Abbey Perumpanani

Clarence Valley Health Service

NNSW LHD

The Story so far….

The Story so far….

• Growth in Size

• Growth in Complexity

• Growth in Expectations

– NEAT

– Triage Target Time

• Change in processes

– EMR

– Handover

– BTF, DETECT

But things have changed in recent years

The Story so far….

• Growth in Size

• Growth in Complexity

• Growth in Expectations

– NEAT

– Triage Target Time

• Change in processes

– EMR

– Handover

– BTF, DETECT

• Working harder

• Working longer

• Taking risks

• Taking shortcuts

… and how we coped But things have changed in recent years

But problems started showing up

But problems started showing up

But problems started showing up

But problems started showing up

But problems started showing up

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. Monthly Management Meeting

10. Change Management strategies

11. M&M Meetings

12. Departmental Teaching

13. Integration of Services in the

Valley

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. Monthly Management Meeting

10. Change Management strategies

11. M&M Meetings

12. Departmental Teaching

13. Integration of Services in the

Valley

Emergency Services Management Committee

Strategy

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. Monthly Management Meeting

10. Change Management strategies

11. M&M Meetings

12. Departmental Teaching

13. Integration of Services in the

Valley

Emergency Services Management Committee

Strategy

Departmental Meeting

Operations

M&M Safety

Projects Quality

Training Education

Education Training

Projects Quality

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. Monthly Management Meeting

10. Change Management strategies

11. M&M Meetings

12. Departmental Teaching

13. Integration of Services in the

Valley

B1

B2

B3

B4 B7

B8

B9

B10

P PR C2 C1

CIN M I

C3

PL

T

B6 B5

R1

R2

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. Monthly Management Meeting

10. Change Management strategies

11. M&M Meetings

12. Departmental Teaching

13. Integration of Services in the

Valley

B1

B2

B3

B4 B7

B8

B9

B10

P PR C2 C1

CIN M I

C3

PL

T

B6 B5

R1

R2

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. Monthly Management Meeting

10. Change Management strategies

11. M&M Meetings

12. Departmental Teaching

13. Integration of Services in the

Valley

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. Monthly Management Meeting

10. Change Management strategies

11. M&M Meetings

12. Departmental Teaching

13. Integration of Services in the

Valley

File in 100’s of patient’s notes

Return to Medical Records

Ensure doctors sign results over the next 2-4 weeks

Sort for individual doctors and file

Deliver to Maclean and Grafton hospitals

Sorts @200 results in Pathology and Radiology

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. Monthly Management Meeting

10. Change Management strategies

11. M&M Meetings

12. Departmental Teaching

13. Integration of Services in the

Valley

File in 100’s of patient’s notes

Return to Medical Records

Ensure doctors sign results over the next 2-4 weeks

Sort for individual doctors and file

Deliver to Maclean and Grafton hospitals

Sorts @200 results in Pathology and Radiology

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. Monthly Management Meeting

10. Change Management strategies

11. M&M Meetings

12. Departmental Teaching

13. Integration of Services in the

Valley

File in 100’s of patient’s notes

Return to Medical Records

Ensure doctors sign results over the next 2-4 weeks

Sort for individual doctors and file

Deliver to Maclean and Grafton hospitals

Sorts @200 results in Pathology and Radiology

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. Monthly Management Meeting

10. Change Management strategies

11. M&M Meetings

12. Departmental Teaching

13. Integration of Services in the

Valley

Dedicated notice boards for

1. Memos

2. Meetings

3. Social Events

Targeted Mailing lists

1. Whole ED

2. Special Interest

Groups

Traditional

Digital

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

• Regular Contracted Medical Officers

• Locum agencies

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

• Regular Contracted Medical Officers

• long-term Locums

• Locum agencies

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

Maclean 15 K

Grafton 23 K

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

Green POD

Blue POD

Yellow POD

Maclean POD

Clarence Valley

Emergency Services

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

BENEFITS

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

BENEFITS

55%

60%

65%

70%

75%

80%

85%

Dec

-12

Mar

-13

Jun

-13

Oct

-13

Jan

-14

Ap

r-14

Long Term

NEAT

NEAT Performance

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

BENEFITS

55%

60%

65%

70%

75%

80%

85%

Dec

-12

Mar

-13

Jun

-13

Oct

-13

Jan

-14

Ap

r-14

Long Term

NEAT

NEAT Performance

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

BENEFITS

55%

60%

65%

70%

75%

80%

85%

Dec

-12

Mar

-13

Jun

-13

Oct

-13

Jan

-14

Ap

r-14

Long Term

NEAT

NEAT Target

2013

NEAT Performance

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

BENEFITS

55%

60%

65%

70%

75%

80%

85%

Dec

-12

Mar

-13

Jun

-13

Oct

-13

Jan

-14

Ap

r-14

Long Term

NEAT

NEAT Target

2013

Changes

Begin

NEAT Performance

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

BENEFITS

55%

60%

65%

70%

75%

80%

85%

Dec

-12

Mar

-13

Jun

-13

Oct

-13

Jan

-14

Ap

r-14

Long Term

NEAT

NEAT Target

2013

NEAT Performance

Changes

Begin

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

BENEFITS

55%

60%

65%

70%

75%

80%

85%

Dec

-12

Mar

-13

Jun

-13

Oct

-13

Jan

-14

Ap

r-14

Long Term

NEAT

NEAT Target

2013

NEAT Target

2014

NEAT Performance

Changes

Begin

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

BENEFITS

55%

60%

65%

70%

75%

80%

85%

Dec

-12

Mar

-13

Jun

-13

Oct

-13

Jan

-14

Ap

r-14

Long Term

NEAT

NEAT Target

2013

NEAT Target

2014

NEAT Performance

Changes

Begin

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

BENEFITS

Better Supported environment

--- Greater flexibility

of work arrangement

-- 12.5% decreased

work load

Nurses

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

Greater sense of ownership

-- Greater work satisfaction

Doctors

BENEFITS

Better Supported environment

--- Greater flexibility

of work arrangement

-- 12.5% decreased

work load

Nurses

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

Greater sense of ownership

-- Greater work satisfaction

Doctors

BENEFITS

Better Supported environment

--- Greater flexibility

of work arrangement

-- 12.5% decreased

work load

Nurses ED

Less noise and confusion in the well of the ED

-- Streamlined operations

-- Fewer people in

the waiting room

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

BENEFITS

Being seen quicker

-- Being processed

faster ---

Fewer leaving before being fully

cared for

Patients

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

COSTS

Theory Clarence

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

↑ Expenditure

↑ Workloads

↑ FTEs

↑ Risk

COSTS

↓ Expenditure

↓ Workloads

↓ FTEs

↓ Risk

Theory Clarence

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

↑ Expenditure

↑ Workloads

↑ FTEs

↑ Risk

COSTS

↓ Expenditure

↓ Workloads

↓ FTEs

↓ Risk

CHANGES

1. A New Governance Model

2. A new Model of care

3. Radiology-on-Demand

4. Electronic sign-off

5. Enhanced Communication tools

6. Stabilising the locum MO pool

7. Targeted investigations

8. Departmental Meetings

9. M&M Meetings

10. Departmental Teaching

11. Change Management strategies

12. Integration of Services in the

Valley

Oh, the problems of growth !

When Growth is the Problem Governance is the Answer

Emergency Services Management

Committee Strategy

Departmental Meeting Operations

M&M Safety

Projects Quality

Training Education

When Growth is the Problem Governance is the Answer

Emergency Services Management

Committee Strategy

Departmental Meeting Operations

M&M Safety

Projects Quality

Training Education

Clinicians

When Growth is the Problem Governance is the Answer

Clinicians

When Growth is the Problem Governance is the Answer

Clinicians

When Growth is the Problem Governance is the Answer

Unit Cost

Activity

Clinicians

When Growth is the Problem Governance is the Answer

Clinicians

Unit Cost

Activity

Unit Cost

Activity