orientation amszauer

7/29/2019 Orientation Amszauer

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Orientationsession

Rigorous diagnostics

Anne-Maree Szauer

Improvement lead

Quality and Safety Branch


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Orientationsession

Aims of the

rigorous diagnostic phase

Identify constraints across the patientjourney

Engage key staff in the process ready to

implement change

Dispel the myths!


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Orientationsession

Activities of the diagnostic phase

Health service data Brainstorming

Process Mapping

Sampling Tool

Involving Patients and carers


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Orientationsession

Activities


Process Mapping Sampling Tool



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Orientationsession

You collect the dataThe minimum data set

Patient level data

patient unit record number (de-identified)

gender date of birth

postcode.

Event details

date of first referral referral source

date placed on clinic list

appointment date

clinic speciality

interpreter required

reason for visit

visit outcome

next scheduled visit.


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Orientationsession

We prepare the measures percentage (%) of new patients

percentage (%) of follow up patients percentage (%) of daily did not attend (DNA) rate

percentage (%) of patients discharged from outpatient services

percentage (%) of patients discharged from outpatient services to

primary health services time between initial referral and appointment date

patient time waiting for outpatient services.


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Easy to use!

Data


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Activities





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Orientationsession

Brainstorm to generate ideas, views and

perceptions about patient flow in outpatients


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Activities





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Orientationsession

Process mapping is a method for

depicting a process, material orinformation flow in a diagrammatic form.

Map minimum of two whole system

patient journeys

Include community/GP interface


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Orientationsession

A patient journey within outpatientsUltra Sound, Breast Core Biopsy, Out Patient

10.12Patient arrives at

ultra sound

10.20Patient shown cubicle andasked to change into gown

10.24Patient sits back down in

waiting area

10.26Patient called into examination

room by nurse,Patient asked to make herselfcomfortable on the couch andthe Radiologist explains the

procedure and that the processwill take about 20 minutes

10.28Examination starts, ultrasound gel is applied, the

radiologist checks theultrasound screen

10.29Radiologist checks

patients past ultra soundimages, the lump is deeper

than he had anticipated

10.30Radiologist explains that thelump looks benign, that hewill measure its size and

reassures the patient that hewould be surprised if it was a

. Explains to patient thatthe biopsy sample will givethe definitive answer

10.32Radiologist marks area for core biopsy

gun to penetrate. Explains that the needlewill be inserted briefly, but will give ptLA first, pt is concerned about 2 needles

being used, asks if she can be repositioned,and asks if lump is cancer or cyst.

Radiologist explains that it is probably afibramoma (a bristly type lump which arefairly common). Patient says she does notwant surgery. Radiologist says that she can

discuss this with MS Shah

ExampleofProcessMap

This is the first part of a three

part process map of which in

its entirety was too detailed tosuccessfully display.


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Orientationsession

A whole system patient journey

Patientfeels unwell Sees GP

Referralletter sent

Prioritised byconsultant

Appointmentsent

Patient attendsOP clinic

Added towaiting list

letter sent

Patient

attend PAC

Patientadmitted for

operation

Diagnostictests

Reviewin clinic

transfer

home

Added to OPpending list


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Orientationsession

Activities





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Orientationsession

Sampling tool

Ask staff to identifythe key delays

Chart delays for

each patient each

day

Total at end of timeperiod


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Orientationsession

Activities



Involving patients and carers


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Orientationsession

Patient,carer and relative

involvement

Small sample togain consumer

input

Use the tools

one to one with

patients


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Orientationsession

Completion of diagnostic phase

Review the results and priorities theconstraints that are causing the most

disruption to the largest patient group.

Identify the improvement team

Develop the action plan


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Orientationsession

Handy hints Share the workload

Gain as many views as you can Use this phase to find the constraints

and test assumptions Start a PFCII network!

Enjoy the focus on patient process Have fun!!!!!!


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Q u e s t i o ns?


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Team planning time

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