Annie Williams, Goulburn Valley Health - “A Blank Canvas” – Implementation of a Organisational wide Redesign Program


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Annie Williams, Manager Innovation & Improvement, Goulburn Valley Health delivered this presentation at the Clinical Redesign & Process Mapping conference. This conference provides case studies of succesful redesign projects to assist delegates in identifying the root causes of issues impacting patient journeys and then develop and implement sustainable change processes to improve the way health care is delivered.

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Annie Williams, Goulburn Valley Health - “A Blank Canvas” – Implementation of a Organisational wide Redesign Program

  1. 1. A Blank Canvas: Implementation of an Organisational Wide Redesign Program Annie Williams, Manager of Innovation & Improvement Goulburn Valley Health, Shepparton, Victoria
  2. 2. Focus of this presentation Program Establishment Redesign Program Success Stories “Redesign by Stealth” Skills & Capability Building
  3. 3. Organisational Background
  4. 4. Our Approach Our approach?
  5. 5. Program Establishment  Strong executive sponsorship  Project reporting and governance  Branding and Communications  Extensive diagnostic – qualitative and quantitative  Patient & Carer perspective  Collaboration & Communication
  6. 6. We had a problem...  A very aged and historical model for OT allocations  Limited physical capacity  Multiple Surgical Services reviews [internal and external]  Minimal planned capacity for emergency surgery  High rates of DOS cancellations  High LOS for emergency surgery patients awaiting surgery  High rates of OT staff overtime Scope: Review the journey of Elective and Emergency Patients, from the time of being confirmed for surgery to entering Recovery”
  7. 7. REDDSoC Diagnostic Summary • Limited existing physical and staff resources • Current allocations process did not maximise existing limited resources • Variation in data entry and documentation Emergency activity 1/3 of all GVH OT procedures  Emergency demand was predictable  Limited existing capacity or planning for emergency demand Report Card Elective surgical management meeting internal and external KPIs
  8. 8. REDDSoC Model 1. Allocation and capacity building based on demand, both emergency and elective 2. Allocations made to Surgical Specialities 3. Quarantined allocations for emergency surgery by specialty 3. Capacity for General Surgery and Orthopaedic Surgery daily 4. Capacity created for recruitment for additional surgical specialties – including those to address areas of high elective demand e.g. ENT 5. Approved set of Business Rules for OT allocations, including regular reviews
  9. 9. REDDSoC Model: ED LOS - Pre & Post Implementation Insert heading here ED SURGICAL PATIENTS ED SURGICAL PATIENTS [ED ADMISSION TO PROCEDURE] Sept 2011 to Oct 2011 90 80 70 60 50 40 30 20 10 0 140 ED < 8 hrs ED > 8 hrs Number of Patients Number of Patients [ED ADMISSION TO PROCEDURE] July 2010 TO Aug 2010 120 100 80 60 ED < 8 hrs 40 ED > 8 hrs 20 0 GS ORT Surgical Specialty GYN GS ORT Surgical Specialty GYN
  10. 10. REDDSoC Model: ED Triage to OT - Pre & post implementation P 35 GVH REDDSoC Project: Patient ED Triage to OT 173 pts 29 hrs 30 25 20 15 LOS ED Triage to OT [Hrs] 10 5 0 2010 246 pts 5.8 hrs 2011
  11. 11. Some more success stories... RESMED Project: o Reduction in LOS of Medical ward patients for 5 main admission DRGs Patient Flow Project: o Process improvements o Data system & report development, o ED LOS
  12. 12. Redesign by Stealth  Redesign skills for problem solving • Process mapping • Workshop facilitation • Statistical Process Charts [SPC] – power of the data!  Project reporting • A3 Reports formatted to meet identified needs  Communications & Marketing  Patient & Carer Experience Building trust and credibility
  13. 13. Current State Process Mapping GVH Surgical Ward – Medication Process Patient Journey v 1.0 Patient Transferred/returned to Surgical Ward Patient admission Nurse Review of MR6 Are the prescribed Medications available on the ward? Yes Medications obtained from ward pharmacy No Nurse commences Patient medication rounds Nurse confirms Medications, route and prescribed times In hours fax copy of MR6 to Pharmacy Out of hours, contact with AH Manager, who will dispense from Pharmacy Medications obtained and placed in Patients bedside locker Patient observations and review Medication script to be written Patient medications dispensed Ongoing clinical management care in Surgical Ward continues Yes Is the patient ready for discharge? Patient discharge or transfer Patient care in Surgical Ward continues No 13
  14. 14. Current State Process Mapping GVH Surgical Ward – Medication Process Patient Journey v 1.0 Medication Process Patient Transferred/returned to Surgical Ward Patient admission Nurse Review of MR6 Medication Issues Comment: * Patients most commonly transferred from ED and OT Issue: • Patient name bands may be missing post op Issues: • Routine medications often not charted • Unknown or unidentified signature/s • Aneasthetist - documents post op meds only Issues: • Legibility of medication order • Allergies section of MR6 often not completed, and discrepancies between allergy, sensitivity and highlighted conditions • Delay in identifying and contacting MO to clarify order • Medications often requested using proprietary names – not generic 14
  15. 15. Emergency Department Ambulance Ramping: Management and Escalation Process - Draft v1.0 Is there a cubicle available? Ambulance Arrives Yes Pt unloaded into cubicle Can the pt go to the waiting room? No Yes •Pt transferred to waiting room •Triage Nurse to complete keystroke No ED ANUM & AO:  Assess which pts can go to EMU  Assess pts for admission  Assess pts to go to waiting room  Ensure ambulance pt transfer to cubicle Review @ 20 minutes ED ANUM +/ AHHM:  Contact ward that have admissions waiting in ED and expedite Assess which pts can go to EMU  Assess pts for admission Review @ 30 minutes GVH Patient Flow ED Play Your Part
  16. 16. Surgical Services Redesign Project Report 25/08/10 1. a) Purpose of This Project * Reduce DOS cancellations by 30% * Increase capacity to meet current demand for services * Identify future opportunities to develop a more comprehensive range of speciality operative sessions b) Actions * ED Surgical Patient Process Mapping * OT Capacity measurements - Wait list review of cat 2 Breeches - craft groups and time frames 3. Risks and Issue Summary Risks Mitigation Strategy * Issues * Confirmation of Redesign Project Steering Committee times/dates required to ensure clinical stakeholder enegagement * Confirmation of attendees for Balancing Elective and Emergency Surgery Workshop, 9 - 10 Sept. Actions * Four week minimum notice required for clinician representatives 2. KPIs and targets KPI Description Target DOS Cancellations Reduce cancellations of patients on day of surgery by 30% HIPs Hospital Initiated Postponements - DoH target 8% GVH 7.5% 5. Action plan starts 1-Jul Week/Progress ## ## ## ## ## ## ## ## ## ## ## ## Wait List Review current wait list management process (current DoH target 600) Activity Initiation Who is responsible Project Governance established AW/KH/Exec Project Team AW/KH Identification of stakeholders AW Communications AW/KH Recruitment of Facilitator AW Data Analysis AW/RS/MM Riskman Review Elective Surgery - Major + Minor 2009 BBM/AW 600 500 400 Result LCL 300 Diagnostics UCL 200 100 PaCE - Ethics submission 0 1 2 3 4 5 6 7 8 9 10 11 12 Patient Journey Mapping Emergency Surgery Major + Minor 2009r 300 250 Solution Design 200 Result LCL 150 UCL Median 100 Key: 50 Compete Underway 0 1 2 3 4 5 6 7 8 9 10 11 12 Scheduled Signatures: 1 2 3 4 5 6 7 8 9 10 11 12
  17. 17. Overall Average: 229 Overall Median: 231 Sep-13 Aug-13 Jul-13 Jun-13 May-13 Apr-13 Mar-13 Feb-13 Jan-13 Dec-12 Nov-12 Oct-12 Sep-12 Aug-12 Jul-12 Jun-12 May-12 Apr-12 Mar-12 Feb-12 Jan-12 Dec-11 Nov-11 Oct-11 Sep-11 Aug-11 Jul-11 WONZ IDDM ONC OPEN Individual Total Patients Value SPC Charts GVH ONCOLOGY SERVICES INPATIENT [DAY ADMISSIONS] JULY 2011 TO SEPT 2013 Special Cause Flag 250 200 150 100 Period Data Source: GVH Cold Fusion Reports
  18. 18. Communications & Marketing  Targeted and tailored to meet needs of the audience  Logos, branding and colour to cut through the “wallpaper of health”  Multiple channels – avoidance of email only  Keeping it fresh and refreshed  Building and supporting relevant computer skills to deliver effective communications  Confidence building in redesign approach
  19. 19. GVH Patient Flow “Patient Flow – Play Your Part” Play Your Part Goulburn Valley Health Goulburn Valley Health has identified that to meet increasing demand from the community for services, and in order to provide quality and timely care to all our patients, Discharge before 10am is vital. As well as being beneficial to patients who come through the Emergency Department, early discharge helps elective surgery patients as they can be assured that we are doing everything we can to prevent their surgery being cancelled. This process also streamlines and enables the transfer of patients to and from the ICU, so these specialised resources can be directed to the patients who need them. The creation of new discharge promotional posters, together with changes to current processes, will ensure that staff, patients and their families will be aware of the hospital’s updated discharge policies and timeframes. Discharge information will be displayed in the wards, service areas and public areas such as lifts and waiting areas. This information will encourage patients, their families and carers to take the initiative in talking with staff, and finding out about their discharge details from their treating team, and to confirm discharge plans so that they can arrive on time to take relatives and friends home. This new initiative, along with other project strategies such as the updated patient journey boards and electronic patient flow systems, will assist the hospital to achieve its discharge targets of:  a minimum of 3 patients per ward discharged before 10am, and  60 % of patient discharges finalised prior to 12noon.  Feedback on performance will be provided to operational managers GVH Patient Flow Discharges 3 by 10 Play Your Part Further information? Contact: Penny Whelan – Project Coordinator phone : [O3] 58323 074 or
  20. 20. Patient & Carer Experience Patient and staff perspective valuable lever for change Stand alone or project focus Alignment with National Standards Tools, training & templates available at:
  21. 21. Skills & Capability Building Spring Clean Program: Internal small scale environmental and process improvement project management training program 3 waves – separate branding Spring Clean March Makeover Show & Shine  75 participants – clinical and nonclinical backgrounds  Project scope – to enable completion in 4 week period  Project Management basic training Key component - Strong executive sponsorship and involvement
  22. 22. GV Health “Environmental Spring Clean – Everything Speaks” Project Methodology Project Nomination/s Train the Trainer Project Commences Identified and prioritised areas for improvement required ? Environmental Evaluation No Yes Plan Executive Walkthrough Week 2 Resources Report Review & Evaluate Action +/- Review & Approval
  23. 23. Example of poster developed on completion of project
  24. 24. Thankyou I would like to sincerely thank IIR conferences and the organising committee for the opportunity to be with you today , and welcome any questions or comments