Patient Flow Collaborative Learning Session 3

1. Patient Flow Collaborative Learning Session 3 WHOLE SYSTEM ACCESS Bellarine Room 4 Marcus Kennedy and Prue Beams

2. A whole system approach to acute care management Breakout session 4Bellarine Room 4 9.40 – 10.35 Siva Sivarajah Executive Director – Rosebud Hospital, RAPCS, & Allied HealthExecutive Sponsor – Peninsula Health PFC, Peninsula Health 9th February, 2005

3. Presentation A WHOLE SYSTEM APPROACH TO PATIENT FLOW MANAGEMENT

4. Aims • How we got started • Challenges to date and in the future • Key strategies • Early achievements & activities to date • Lessons learned • Next steps

5. How we got startedThe first six months • Key stakeholders chosen from the quality area • Multiple collaboratives underway at same time • Facilitator could not provide a focussed effort due to workload commitments • Minimal communication about the PFC • Brainstorming sessions across Peninsula Health • Small project focussed

6. How we got startedThe second six months • Change in key stakeholders • Executive Sponsor Vision – Major Change Initiative • A facilitator that could provide a focussed effort • Increased co-ordination & communication • Regular meetings with new PFC Executive Team • Multiple project teams built • Gained increased PH Executive support

7. How we got started - The first six months Who was involved? • Peninsula Health wide brainstorming • Patients • Frontline staff • Departmental Managers Reactions? • Have done it before • Good, let’s get this right

8. How we got started - The second six months • Collation of Brainstorming results into Priority Areas • Identifying Priority Area Leaders • Refining Priority Areas • Re-aligning Priority Area Leaders to Priority Areas • Turning major trends into projects • Linking into work already done for quick wins • Submerge PFC into Day to Day Business

9. Peninsula Health PFC Executive Team Executive Sponsor - Siva Sivarajah Facilitator - Eddie Dunn Priority Area Leader’s (PALs) • Priority Area 1 - Dr Susan Sdrinis & Shamala Jones • Priority Area 2 - Jane Poxon & Robert Barker • Priority Area 3 - Di Jamieson & Kate MacRae • Priority Area 4 - Jan Child & Lyn Jamieson

10. Priority Areas • Optimise patient flow from the Emergency Department • Eliminate delays for patients awaiting surgery • Optimise bed utilisation across all sites • Facilitate consistent systems and processes across Peninsula Health

11. Whole System Approach

12. Whole System Approach

13. Guiding Statement “A delay in the discharge of one patient means a delayed admission for another.”

14. Guiding Principles • Patient focussed • Improved patient outcomes • Right patient, place, resource, time and clinician • Prompt access • Optimal flow • Enhance professional networks and relationships • Efficiency

15. Key Strategies – Co-ordination • Have a vision • Build an Executive Team from multiple disciplines • Agree on a direction and Priority Areas • Meet regularly and empower PALs • Encourage accountability through regular reporting

16. Challenges – Co-ordination • Needed to bring all PFC info to date together • Needed to provide up to date information • Needed to develop consistent tools for all to use • Needed to “Pinch with Pride” and share

17. Key Strategies – Co-ordination • Have a central point for all information and make available all information from all projects • Disseminate information • Format tools that could be used across multiple projects • Communicate, communicate, communicate

18. Challenges -Communication • Needed a co-ordinated approach • Needed to use the same language • Needed a signature / design • Needed to be simple, understandable & effective • Needed to be targeted • Needed to be planned

19. Key Strategies -Communication • Develop a Public Folder for all PFC Teams/participants • Executive Sponsor – “Paving the way for success” • Standing Item on Operational Executives meeting • Fortnightly PAL meetings • Engaged Peninsula Health’s Public Relations Unit • Quarterly four page newsletter and monthly update

20. Next steps -Communication • Develop a PFC Intranet site with a “Score Chart” • Update Internet site • Road show • Maintain the central point of documented evidence • Orientation programme presentation

21. Communication “This is bureaucratic gobbledegook to clinicians. I have NO IDEA what a patient flow collaborative is, something to do with Urology perhaps?” (Peninsula Health Medical Officer December 2004)

22. Early Achievements • Focus on quick wins • Identified established work that could link with PFC • Targeted projects from Brainstorming Analysis • High Level Executive Support • Team approach

23. Activities to date • ED / Radiology • Emergency Streaming • Direct RAPCS admissions from ED • Allied Health Pre-discharge Home Visits • Patient Transfers and Transport

24. Activities to date • LOS and Early Discharge • Volunteers • Incident Management • Theatre Utilisation Project

25. Future Activities • Communication and referral processes between ED and Inpatient Units • Orthopaedic Streaming • Neuro Streaming • Weekend Discharges

26. Future Activities • Multiple patient assessments • High Risk follow up • Transfer of Medical Records across sites • Ward Clerk and PSA roles

27. Future Challenges • Gaining participation of medical officers • How to involve more frontline staff in the process • Keeping staff motivated • Managing the growth of activity

28. Critical to Success • High level management support • Clinicians fully engaged • Clinical Leadership • Team work • Communication & mass involvement of staff and healthcare partner organisations • Improvements must involve structures, processes & patterns

29. Questions ?

30. Morning Tea Meet us back here for Workforce strategy development at 10.50

31. Workforce strategy developmentRight People, Right SkillsDHS workforce design strategy Breakout session 4 Bellarine Room 4 10.50 – 11.45 Jennifer Colbert Workforce Strategy and Regulation, DHS 9th February, 2005

32. Right People, Right SkillsDHS workforce design strategy Jennifer Colbert Service & Workforce Planning

33. Human services workforceKey challenges • Factors impacting workforce supply • Changing workforce demographics • Changing working patterns & mobility • Shrinking pool of workforce entrants • Increasing specialisation & entrenched professional ‘silos’ lead to fragmentation of care • Factors influencing workforce demand • Increasing service demand • Changing technology and evolving models of care • Increasing client complexity

34. Human services workforceEnablers for change • Getting national/state/local approaches & outcomes • Engaging with the VET, tertiary & post tertiary education sectors • Overcoming professional/industrial legacies • Adjusting workforce expectations • Acceptance of learning from overseas • Getting investment in workforce development • Willingness to embrace change

35. National workforcestrategic framework • Established to guide national investment in health workforce • Allows better identification of workforce priorities that would benefit from national approaches • Provides capacity to promote collaboration between jurisdictions and reduce duplication • Work plan for 2004-05 includes: • Nationally consistent medical registration project • AMWAC Studies in surgical specialties • Alternative workforce planning approaches • Improving workforce data

36. Developing a Victorian action plan • Key areas to be progressed include: • Increase workforce supply • Improve workforce distribution • Improve workforce data & analysis • Explore opportunities for role redesign • Combination of short, medium and long term strategies required

37. Health workforce:Strategies & solutions Short term Medium term Long term Attract locally trained international students Improve Supplement existing overseas recruitment strategies workforce Expand strategies to encourage re - entry supply Increase funding for clinical placements E C R Fund growth in early graduate positions O F Improve K Establish alternative approaches to management & R workforce O allocation of early graduate & vocational training positions distribution W H Expand recruitment & retention strategies in priority services & occupations T L A E Fund projects to design & influence curriculum H Redesign Support skills mix projects the Expand training & utilisation of certificate trained staff workforce Fund local workforce innovation projects which pilot work roles &/or design

38. Workforce StrategiesIntegration

39. Role review & design:Principles • All role changes should improve the patient journey through the health care system • Ideally, follow on from service review • Allow professional staff to work at their training level – delegate technical and irrelevant work • Expand use of trained support staff • Maintain safety and quality

40. Role review & design:Education & training • Improve liaison with higher education & VET sectors – tailor curricula to roles • Explore alternative education models – deliver skilled workers more efficiently • Encourage articulation between VET & higher ed – career paths and career flexibility

41. Role review & design:Skills mix projects • Undertake statewide pilots to identify effective approaches and tools • Support local innovation, existing and proposed • Priorities for 2004-05: ·Extended roles for allied health assistants; ·Support roles in acute care; ·Support roles in rehabilitation; ·Extended roles in eye care (building on the VictorianOphthalmology Services Service Planning Framework; ·Support and professional roles in mental health; ·Extended allied health professional roles.

42. Role review & design:Methodology

43. Role review & design:Governance

44. Role review & design:Going forward • More information please – forums, visits to services • Call for expression of interest from health services for redesign pilots • Communication, consultation & ongoing liaison with stakeholders • Formation of reference groups & teams • Development of redesign tools

45. DHS workforce design strategy:Interested? Questions? Contact: Email jennifer.colbert@dhs.vic.gov.au Phone 03 9616 7872

46. Team Presentations11.45– 1.00 • Prue’s Cluster Bellarine Room 4 • Peter MacCallum Cancer Centre • Northern Health • Bendigo Healthcare Group • Western Health • Box Hill Hospital

47. Tabletop presentations The aim of this session is to; • Promote discussion • Share “Peer to Peer” practical experiences of innovation • Increase energy for change and shared learning • Spread ideas between teams

48. Session format • 2 teams per table • Team A has 10 minutes to share experiences with team B • Whistle blows • Team B has 10 minutes to share experiences with team A • Rotation 1 • Continued….

49. Session format

50. Session format