General Medicine Improving Quality Care Presenter: Jane Lees

1. General Medicine Improving Quality Care Presenter: Jane Lees Innovation Poster Session HRT1215 – Innovation Awards Sydney 11th and 12th Oct 2012 Health Service: Auckland District Health Board The Health Roundtable 1-1a_HRT1215-Session_LEES_ADHB_NZ

2. The Health Roundtable 4. Key Changes for the redesign of General Medicine 1. Key Problem/Background General Medicine is a vital service specialising in the diagnosis and management of the acute, undifferentiated adult patient as well as the management of complex patients with multiple co-morbidities. It is the largest acute inpatient service in the hospital admitting roughly three times as many patients from the Emergency Department as the next largest service. In addition to providing patient care, General Medicine plays a critical role in the teaching and training of New Zealand’s future health workforce. For some time, however, the service has laboured under adverse conditions that often prevent best in class patient care and workforce training and development. November 2010-November 2011 • Service Excellence Program launched • Core SMO team formed • Consultation document drafted for a service redesign to best meet needs of patients and staff December 2011 • Our staff sometimes… • Had significant workload imbalance • Missed teaching and training opportunities • Had limited SMO guidance/support in afternoons • Struggled with staffing vacancies • Spent more time away from patients than with them • Did not feel a part of the team Our patients sometimes… • Waited too long for an inpatient bed • Waited too long to be moved to the ward • Waited too long to be seen after hours • Received inadequate weekend care • Were admitted unnecessarily • Gave us feedback that we did not capture 2. Aim of this Innovation • Provide better patient care, particularly at weekends, evenings • Enhance the efficiency of the service to improve compliance with MOH shorter stays in ED target and reduce Length of Stay • Create a more attractive work environment for SMOs and RMOs to ensure the long-term viability of General Medicine. Service Redesign: Improving Quality of Care in General Medicine 3. Baseline Data: 2010 Performance on the MOH Shorter Stays in ED goal was dependent on Gen Meds ability to rapidly assess, admit, transfer or discharge patients 24/7. • Annually we are treating many more patients than are discharged • Frequently patient referrals to Gen Med exceeded weekend capacity (30 patients per day) 32.4% 5. Outcomes so Far Roster gaps, particularly with Registrars during busy months caused: • Increased clinical risk for • Significant frustration for staff • Longer waits for patient intervention • Leads to frustration and decreased morale • Difficult workload level • Decreased teaching opportunity and effectiveness • Unattractive roster – difficulty in recruiting • ?Cause of Roster gaps • Unattractive roster enhances recruitment challenges • Heavy workloads and resultant difficulty attending teaching • Current Roster – Registrars work 1 weekend in 2 (other hospitals 1 in 4) Voice of Our Staff Several workshops were undertaken with SMOs, Senior Nurses, Allied Health team leaders, and General Medicine leadership to brainstorm the ways General Medicine could be better for patients and for staff (Priority Voting by Participants in Circles) • 120 day review – Staff Survey Highlights • 93 Responses • “I am satisfied with the current service delivery model” • 50% Agree vs. 15% Disagree • “I am satisfied with my job” • 63% Agree vs. 9% Disagree • Most common areas of concern • “General Medicine has the capacity to care for unstable patients” • 48% Agree vs. 28% Disagree • “Dividing Medical Staff btw L2 and Home Ward is good for Patients/Staff” • 56% Agree vs. 18% Disagree • Breakdown of results by role available (circulated for review) 6. Lessons Learnt Critical To Quality - • Engaging the whole team • Improvement Specialist support - appropriate project and change management skills • Listening & prioritising key issues for our staff and patients to enable the focus for improvement • Robust metrics and strong business case for SMO & Senior leadership team engagement • Strong clinical leadership and champion team to support the change & monitor improvement • The ability to regularly communicate progress to all stakeholders • Being prepared to listen to feedback – negative and positive • Ongoing monitoring and continuous improvement strategy is now in place Prepared by Charlotte Porter: ASKLEPIOS