patient flow collaborative learning session 3

Department of Human Services

Patient Flow Collaborative Learning Session 3

WHOLE SYSTEM ACCESS

Bellarine Room 3

Tony Snell and Rochelle Condon


Using templating for clinical system Using templating for clinical system redesignredesign

Rowena Clift and Mick KirbyBallarat Health Service

9th February, 2005

Breakout session 3Bellarine Room 3

9.40 – 10.35

Objectives Breakout Session Objectives Breakout Session

• Introduce use of process templates in system redesign

• Review of NHS applications• Present a case study of our experience

BackgroundBackground

• Presentation by Helen Bevan NHS Modernization Agency

• Use of Process Templating in 10 High Impact Changes

Time to look from a new Time to look from a new perspective - Day Oncologyperspective - Day Oncology

Day Oncology (Background)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

Day Oncology AttendancesDay Oncology Attendances

0

50

100

150

200

250

Day Oncology Attendances2004_05

2003_04

2002_03

2004_05 114 154 150

2003_04 214 185 159 157 128 171 167 156 146 140 141 144

2002_03 210 180 212 244 198 200 229 184 178 188 232 177

July AugustSeptemb

erOctober

November

December

January February March April May June

Day OncologyDay 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?

Day OncologyDay 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

Day Oncology Process TemplateDay Oncology Process Template

8 181312 1611 1710 15149TIMELINE

Patient treatment time

Staff Shift hours

Oncology clinics

Home Visits

Oncology clinic: staff called on forvarious tasks - educ, appt, path, prep

histories, chaperone.No nursing staff allocated to this clinic.

AM staffmember arrives0800 hrs prepshistories, path,stats, phones,

primes IVs, drugchecks

Where possiblethe 0800 staff visithome pts on wayto work. On dayof observationstaff arrived at

1000 hrs

Home visits attendedduring quieter period

After patients left:time utilised on

histories for nextday, path, stats

ONCOLOGY PROCESS TEMPLATE

Process TemplateProcess 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.

8 181312 1611 1710 15149TIMELINE

Patient treatment time

Staff Shift hours

Oncology clinics

Home Visits

Oncology clinic: staff called on forvarious tasks - educ, appt, path, prep

histories, chaperone.No nursing staff allocated to this clinic.

AM staffmember arrives0800 hrs prepshistories, path,stats, phones,

primes IVs, drugchecks

Where possiblethe 0800 staff visithome pts on wayto work. On dayof observationstaff arrived at

1000 hrs


After patients left:time utilised on

histories for nextday, path, stats


What did we learn?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

Day Oncology Process Day Oncology Process TemplateTemplate

• 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

Staff Process TemplateStaff Process Template

DAY ONCOLOGY WARD STAFF WORKLOAD ANALYSIS

PT CARE TIME52%

OPD Activity8%

WARD CLERK DUTIES26%

WARD ASSISTANT DUTIES2%

OHC PROGRAM9%

PREPARATION BY NURSE3%

PT CARE TIME

OPD Activity

WARD CLERK DUTIES

WARD ASSISTANT DUTIES

OHC PROGRAM

PREPARATION BY NURSE

• What does this template show us?

Staff Process TemplateStaff Process Template


PT CARE TIME52%

OPD Activity8%



OHC PROGRAM9%


PT CARE TIME

OPD Activity

WARD CLERK DUTIES


OHC PROGRAM


ResultsResults

• 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


PT CARE TIME52%

OPD Activity8%



OHC PROGRAM9%


PT CARE TIME

OPD Activity

WARD CLERK DUTIES


OHC PROGRAM


Outpatient Activity DataOutpatient Activity Data

0

20

40

60

80

100

120

Oncology OPD no Radiation2004_05

2003_04

2002_03

2004_05 87 114 107

2003_04 75 63 56 89 81 77 70 76 98 83 103 92

2002_03 48 72 51 55 59 42 56 79 73 61 100 71

July AugustSeptem

berOctober

November

December

January February March April May June

What will we do?What will we do?

• Clerical staff request approved– Just appointed

• Opportunities now for further practice changes.– Scheduling– Staff profile

Process TemplateProcess Template

8 181312 1611 1710 15149TIMELINE

Team LeaderOncology clinics

Home Visits

Oncology clinic:Where possiblethe 0800 staff visithome pts on wayto work. On dayof observationstaff arrived at

1000 hrs



Ward clerk

Clinical Staff 1

Clinical Staff 2

SchedulingScheduling

• Same patient mix• Applied

appointments and templated

• Spread workload over shift

• Staff ratio applied

8 181312 1611 1710 15149TIMELINE


Home Visits


1000 hrs



Ward clerk

Clinical Staff 1

Clinical Staff 2

StaffingStaffing

• Created Team Leader role– Triage Drop In patients– Deal with OPD requests– Provide support to clinical

staff• Inc workload• Breaks• Education• Quality avtivities

8 181312 1611 1710 15149TIMELINE


Home Visits


1000 hrs



Ward clerk

Clinical Staff 1

Clinical Staff 2

StaffingStaffing

• Ward Clerk– Employed during OPD

times– Relieved clerical

activities from nursing staff

8 181312 1611 1710 15149TIMELINE


Home Visits


1000 hrs



Ward clerk

Clinical Staff 1

Clinical Staff 2

Process SummaryProcess 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

Questions

?

Morning TeaMorning Tea

Meet us back here for

Booking systems for elective and Booking systems for elective and outpatient servicesoutpatient services

at 10.50


Breakout session 3 Bellarine Room 3

10.50 – 11.45

Ruth SmithActing Manager Clinical Innovations Agency

Penny PereiraImprovement Partnerships for HospitalsModernisation Agency

9th February, 2005

Booking systems for elective and Booking systems for elective and outpatient servicesoutpatient services

It’s booking Jim, but not as we know it”

At your tables discuss what services you are currently

booking or planning to book

10 minutes

The patient’s experience The patient’s experience can be characterised bycan be characterised by

• Delays and waits

• Poor coordination

• Different locations

• Lack of choice or certainty

• Patchy information

What do the patients say?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 don’t drive”

Access Access

What do patients want ?Choice of date

Ability to plan life

Greater information & certainty

Fewer visits & ‘hand-offs’

Commitment to date

So how does booking help?So how does booking help?

• Improving access for patients

• Choice

• Communication

• Organisational benefits

So what does that mean?So what does that mean?

• What is “full booking”?

• What is “partial booking”?

Improve

communication

- It’s not just about - It’s not just about bookingbooking

GP OP Radiology Endoscopy

Results Review

Treat

Booking thereferral

Preplanning the journey(Booking & choice at every stage)

Matching & managing demand and capacity

Make it Make it

mainstreammainstream

Focus on

patient’s needs

Redesign and pre-planning the Redesign and pre-planning the journeyjourney

• Appointment > Diagnostics > Review > Treat

• Re-organising staff round patients

– Integrate A&C with secretarial team, doctors & nurses

– diagnostic centres / common processes / body part specific

– Consultant team-working -> pooling of queues

Integrated StrategiesIntegrated Strategies

Emergency

access

Cancelled ops

Elective

access

Pre-booked

care

Integrated StrategiesIntegrated Strategies

Emergency

access

Cancelled ops

Elective

access

Pre-booked

care

Systems Systems perspectiveperspective

RedesignRedesign

Demand and Demand and capacitycapacity

Change PrinciplesChange Principles

D: Improve

communication

B: Improve booking processC:

Match demand and capacity

E: Make it mainstream

A: Focus on patients’ journey

Booking OpportunitiesBooking Opportunities

• Day case

• Inpatient

• Outpatient

• Diagnostics

Day caseDay case

• Evidence has shown that booking in day surgery can

produce benefits and it works!

In-patientsIn-patients


Referral in primary care

Booking in tertiary care

Dischargebookingprocess

Booking social care

For diagnostic tests

For pre-assessment

For social/OTassessment

For theatre


• Is harder

– Urgent vs routine

– ‘Emergency pressures’

– Last minute cancellations

• But we have some answers

– Partial booking

– Pooling

– Matching capacity & demand for beds

OutpatientsOutpatients

• Scope– General Practice to Out Patient & Day Case– Out Patient to Day Case & In-Patient

• Longer-term– Hospital to Hospital– “Any to Any”………

Booking – tips from Booking – tips from successful sitessuccessful 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

Group WorkGroup Work

Consider which area you would like to introduce booking into and how you

intend to start – with reference to the change principles

Questions?

Questions

?

Team Presentations11.45– 1.00

Rochelle’s ClusterRochelle’s Cluster Bellarine Room 3Bellarine Room 3

•Angliss HospitalAngliss Hospital

•Maroondah HospitalMaroondah Hospital

•Royal Victorian Eye and Ear HospitalRoyal Victorian Eye and Ear Hospital

•Barwon HealthBarwon Health

•Northeast Health -Wangaratta Northeast Health -Wangaratta

•Goulburn Valley HospitalGoulburn Valley Hospital

Tabletop presentationsTabletop 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

Session formatSession 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….


Time Activity Rotation1200-1210 10 minutes

Angliss presents to BarwonMaroondah presents to WangarattaRVEEH presents to GVH

1210 –1220

10 minutes

Barwon presents to Angliss

Wangaratta presents to Maroondah

GVH presents to RVEEH

1220 – 1230

10 minutes

Angliss presents to Wangaratta

Maroondah presents to GVH

RVEEH presents to Barwon

Rotation 1

1230 – 1240

10 minutes

Wangaratta presents to Angliss

GVH presents to Maroondah

Barwon presents to RVEEH


Time Activity Rotation1240 - 1250

10 minutes Angliss presents to GVH

Maroondah presents to Barwon

RVEEH presents to Wangaratta

Rotation 2

1250 - 1300

10 minutes Wangaratta presents to RVEEH

GVH presents to Angliss

Barwon presents to Maroondah

LunchLunch

Meet us back here for

Better use of beds program - UK

at 2.00


Breakout session 3 Bellarine Room 3

2.00-2.45

Penny PereiraHead of Corporate Services and Clinical Systems PolicyImprovement Partnerships for HospitalsNational Health Service

Better use of beds program - UK

Insert Penny's slides

Questions

?

Afternoon TeaAfternoon Tea

Meet us back in the Plenary for

Statewide strategic innovation

at 3.00

patient flow collaborative learning session 3

Documents