1 / 46

2005 Review by David Dean, General Manager

2005 Review by David Dean, General Manager. Harbourview Hotel, North Sydney 15 November 2005. Happy 10 th Anniversary!. Agenda – 15 November. The Health Roundtable: An Innovation Clearinghouse. Share problems Share solutions Avoid reinventing wheels “Seed” large scale projects

Download Presentation

2005 Review by David Dean, General Manager

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. 2005 Reviewby David Dean, General Manager Harbourview Hotel, North Sydney 15 November 2005

  2. Happy 10th Anniversary!

  3. Agenda – 15 November

  4. The Health Roundtable:An Innovation Clearinghouse • Share problems • Share solutions • Avoid reinventing wheels • “Seed” large scale projects • Provide CEO network Health Roundtable UHC IHI

  5. 36 Organisational Members –over 50 Hospital facilities Plus: Regional Health Improvement Network

  6. The Health Roundtable Team • Michael Hart – Data Processing Analyst • Duncan Stuart – Clinical Consultant • Bindy Krantis – Report Preparation • Peter Reeves – Operational Consultant • Margaret Dean – Accounts Administrator • Pieter Walker – Operational Consultant • Nick Smeaton – Website Administrator • Fabian Chessell – Project Manager

  7. Overview • Look back & review progress since 1995 • Update patient service goals • Identify today’s barriers to reaching goals • Share existing innovations that remove barriers • Seed ideas for innovation-sharing in 2006

  8. Our Origins • Major hospital reviews in 1989-93 highlighted major operational issues, but were expensive and confronting to staff • Approaches to Federal Government in 1993/94 for assistance in developing “best practice” failed on cost and selectivity • Information Technology “solutions” promised huge operational improvements but failed to deliver • Approach by CSC Australia in mid-1995 to Alfred Hospital led to seed funding for process to identify “good practice” • Seven hospitals invited to participate in first meeting

  9. Key Design Principles(Based on avoiding what didn’t work!) • Voluntary participation by hospital chief executives • Emphasis on practical operational issues • Ownership of process by the members themselves • Face-to-face discussion of real data with peers • Multi-disciplinary involvement of staff • Expect all members to share innovative ideas • Honour Code to prevent harmful use of data • Independent, professional analytical support

  10. Inaugural Health Roundtable“How to get patients into and out of high-occupancy hospitals while maintaining high quality patient care” Subtitle: “Removing the Rocks”

  11. The Inaugural Health RoundtableNovember 1995Mona Vale Conference Centre

  12.      Usually Met  Improving  Struggling Patient Service Goals for 1996

  13.      Usually Met  Improving  Struggling Patient Service Goals for 1996

  14. Major Barriers to Reach Goals • Emergency Patient Barriers • Elective Patient Barriers • Day of Surgery Admission Barriers • Discharge Planning Barriers • Primary Care Coordination Barriers

  15. Major Barriers Identified • Emergency Patient Barriers • Delays in deciding whether to admit • Shortage of inpatient beds • Bottlenecks at internal interfaces between ED, ICU, Wards, Labs • Bottlenecks at external interfaces with Ambulance, Psych, Primary Care, Nursing Homes • Lack of timely information on bed status

  16. Major Barriers Identified • Elective Patient Barriers • Unpredictable capacity for elective patients • Difficulty coordinating surgeons & anaesthetist schedules • Inappropriate priority-setting & queue jumping • Perverse incentives blocking efficient treatment of elective patients (capped supply) • Lack of management of waiting lists

  17. Major Barriers Identified • Day of Surgery Admission Blockers • Mistrust of anaesthetic assessment by others • Lack of peri-operative facilities for day-of-surgery arrivals • Lack of alternative accommodation for country patients • Lack of time for patient assessment prior to admission • Inability to measure DOSA episodes

  18. Major Barriers Identified • Discharge Planning • Lack of coordination of care within hospital • Lack of post-acute carers at home • Delays in Nursing Home placement • Lack of data to flag discharge readiness

  19. Major Barriers Identified • Primary Care Coordination • Unknown primary care provider • No financial incentives for GP involvement • Lack of timely info to GP • Mismatch bed allocation to community needs • Lack of coordination of services with primary care / secondary care / nursing homes • Difficulty balancing seasonal changes in emergency / elective demand

  20. What has changed since 1995?

  21. Innovations Spread by The Health Roundtable

  22. More, shorter, inpatient episodes due to fewer bed days available Source: Analysis9495-0405.xls – 8 hospitals with continuous data

  23. Average age rising for patients with chronic diseases, but no change in onset for other conditions Source: Analysis9495-0405.xls – 20 hospitals with continuous data

  24. Major breakthroughs in treatment in some areas, such as cataract lens procedures … Source: Analysis9495-0405.xls – 20 hospitals with continuous data

  25. …and coronary artery interventions, with 177% growth in volume Source: Analysis9495-0405.xls – 8 hospitals continuous data

  26. Most DRGs show gradual reduction in LOS, although some hospitals have dramatically different approach Source: Analysis9495-0405.xls – 8 hospitals continuous data

  27. Day of Surgery Admission Rates have risen steadily, but still find resistance at some hospitals Source: Analysis9495-0405.xls

  28. New Issues

  29. Expecting 25% growth in elderly (80+) this decade to 3.9% of population …

  30. . . . who already consume 22% of all emergency bed days

  31. Drug expenses are rising dramatically

  32. Our workforce is ageing… US example Source: http://bhpr.hrsa.gov/healthworkforce/reports/rnproject/report.htm

  33. … and we are facing major global competition for health workers USA alone – short 500,000 nurses http://bhpr.hrsa.gov/healthworkforce/reports/rnproject/report.htm#chart1

  34. Health system leadership is a key issue with average tenure only 2.5 years

  35. Exciting, but very expensive new technologies are arriving http://www.cts.usc.edu/rsi-davincisystem.html

  36. However, Public Hospital funding share continues to decline – now below 35%

  37. Little new overnight bed capacity has been added to the system in a decade Source: AIHW Hospital Statistics, Table 2.3

  38. Increases in Emergency medical patients have led to reductions in Elective surgical patients Emergency up 600 beds Elective down 760 beds Source: HRT, Bed Occupancy.xls

  39. … with Emergency patients occupying over 62% of beds, up from 56% in 1996 Source: HRT, Bed Occupancy.xls

  40. Australia Predictions Effects of ageing and population growth likely to require 5,000 more beds by 2011 or 6% reduction in bed nights, just to maintain current service levels

  41. Summary

  42. Key Issues in 1995 • Inadequate hospital funding • Commonwealth / State role overlap • Overuse of hospitals vs primary care • Lack of integrated info technology • Rigid working conditions / demarcations

  43. Key Issues in 2005 • Inadequate hospital funding • Commonwealth / State role overlap • Overuse of hospitals vs primary care • Lack of integrated info technology • Rigid working conditions / demarcations • Ageing population and workforce • Rapid growth of new technologies • Lack of long-term leadership

  44. Problem is not in the goals Reality Goals • Universal access • First class quality • Improved health outcomes • Long queues • Unacceptable error rate • Measuring activity not outcomes Translationof goalstoaction It is in translating goals into action

  45. Key message in 1995 still true today • There are no “magic bullets” • Money is necessary, but not sufficient • We can make better use of the money already provided • Micro-level understanding is required to achieve success in macro-level policy implementation -- “removing the rocks” is still important • We can learn more from each other than we can learn separately

  46. Next Steps • Update patient service goals for 2000 • For acute patients • For chronic care patients • Identify today’s barriers to reaching goals • Share existing innovations that remove barriers • Seed ideas for innovation-sharing in 2006

More Related