Patient Flow Collaborative Learning Session 3

1. Patient Flow Collaborative Learning Session 3 WHOLE SYSTEM ACCESS Bellarine Room 3 Tony Snell and Rochelle Condon

2. Using templating for clinical system redesign Breakout session 3Bellarine Room 3 9.40 – 10.35 Rowena Clift and Mick Kirby Ballarat Health Service 9th February, 2005

3. Objectives Breakout Session • Introduce use of process templates in system redesign • Review of NHS applications • Present a case study of our experience

4. Background • Presentation by Helen Bevan NHS Modernization Agency • Use of Process Templating in 10 High Impact Changes

11. Time to look from a new perspective - Day Oncology

12. 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

13. Day Oncology Attendances

14. Day 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?

15. Day 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

16. Day Oncology Process Template

17. Process 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.

19. 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

20. Day Oncology Process Template • 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

21. ONCOLOGY PROCESS TEMPLATE

22. Staff Process Template

23. What does this template show us?

24. Staff Process Template

25. Results • 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

26. Outpatient Activity Data

27. What will we do? • Clerical staff request approved • Just appointed • Opportunities now for further practice changes. • Scheduling • Staff profile

28. Process Template

29. Scheduling • Same patient mix • Applied appointments and templated • Spread workload over shift • Staff ratio applied

30. Staffing • Created Team Leader role • Triage Drop In patients • Deal with OPD requests • Provide support to clinical staff • Inc workload • Breaks • Education • Quality avtivities

31. Staffing • Ward Clerk • Employed during OPD times • Relieved clerical activities from nursing staff

32. Process 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

33. Questions ?

34. Morning Tea Meet us back here for Booking systems for elective and outpatient services at 10.50

35. Booking systems for elective and outpatient services Breakout session 3 Bellarine Room 3 10.50 – 11.45 Ruth Smith Acting Manager Clinical Innovations Agency Penny Pereira Improvement Partnerships for Hospitals Modernisation Agency 9th February, 2005

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

37. At your tables discuss what services you are currently booking or planning to book 10 minutes

38. The patient’s experience can be characterised by • Delays and waits • Poor coordination • Different locations • Lack of choice or certainty • Patchy information

39. 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’tdrive”

40. Access What do patients want ? Choice of date Ability to plan life Greater information & certainty Fewer visits & ‘hand-offs’ Commitment to date Shorter waits Delivered by booking

41. So how does booking help? • Improving access for patients • Choice • Communication • Organisational benefits

42. So what does that mean? • What is “full booking”? • What is “partial booking”?

43. Focus on • patient’s needs Matching & managing demand and capacity - It’s not just about booking Preplanning the journey (Booking & choice at every stage) Booking the referral GP OP Radiology Endoscopy Results Review Treat Improve communication Make it mainstream

44. Redesign and pre-planning the journey • 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

45. Integrated Strategies Pre-booked care Elective access Cancelled ops Emergency access

46. Integrated Strategies Pre-booked care Elective access Cancelled ops Systems perspective Redesign Demand and capacity Emergency access

47. Change Principles A:Focus on patients’ journey B: Improve booking process E:Make it mainstream C: Match demand and capacity D: Improve communication

48. Booking Opportunities • Day case • Inpatient • Outpatient • Diagnostics

49. Day case • Evidence has shown that booking in day surgery can produce benefits and it works!

50. In-patients