Patient Flow Collaborative Action Learning Session No 2

1. November 11th Royal Melbourne Hospital Chair for the day – Megan Bumpstead Patient Flow CollaborativeAction Learning Session No 2

2. Welcome Today is an opportunity for further • Learning • Networking • Challenging yourselves and each other

3. Housekeeping • Mobile phones to silent/vibrate • Delegate packs • Lunch will be served (12:00 – 12:45) • Rest rooms

4. Housekeeping • Take your belongings with you during the day • Work in partnership – no one knows all the answers

5. Agenda 10.00 – 11.00 LaTrobe Regional Hospital Wendy Bazzina experience 11.00 – 12.00 Melbourne Health Di Collins Sub acute experience 12.00 – 12.45 Lunch 12.45 - 13.45 Templating Demonstration from Ballarat Rowena Clift & Discussion and practice Rochelle Condon

6. Agenda 13.45 – 14.15 Project Plans Wendy Tomlinson 14.15 – 14.30 Designing systems Lee Martin 14.30 – 14.45 Communication plans Jannie Selvidge 14.45 – 15.45 High Impact changes Lee Martin 15.45 – 16.00 Web Tracker Wendy Tomlinson Demonstration 16.00 – 16.15 Whole System Thinking Rochelle Condon Quiz

7. November 11th Latrobe Regional Hospital Wendy Bazzina Latrobe Regional Hospital Patient Flow Facilitator The LaTrobe Regional Hospital experience

8. Patient Flow Collaborative The LRH Experience

9. Bed Allocation from ED to Ward • Issues: • Transfer from ED to Ward, once bed is allocated, is spanning 3 to 6 hours • Improvement Strategies: • Breakdown of category’s for Bed Allocation constraints • Aim to set goal for All patients admitted within 1 hour of the decision to admit

10. 12 hour Waits in ED • Diagnostics performed: • ED Hourly data tracking performed for every patient • Collected manually onto A3 tracking tool. • Data analysed monthly to identify constraints. • Improvement Strategies: • Focus on utilisation of SSU • Category breakdown of 12hr violations • Analysis of Bed Allocation delays

11. 12 hour Waits in ED ED 12 hours+ waits % of ED attendances waiting 12 hrs+

12. Bed Waiting • Issues: • Long Acute LOS with GEM patients waiting for transfer to Sub Acute • Lost GEM bed days causing lost revenue • Improvement Strategies: • Established Bed Manager Role • Established Community Bed Register • Networked with Social Workers • Triaged GEM patients for bed allocation • Implemented GEM Functional Maintenance Program • Currently working on Event Driven Discharges • About to launch Fusion Sheets for ‘Issue’ resolution by ward staff Contact: Wen Bezzina, Project Coordinator, wbezzina@lrh.com.au (03) 5173 8139

13. Questions ?

14. November 11th Royal Melbourne Hospital Di Collins Patient Flow Collaborative Clinical Lead Access to sub acute services Access to Sub acute ServicesMelbourne Health

15. Patient Flow Collaborative Acute Sub Acute

16. Diagnostics Undertaken

17. Major finding

18. Intermediate Steps

19. Intermediate Steps

20. Intermediate Steps

21. Measurement

22. Lessons learnt • Need to come back to the basic principles • Sometimes there needs to be a whole system change • Resistance to change is usually based in fear, which leads to defensiveness

23. Desired Impact • Model of care for the aged person admitted to Melbourne Health • Intermediate term • Reduced length of stay in the sub acute • A tailoring of MH residential care facilities to meet our patients’ needs • Increased use of sub acute ambulatory services • Transparent communication between the acute and sub acute • Integrated bed management system across the acute and sub acute

24. RESULT SO FAR

25. What has led to our success What does culture change mean? What leads to success? Why do some things work? What sustains change? Is it systems changes? Is it changes in people’s attitudes? Is it changes in leadership? Is it an alignment of the planets?

26. Questions ?

27. Lunch –meet us back here at 12.45

28. Patient Flow Collaborative Process TemplatingRowena CliftMick KirbyBallarat Health Services

29. Background • Presentation by Helen Bevan NHS Modernization Agency • Use of Process Templating in 10 High Impact Changes • BHS similar scenarios • Dialysis • Oncology • Fact not Fiction

30. Dialysis • New Department • Different work practices – bigger dept • Perception of being busier • Request – increase EFT • No supporting evidence

31. Old Unit

32. Dialysis 2004

33. Process • Met with staff developed templates • Scheduling • Patient types • Data review

34. Dialysis Treatments

35. Dialysis Data Collection

36. Dialysis

37. Process • Reviewed Template with staff • Identified needs • Variety Staffing options • Clerical • Technician / Ward Assistant • Volunteers • Shift Changes • Update

38. Outcomes • Employed new staff • Patient Services Attendant • Clerical • Technician • Volunteers • Recommended review of rosters • Early Evaluation

39. Outcomes • Service Provision Changes • New department • Co located OPD • Increased clinic numbers • New Oncologists

40. Day Oncology (Background) • Perceived Increased workload • No evidence of increased throughput • Requested Clerical Assistance

41. Day Oncology Process Template

42. Day Oncology Attendances

43. Process Oncology Time line1.xls

44. Staff Process Template

45. Outpatient Activity Data

46. Process • Gathered Info • Identify core business / activity • Observation • Staff Input • Templated • Reviewed by staff • Recommendations

47. Outcomes • Templating • Scheduling issues • Non core business activity • Inappropriate staff mix • Data analysis • Evidence of non core activity • Staff focus groups • System and process issues • Drop ins, protocols, work practice issues

48. Outcomes (cont.) • Recommendations • Clerical assistance • Review scheduling • Develop new work practices • Internally • With other departments

49. Recommendations – alternate scheduling and rostering

50. Learnings • Staff buy in • Information must come from them • Use data • Templates • Allow visualisation • More to learn • Different scenarios need different approaches • Whiteboard!!