Proportion of appointment
  requests (referrals) in month receiving a
  response.
• Booking response time - Proportion of appointment
  requests (referrals) in month receiving a
  response within 7 days.
• Clinic access - Proportion of appointment
  requests receiving an appointment within 8 weeks,
  and within 12 weeks

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Clinic Visits
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Patient attendance
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Clinic Visit Duration
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Patient Discharge Rate
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Booking Response time
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Clinic Access
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Where to from here?

• Monitor and develop
• Refine data collection
• Evaluate flow-on effect
• Further staff and patient surveys
• Evaluation of project overall

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• Questions

?
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Lunch

• Meet us back here for
• Team tabletop presentations
• at 12.45

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Team presentations12.45 3.15

• Ruth Smith Room M7 and M8
• Peninsula Health
• Royal Childrens Hospital
• Maroondah Hospital
• Bendigo Healthcare Group
• Royal Victorian Eye and Ear Hospital
• Sir Charles Gairdner Hospital

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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

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Session format

• 2 teams per table
• Team A has 15 minutes to share experiences with
  team B
• Whistle blows
• Team B has 15 minutes to share experiences with
  team A
• Rotation 1
• Continued.
• Working afternoon tea is available

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Session format
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Session format
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• Meet us back in the plenary for
• Team planning time
• at 3.20