1. Pilot Case Study

2. Melbourne Health Approach • Melbourne Health is fully engaged and committed to achieving the aims of the Patient Flow Collaborative • Real opportunity to built on 3 years of improvement activity

3. Background to Pilot • Many great initiatives through HDM and HARP including the Short Stay Unit, MAPU, Day of Surgery Admissions, • Resulted in reduced bypass and decreased waiting lists and hospital initiated postponements • Our experience is that while this approach brings improvements, it shifts the pressure from one area to another • The Health Round Table has had a similar realization

4. Currently we still have delays in…. • Access to wards • Access to diagnostic services • Access to Theatres • Access to specialist review • Access to Sub acute services Working to fix problems in isolation • Results in friction between Departments and campuses • Considerable scepticism and anxiety

5. Patient Centred Care • We are striving for a quality health service across the whole patient journey • Past experience has shown that a “whole of service” approach is the only way to address and fix problems

6. The Melbourne Health Approach Objectives: • Embrace as a Melbourne Health project – not just an RMH project • Follow the patient journey across all services, including RMH, MECRS and community based • Engage Divisional leadership and obtain active support at an Executive & Management level • Involve and seek input from staff at all levels, across all disciplines • Adopt the project methodology as an organization wide approach for ongoing improvement activities.

7. The Melbourne Health Approach • Use existing structures and processes: • Patient Management Taskforce • Operational Planning Process • Incorporate program measures in Balanced Scorecard • Report through Melbourne Health Executive • Executive staff in coordination groups • Cross section of senior clinical staff in Clinical Area teams – who were nominated and endorsed by relevant Directors and includes Executives.

8. Teams to support the work Executive Team Clinical Area Team Clinical Area Team Clinical Area Team

9. Structure • Executive Team – led by Julian Maiolo, Executive Director, Operations Management • Clinical Area teams led by Senior Clinical staff and supported by facilitators from the Executive Team

10. Clinical Teams • Access to Sub acute & Rehabilitation Services -Stephen Davis, Director – Neurology • Access to Radiology Services – Brian Tress, Director, Radiology Services • Communication between Medical Units and amongst Clinicians– Peter Brennan, Executive Director, Medical Services • Access to the Operating Theatre – Bruce Mann General Surgeon, specializing in trauma and oncology • Bed Accessibility through Systems & Process Improvements – Gavin Becker, Divisional Director, Medicine.

11. Team Approach • Diagnostics – to understand the process and problems • Scope Innovations – using tools and processes that are available through the Collaborative • Plan, do, study, act – implement and test improvement • Spread – start in one area, then introduce to whole of organization once proven • Mainstream – so that it becomes part of the culture.

12. Patient Delay Tracking Tool Pilot • First innovation – to be implemented within a few weeks • Web based (paper based in ED currently) • Encompass all areas: Emergency, acute and subacute wards • Promote ‘pull’ rather than ‘push’ system. • Good means of data collection • Reasonsfor delay can be tracked and managed • Gives a view of who is waiting • Allows for prioritization

13. Leadership and Communication • Clear message that this project is a major priority • Executive Commitment • Staff involvement • Board sub-committee and community involvement through the Community Advisory Committee and Safety & Service Improvement Committee • Regular Updates • Intranet site

14. Questions?