Patient Flow Collaborative Learning Session 2

1. Patient Flow Collaborative Learning Session 2 Welcome 5TH October 2004 Melbourne Convention Centre

2. Patient Flow Collaborative Learning Session 2 Dr Jenny Bartlett Chief Clinical Advisor 5TH October 2004

3. Welcome • Challenge each other to improve patient care • Promote team work • Plan to spread • Lots to share • Have fun

4. Victorian Travelling Fellowship Program • Strategically drawn together to underpin the Patient Flow Collaborative innovations • Story boards on display highlighting • Who • Where • When • Major learnings

5. Housekeeping • Mobile phones to silent/vibrate • Delegate Packs on tables • Lunch will be served in the foyer (12:00 – 12:45) • Rest rooms • Fire alarms and exits

6. Housekeeping • Take your belongings with you during the day – room configuration will change • Work in partnership – no one knows all the answers • Support people – Clinical Innovations Team & Planning Group Members (red badges)

7. Story Board Voting • Each team has been given a sticker to allocate to the storyboard they think is the best • Criteria includes: • Achievements • Team development • Impact for communication • Deadline for voting is 14:30hrs • Winner announced at the end of the day

8. Agenda 9.10 – 10.30 Where are we and what’s next? Lee Martin 10.30 – 10.45 Morning Tea 10.45 – 12.00 First Concurrent Session Team Presentations 12.00 – 12.45 Lunch

9. Second Concurrent Session12.45 – 2.00 • How to encourage a culture of innovation Cathy Balding and Mary Mitchelhill • Outpatient department toolkit Veronica Strachan and Kim Moyes • Communication strategies Julian Murphy and Sharon Neal • Advanced project management Ruth Smith and Claire Mackinlay • Managing variation, elective & emergency Lee Martin and Bernadette McDonald and Marcus Kennedy

10. Agenda 2.00 – 2.30 Afternoon tea 2.30 – 3.15 Team planning time 3.15 - 4.30 Healthsmart Anthony Bibby Update web delay tracker Marcus Kennedy Paper based delay tracker Peter Wright 4.30 – 4.45 Update Melbourne Health Melbourne Health Next steps and close Marcus Kennedy

11. “To change the results, we need to change the paradigm”

12. Hospital Demand Management Performance Kathryn Cook Director Metropolitan Health Service Relations 5 October 2004

13. Hospital Bypass

14. Percentage of time spent on bypass by hospital September 2004

15. Patients spending longer than 24 hours in the ED

16. Patients spending longer than 24 hours in the ED by hospital

17. Patients spending longer than 48 hours in the ED

18. Patients spending longer than 48 hours in the ED by hospital

19. Mental Health Patients spending longer than 24 hours in the ED

20. Mental Health Patients spending longer than 24 hours in the ED by hospital

21. Percentage of elective patients postponed before admission grouped by postponement reason by hospital

22. Patient Flow

23. Where are we and what’s next? Lee Martin Collaborative Director 5 October 2004

24. Resource pack

25. Orientation Learning session 1 • Masterclass series • 12 weeks of rigorous diagnostics • Whole system overview • Social networks • Breaking the myths

26. Learning session 1 • Formed innovation teams • Constraint diagnostics • Started improvements • Utilisation of the first draft toolkits • Building on the excellent work done already • Formed communication plans

27. Individual constraint areas • Bed management • OPD • LOS • Elective stream • Theatres • Radiology • Emergency Care • Sub-acute

28. Stickers

29. Individual constraint areas Bed Mgt OPD Elect LOS Sub Acute Radiology ED OR

30. Voting • The answer is NO • disruptive • pointless • vote the right/best way • The answer is YES • progressive • helpful • moving in right direction • The answer is • AMBIGUOUS • results are mixed • pros and cons • good in parts • The answer is • HARD TO DETERMINE • not enough data • not clear, not sure • need to investigate • hard to make sense of

31. Voting time From the Collaborative work so far, do you feel you have identified the true constraint areas? No Yes Ambiguous Hard to determine

32. Organisational view   • Building whole care view • Removing key constraint area • Practiced improvement tools and creating new ones • Building on appreciation in our organisation (Can do this task!) Starting to look at sustainability?

33. Sustainability planning Sustainability assessment toolkit

34. Next challenge Once removed major constraint, what next? • Remove constraint  • Understand and manage capacity and demand • Manage flow with pull systems (no delays in process) • Build new ways to treat patients • Develop your modernisation plan

35. Voting time Would establishing capacity and demand management with scheduling systems help to build effective organisational flow? No Yes Ambiguous Hard to determine

36. Analysing variation and manage capacity and demand Ward Speciality Divisional Organisational

37. Emergency Admissions Range between the process limits is 20-55 Average is 38

38. Elective Admissions Range between the process limits is 4-50 Average is 27

39. Understanding EL/EM Variation Which has the greater variation… Emergency or Elective

40. Admissions Range between the process limits is 19-95 Average is 57

41. Discharges Range between the process limits is 5-107 Average is 56

42. Understanding Adm/Disch Variation Which has the greater variation… Admissions or Discharges

43. Variation in Inpatient Processes

44. Predicting Emergency Admissions

45. Variation in Admissions and Discharges/Deaths

46. Variation in Bed Usage

47. Murphy’s law Problem will occur at the worst point, the worst time and when you least expect it.

48. Simple pull system for managing inpatient delays Front page Back page

49. Hot topic call

50. Managing capacity and demand Elective Increase day surgery Remove delays in length of stay ED Capacity and Demand Remove % through Chronic Disease Management Length of stay Decrease repeat tests, examinations Eliminate not ready for care, cancellations on day of admission