2006 Review by David Dean, General Manager

1. 2006 Reviewby David Dean, General Manager 2006 Reviewby David Dean, General Manager Annual General Meeting 29 March 2007

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

3. 37 Organisational Members –66 Hospital facilities

4. H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  Health Roundtable Structure Health Service Organisational Members Organisational Members Nominate Personal Members Personal Members Elect Board of Directors Board Appoints Members To Audit & Compliance Committee

5. Board of Directors Kaye Challinger, President Margot Mains, Vice President Kerry Stubbs, Treasurer Michael Szwarcbord George Jepson Jennifer Williams John O’Donnell John Mollett (to 3/07) (David Dean, Secretary) Audit & Compliance Kerry Stubbs, Chair Kaye Challinger Margot Mains Michael Szwarcbord George Jepson Ross Cooke (External) David Dean, Secretary Board & Committee Members 2006

6. H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  H  Health Roundtable Structure Health Service Organisational Members Organisational Members Nominate Personal Members Personal Members Elect Board of Directors Board Outsources Management Services with Biennial Contract Chappell Dean Network

7. The Health Roundtable Team 2006 • David Dean – General Manager • 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 • Brian Dolan – Clinical Consultant • Michael Blatchford – Process Engineer • Greg Launder – Systems Analyst

8. Overall Program for 2006

9. Roundtable Meetings Making Sustainable Changes Work & Workforce Redesign Lessons Learnt Emergency Models of Care Improving Patient Safety

10. 68 Projects were submitted 24 Projects (35%) were not evaluated or reported 27 Projects (40%) showed “sustained improvement” 11 Projects (16%) showed “temporary improvement” 6 Projects (8%) showed “not much change” HRT0601 – Making Sustainable Changes

11. HRT0601 Key Ideas • Event-driven discharge criteria • 23-hour ward for surgery • Allied Health staff in ED • Frequent Attender management • Nurse-led preadmission clinics • Patient streaming through ED • Overall patient flow re-design All presentations are available at www.healthroundtable.org.au

12. HRT0602 – Work Redesign Initiatives

13. HRT0602 – Work Redesign Initiatives All presentations are available at www.healthroundtable.org.au

14. HRT0603 – Lessons Learnt All presentations are available at www.healthroundtable.org.au

15. HRT0604 -- Emergency Models of Care Shared Issues • ED Over-crowding • ED used politically as “damage containment zone” • Model of care planning wrong - ED pays the price • Insufficient beds available at all stages of the care continuum (on current utilisation) • “Only ED has a burning platform” • “Only wards can fix ED crowding” • “Over-crowding is a hospital-wide problem”

16. HRT0604 - Emergency Models of Care “Good Ideas” Already Implemented

17. HRT0604- Emergency Models of Care

18. HRT0605 -- Improving Quality & Safety – The issues In 2006, the lead hospitals have fully implemented only half of the “good practices” surveyed

19. HRT0605 Improving Quality & Safety – The issues Most hospitals have at least two deaths per month warranting further investigation (with a complication of care coded)

20. HRT0605 Improving Quality & Safety Examples of Project Aim Statements • Reducing preventable deaths to 0 (in ED (Altair), elective surgery (Cougar), general medicine (Vulcan), Hospital Wide by 50% (Panther) • Standardised M+M meetings /process in 100% of units (Electra) • Have 100% of clinical units providing reports on their morbidity / mortality (Athene) • Reduce repeat adverse major events to 0 (Thunder) • Achieve 100% review and follow-up actions on all abnormal results for histopathology, cytology, radiology, endoscopies (Polaris & Regulus) • Reduce delays or inappropriate treatment of patients after hours by 80% (Eagle) • 100% context-appropriate structured handover at all inpatient facilities (Tornado) • 100% credentialing of Medical Staff (Tiger+)

21. New Project Status Lean Healthcare Program Activity BarCoding System Online Staff Surveys

22. Lean Healthcare Program –Design – 10-12 Weeks Workshop One (2 days): Welcome and Introductions – Setting the Scene What is Lean Thinking? Why Lean in Healthcare? Seven Wastes Value Stream Mapping – Current State Starting your Value Stream Map 5 S Workshop Two (2 Days): Review Current State Maps Develop Future State Designing “Pull” Visual controls Standardisation Predicting Output Kanban Weekly Coaching Workshop Three (1 day): Report & Review Project Progress Extending and Expanding Projects Change Management Issues Next Steps Weekly Coaching

23. Lean Healthcare Program • Our Goal: Train mid-level managers in process improvement techniques • 2006 Program – September/November • 23 participants, 8 hospitals, 12 projects • 2007 Program – 3 Separate courses • NZ, QLD, and Victoria • In-house customised workshops

24. WHAT IS DIFFERENT ABOUT LEAN? ED LAB Theatre Ward Wait Wait Wait Wait Wait Main Focus on Reducing Waste Across the Overall Patient Journey rather than just inside Departmental Silos

25. W W W Outpatient Process Referral Appointment Specialist Consult Clinic Reception 20 min 20 min 50 min 5 min 49 days 7 days 20 min Process Time: 95 min Delay Time: 80660 min

26. Activity BarCoding System Uses Barcodes & Built-in Clock to Record Activity Upload Scanner Data Edit Time Sheet Review Staff Activity

27. Initial pilot tests completed at Royal Brisbane & Women’s and St Vincent’s Sydney Currently preparing for Phase 2 Trials with expanded reporting, system interfaces and data entry options

28. Benchmarking – Staff Survey

29. Benchmarking Activities Allied Health Mental Health Clinical Costing Key Performance Indicators Emergency Presentations Inpatient Casemix

30. Benchmarking – Allied Health 05/06

31. Screening report highlights specific DRGs for review

32. Mental Health Benchmarking Group

33. HRT0606 Mental Health Benchmarking Group Focus of the 2006 Workshop was Aggression Management – KPIs used to stimulate discussion Have been working hard on bringing these indicators down Focus on seclusion management – clinical educators Moving towards 0 seclusions

34. Cost Benchmarking

35. Key Performance Indicator Highlights

36. Key Performance Indicator Highlights Time from Arrival to Ward

37. Emergency Presentation Analysis

38. Emergency Presentation Analysis

39. Casemix Comparison Issues Ongoing administrative issues: • Are we capturing the same diagnoses? • Are we identifying the same changes of care type? • Are we capturing the same inpatient episodes of care?

40. Differing coding strategies or patients?

41. Differing caretype coding or services?

42. Same-day rates suggest high diversion of ambulatory patients for some hospitals and use of “same-day emergency admits” at others

43. Emergency Same Day Admissions

44. Casemix Analysis Changes • Age Groups (0,1-16,17-49,50-64,65-79,80+) • Expanded to 6 categories • Aligned with census statistics for older patients • RSI Calculation (Emergency SameDay added) • Control for emergency admission practice differences • Separates same-day emergency admission/discharges from “regular” emergency admissions • Peer Groups Being Established • Your chosen peers included in briefing reports • Comparisons provided in hospital table for peer selection

45. Relative Stay Index – Adjusting for Differences • Based on all member facilities in Australia and New Zealand in 2003/2004 • Over 2 million inpatient episodes • Benchmark is Average Length of Stay for 8000 combinations of: • DRG 5.0 • Six age groups (0, 1-16, 17-49, 50-64, 65-79, 80+) • Emergency SameDay/Emergency Multi-day/Elective • Regular admission or Transfer in • Discharge destination (Home, Transfer, Died, Other) • Complexity: “Complex” if 3 or more disease chapters • Where at least 20 episodes of the same combination found. For rarer combinations, benchmark is set to actual length of stay • Over 90% of episodes were compared to a group benchmark

46. Impact of same-day emergency episodes on RSI calculations for 2005/2006

47. New Relative Stay Index – By Region 2005/06 CSG Casemix report – available in “data download” section on website

48. Relative Stay Index – All Members 2005/06

49. Relative Stay Index – All Members –July-Dec 2006

50. Relative Stay Index – Individual Facilities