Patient Flow Collaborative Learning Session 3

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Patient Flow Collaborative Learning Session 3
WHOLE SYSTEM ACCESS Bellarine Room 3 Tony Snell
and Rochelle Condon
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Breakout session 3Bellarine Room 3 9.40 10.35
Using templating for clinical system redesign
Rowena Clift and Mick Kirby Ballarat Health
Service 9th February, 2005
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Objectives Breakout Session

• Introduce use of process templates in system
  redesign
• Review of NHS applications
• Present a case study of our experience

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Background

• Presentation by Helen Bevan NHS Modernization
  Agency
• Use of Process Templating in 10 High Impact
  Changes

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Time to look from a new perspective - Day Oncology
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Day Oncology (Background)

• Day oncology request for more EFT
• Clerical staff
• Rationale
• Increased workload
• No data supplied to support this
• Observation of the unit
• Appeared busy
• Disorganised
• We went in search of data to support claim

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Day Oncology Attendances
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Day Oncology

• Workload had in fact decreased
• Background
• Resignation of oncologists
• Decreased throughput
• Attendances had not reached previous numbers
• Why did they believe they were busier?
• Why did observation suggest they were busier?

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Day Oncology

• Met with staff from oncology
• Attempted to identify core business
• Establish areas that were impinging on their
  ability to deliver core business
• Template a typical day for oncology

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Day Oncology Process Template
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Process Template

• What can you identify from this template that may
  be impacting on the staff workload?
• What further information would you require?
• 5 minute group discussion.

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What did we learn?

• What did template reveal
• Scheduling practices
• New department location
• Co located OPD
• Same Work Practices
• Further questions revealed
• Increased OPD clinic numbers
• New Oncologists
• New practices
• Home Oncology Service
• Drop Ins!!
• Lack of education and quality activities

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Day Oncology Process Template

• Previous template followed the department
  structure.
• Identified core business
• Identified non core activity
• Repeated template
• Asked staff to document what they did over
  typical shift
• Put this into a template

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ONCOLOGY PROCESS TEMPLATE
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Staff Process Template
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• What does this template show us?

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Staff Process Template
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Results

• Core business only 50 of staff time
• Impact of non nursing clerical duties
• Impact of OPD
• No extra resources
• Increased clinics 5 per week from 2
• 80 inc. in attendances

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Outpatient Activity Data
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What will we do?

• Clerical staff request approved
• Just appointed
• Opportunities now for further practice changes.
• Scheduling
• Staff profile

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Process Template
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Scheduling

• Same patient mix
• Applied appointments and templated
• Spread workload over shift
• Staff ratio applied

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Staffing

• Created Team Leader role
• Triage Drop In patients
• Deal with OPD requests
• Provide support to clinical staff
• Inc workload
• Breaks
• Education
• Quality avtivities

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Staffing

• Ward Clerk
• Employed during OPD times
• Relieved clerical activities from nursing staff

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Process Summary

• Received request
• Asked for evidence
• Need evidence to support claim
• Included staff and observed practice
• Staff buy in imperative
• Asked staff to identify issues
• Process Templated
• Allowed clearer view of issues
• Identified issues not evident earlier on
• Only a part of the process
• Identified issues
• Met with staff
• Made recommendations
• Starting to implement recommendations

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• Questions

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Morning Tea

• Meet us back here for
• Booking systems for elective and outpatient
  services
• at 10.50

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Breakout session 3 Bellarine Room 3 10.50
11.45
Booking systems for elective and outpatient
services
Ruth Smith Acting Manager Clinical Innovations
Agency Penny Pereira Improvement Partnerships
for Hospitals Modernisation Agency 9th February,
2005
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Its booking Jim, but not as we know it
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At your tables discuss what services you are
currently booking or planning to book 10 minutes
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The patients experience can be characterised by

• Delays and waits
• Poor coordination
• Different locations
• Lack of choice or certainty
• Patchy information

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What do the patients say?

• Appointments take ages to come through and you
  get what you are given
• I work shifts so it is sometimes impossible for
  me to make the first appointment that is sent to
  me
• It would be easier if I could speak to the
  hospital myself to arrange times and dates as I
  have 3 children (2 at school) and I dont drive

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Access
What do patients want ?

• Choice of date
• Ability to plan life
• Greater information certainty
• Fewer visits hand-offs
• Commitment to date

Shorter waits
Delivered by booking
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So how does booking help?

• Improving access for patients
• Choice
• Communication
• Organisational benefits

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So what does that mean?

• What is full booking?
• What is partial booking?

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- Its not just about booking
Preplanning the journey (Booking choice at
every stage)
Booking the referral
GP
OP
Radiology Endoscopy
Results Review
Treat
Improve communication
Make it mainstream
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Redesign and pre-planning the journey

• Appointment gt Diagnostics gt Review gt Treat
• Re-organising staff round patients
• Integrate AC with secretarial team, doctors
  nurses
• diagnostic centres / common processes / body part
  specific
• Consultant team-working -gt pooling of queues

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Integrated Strategies
Pre-booked care
Cancelled ops
Elective access
Emergency access
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Integrated Strategies
Pre-booked care
Cancelled ops
Elective access
Systems perspective Redesign Demand and capacity
Emergency access
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Change Principles
A Focus on patients journey
B Improve booking process
E Make it mainstream
C Match demand and capacity
D Improve communication
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Booking Opportunities

• Day case
• Inpatient
• Outpatient
• Diagnostics

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Day case

• Evidence has shown that booking in day surgery
  can produce benefits and it works!

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In-patients
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In-patients
Referral in primary care
Booking in tertiary care
Discharge booking process
Booking social care
For social/OT assessment
For pre- assessment
For diagnostic tests
For theatre
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In-patients

• Is harder
• Urgent vs routine
• Emergency pressures
• Last minute cancellations
• But we have some answers
• Partial booking
• Pooling
• Matching capacity demand for beds

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Outpatients

• Scope
• General Practice to Out Patient Day Case
• Out Patient to Day Case In-Patient
• Longer-term
• Hospital to Hospital
• Any to Any

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Booking tips from successful sites

• Plan ahead as far as possible planned leave
  etc.
• Look for leave trends
• Develop robust communication systems
• Agree how sessions are covered during leave
• Minimise down time/maximise all available slots
• Look at the types of queues e.g. soon, urgent
• Reduce queue types and define routine/urgent
• Continuous validation
• Monitor activity/data measure improvements
• Review appointment templates to improve flow
• Use firebreaks in the list

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Group Work

• Consider which area you would like to introduce
  booking into and how you intend to start with
  reference to the change principles

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• Questions?

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• Questions

?
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Team Presentations11.45 1.00

• Rochelles Cluster Bellarine Room 3
• Angliss Hospital
• Maroondah Hospital
• Royal Victorian Eye and Ear Hospital
• Barwon Health
• Northeast Health -Wangaratta
• Goulburn Valley 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 10 minutes to share experiences with
  team B
• Whistle blows
• Team B has 10 minutes to share experiences with
  team A
• Rotation 1
• Continued.

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Session format
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Session format
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Lunch

• Meet us back here for
• Better use of beds program - UK
• at 2.00

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Breakout session 3 Bellarine Room 3 2.00-2.45
Better use of beds program - UK
Penny Pereira Head of Corporate Services and
Clinical Systems Policy Improvement Partnerships
for Hospitals National Health Service
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Insert Penny's slides

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• Questions

?
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Afternoon Tea

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