Your SlideShare is downloading. ×
0
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Patient Journey Project: Involving Consumers in the Improvements to Patient Flow Strategies

619

Published on

James Lind, Acting Director of Access and Patient Flow Unit, Gold Coast Hospital delivered this presentation at the 6th annual Hospital Bed Management & Patient Flow conference 2013 in Melbourne. For …

James Lind, Acting Director of Access and Patient Flow Unit, Gold Coast Hospital delivered this presentation at the 6th annual Hospital Bed Management & Patient Flow conference 2013 in Melbourne. For more information on the annual event, please visit the conference website: http://bit.ly/1f3Pp03

Published in: Health & Medicine, Business
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
619
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
23
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. 1 6th Annual Hospital bed management and patient flow conference 25 Feb 2013
  • 2. 2 The team
  • 3. 3 What is the Gold Coast health Service district? Demographics Gold Coast Southport Gold Coast Robina Carrara Hospital
  • 4. 4 You pay for this……. But not for this! Why would we go back?
  • 5. 5 Are we Patient-centric? 3P philosophy is it right? •Patients •Providers •Payers Are we patient centric
  • 6. 6 Distances between: Southport-Robina 20kms- 25kms 25-27 mins Southport- Pindara 6.4kms- 8.9kms 12-15 mins Robina- Pindara 13kms- 17.7kms 18-22 mins Physiotherapy Post-Surgery Robina Self- Referral CNC Clinic Robina Preadmission Outpatients Robina Genetic Counselling Robina -counselling Brisbane Operating Theatre Robina Hookwire ONLY Southport Radiology Riverwalk Way Robina Physiotherapy / OT For OP appointment GCH Southport Lymphosintigraphy +HW Pindara Private Hospital Benowa KS Guided Core FNA Medical Imaging GCH Southport Lymphosintigraphy + HW South Coast Radiology Chemotherapy (most) Hormonal Treatment GCH Oncology Southport FNA In clinic GCH Southport Frozen Section - GCH Southport Our organisation is provider centric
  • 7. 7 Is there a common ground through KPIs
  • 8. 8 90 in 4 The bodies of work
  • 9. 9 Stage 0: Plan Weeks 1-6 Weeks 7- 10 Weeks 11-20 Stage 1: Diagnostics Stage 2: Solution design Stage 3: Implementation Weeks -4 to 0 Commencing: 11th April Methodology Week 15 Week 16 Week 17 w/c 9 May w/c 16 May w/c 23 May • Sponsors and leads checking readiness factors to progress strategic enablers and phase 1 • Communications planning (including launch) • KPI reporting mechanism design • Strategic enablers & phase 1 solutions commence implementation • Communication events • Formalise monitoring & reporting • Continued implementation and support • PJP Project Board meeting 3 May Implementation Report signed off
  • 10. 10 Strategic enablers subacute & community care Inpatient care Emergency care • Planning does not happen effectively at a strategic level • Responsibilities for bed management are assigned across many different roles. This causes confusion and impedes effective patient flow management • The geriatric population are a disproportional number of ED attendances and admissions • The elderly are accessed blocked from designated inpatient units • Cat 2 waiting times exceed QH targets of 10 min • Cat 3 waiting times exceed the QH target 30 min • The current model of care for out-of-hours and weekends does not allow for ongoing quality patient management nor efficient discharges • Access block is compounded by a poor rate of discharges over weekends • Patients do not receive allied health care over the weekends • Pharmacy is unable to meet the demand for clinical pharmacy services, causing medication related discharge delays and an increased risk of medication errors • Limited pharmacy services „after hours‟ increases the risk of medication error • Most consultant ward rounds are not scheduled and often occur at an extremely fast pace • Poor documentation from treating teams leads to delays in patient care activities being carried out • Poor communication within the multidisciplinary team • Lack of coordinated patient care • The transit unit is underutilised at Southport and is not configured to be used as a discharge unit • Patients are not transferred to the Southport transit unit due to delays in prescription writing • Robina does not have a transit unit • Patients are staying in hospital too long because referrals to subacute care isn‟t starting early enough in the patients‟ journey • Referrals to subacute are not comprehensive enough • Transport delay is a major factor in timely patient transport both within the organisation and home • Patients perceive their treatment is uncoordinated, not integrated and not communicated effectively • Inconsistent referral methods across specialities and teams causing confusion • Delays occur in actioning referrals and assessments • Patient / Carer Experience surveys indicated that there is a lack of co-ordination and integration of care (including discharge) • Discharge planning is fragmented and starts too late in the patient journey • There is lack of coordinated care and discharge planning between staff that can lead to delays in patients discharge • Consistently high bed occupancy adds complexity to management of patient flow • The District‟s patient flow procedure is complex and not applied consistently or effectively • Medical and surgical elective admissions are not always aligned to capacity • PAU is perceived to have fragmented processes with increased patient delays for review • PAU lacks support from senior medical staff • Patients and staff experience delays of up to one week, waiting for diagnostic tests • Patients often arrive in the medical imaging department with patient preparation requirements incomplete causing delays in patient throughput. • There is a lack of clarity in the accountability and ownership of patient and process of referrals • Medical officer referrals are not consistently responded to in a timely manner or by appropriate seniority leading to compromises in patient safety The diagnostic exercise identified a range of issues across the patient journey Diagnostic Phase - Overview Draft for discussion only – Not for distribution – Gold Coast Health Service District 10 Draft for discussion only
  • 11. 11 A range of stakeholders have been engaged to identify and develop solutions to address the key issues identified in the diagnostic report 27 solution design workshops conducted 15 working parties established Leading best practice research 69 patient interviews conducted More than 200 staff and external stakeholders have contributed to the solution design phase Workshops Approach to solution design 11
  • 12. 1212 Implementation Report – How did we get here? 12 This report is a documented practical guide for implementation of the identified solutions aligned to the District goal for access block. Post-acutecare Treatment /care Communication&HR Informationmanagement&reporting Patientflow& bedmanagement TransitionReferral Inpatientcare Discharge coordination Care delivery Assess & admit Emergencycare DecisionTreatAssessTriage Pre- present &present • A high proportion of QAS presentations consist of category 1 and 2 patients • A high proportion of elderly patients present as category 2 and 3. Generally, these patients are more likely to need an inpatient bed • Services are fragmented and difficult for both care providers and consumers to navigate • Inaccurate or inappropriate referrals are often made due to a lack of awareness regarding what services are available and how they should be accessed • Delays between referral and transfer to sub-acute services result increased length of stay • There is limited or no coordination between service providers • Patients and staff also experience delays waiting for diagnostic tests and receiving test results • There are opportunities to improve the utilisation of theatres across campuses • Pre-admission clinic is perceived to have fragmented processes with increased patient delays for review and lacks support from senior medical staff • The number of presentations at ED is increasing, with an increasing proportion of elderly patients presenting at ED • Typically elderly patients are complex and have multiple co- morbidities, they are more likely to present to hospital more than once • Several issues can routinely impact patient care during the assessment and admission process, and when patients are transferred to the ward • Medical and surgical elective admissions are not always scheduled to align to available bed capacity • Challenges experienced by staff who coordinate patient flow are exacerbated because relevant information is not available to support timely decision making • Responsibilities for bed management are assigned across many different roles. This causes a mismatch and impedes effective patient flow management • High levels of ward block impede the ability of the District to transfer patients from the ED to an inpatient bed and some wards are more frequently access blocked • Elderly patients wait longer for an inpatient bed and also end up having a longer length of stay • Significant delays occur waiting for inpatient teams to review patients in the emergency department. This exacerbates access block • Unclear communications between patients and staff result in patients not feeling valued or empowered • Patients perceive that their treatment is uncoordinated and not communicated effectively to them • Poor data integrity impedes patient care throughout the patient journey • Discharge planning in the District is fragmented and starts too late in the patient journey • Challenges related to the coordination of care within teams impedes the discharge process • Access block is compounded by a poor rate of discharges on the weekends • Failure to prepare and send patient discharge summaries is impeding continuity of care within the community • Wait times for transport services provided by QAS contribute to discharge delays from the transit lounge • There is a perception that the transit lounge could be utilised to facilitate a greater proportion of discharges from the Southport campus This approach involved District staff prioritising a over 250 solution ideas based on ease and impact Solution themes Patient flow and bed management Care coordination and communication Diagnostics Pharmacy ED cat 2 & 3 Geriatric model of care subacute referrals Transit lounge Transport Pre-admission Out of hours rostering Greater level of impact 21 3 Greatereaseofimplementation 213 Approach to solution design 11 Implementation Report The purpose of this document is to: • Detail the District‟s solutions to patient flow issues • Provide appropriate plans to guide the implementation • Provide a framework for managing the implementation • Outline benefit management approach • Identify key readiness criteria • April 2011 Stage 3: Implementation Report Solutions ReportDiagnostic Report Stage 0: Plan Weeks 1-6 Weeks 7- 10 Weeks 11-20 Stage 1: Diagnostics Stage 2: Solution design Stage 3: Implementation Weeks -4 to 0 Diagnostic Report Solution Design Report Project Plan Implementation Report
  • 13. 13 Overview of the Implementation Report – for each solution 13 Solution statement Implement standardised and streamlined discharge process including clear roles and responsibilities to improve patient experience, quality and timeliness of discharge Proposed benefits and outcomes:  Reduced confusion and duplication between staff  Reduce discharge delays  Improved patient and carer experience  Earlier discharge of inpatients  Improved staff satisfaction including primary care Leading practice: • Best practice is a comprehensive discharge plan developed within 48 hours of admission • Identification of patient trajectories early and matches patients to next step (Barwon Health) • Re-engineering discharge incorporates Virtual Louise for discharge education and dedicated discharge planning work station (protected space) • Clinical care pathways facilitate discharge by achieving enhanced and quicker patient recovery (Health Advisory Board, 2010) KPIs • Discharge by time of day • Patient experience indicators • Utilisation of discharge tools • Number of patients with discharge summaries within 24 hours of discharge • Feedback from General Practitioners Solution design:  Implement standardised and streamlined discharge process that reflects leading practice (should include informing patient and family of likely discharged date as early as possible)  Implement early assessment and identification of discharge needs.  Implement consistent patient education on discharge (patient hand-outs)  Evaluate the effectiveness of tools used to facilitate discharge and recommend changes to simplify  Review roles and responsibilities for alignment of discharge processes including ownership of the patient (family and carers)  Measure and report adherence to streamline process and monitor effectiveness of tools and teams Key issues/insights: • Patient / Carer Experience surveys indicated that there is a lack of co-ordination and integration of care (including discharge) • Discharge planning is fragmented and starts too late in the patient journey • There is lack of coordinated care and discharge planning between staff that can lead to delays in patients discharge • Poor communication between and within disciplines. • Team members work in silos and do not share information with other disciplines • Perceived inconsistency in providing information / education to patients Sponsor: Morven Gemmill Solution l: Implement standardised and streamlined discharge process and toolsSolution l: Implement standardised and streamlined discharge process and tools 1 Tasks Owner Dependency 1 2 3 4 5 6 7 8 9 10 11 12 Ongoing Planning and preparation Leadership Sponsor Change Management leadership Lead Determine sponsors and advocates Lead Agree responsibilities Sponsor Change Readiness Sponsor Sponsor the change Sponsor Monitor change management & stakeholders Lead Report progress to executive sponsor Lead Formalise working party Sponsor Identify and agree working party Sponsor Obtain commitment from working party members Lead >>>>>>>… Resource requirement plan Review current staffing levels and services provided Lead Develop draft staged plan for additional resoucres to meet demand for clinical pharmacy services Lead Seek feedback from stakeholders regarding resource plan Lead Resource plan endorsed Sponsor/board Board approval Funding approved Executive Executive approval Recruitment and deployment Positions advertised Lead Interviews completed Lead Order of merit for HP3 and HP4 pharmacists finalised Lead Appoint from order of merit Lead Executive approval Pharmacists commence Lead Orientate to department Lead Deploy pharmacists as agreed in implementation plan Lead Resources Identify requirements in line with endorsed implementation plan Lead Purchase required dect phones, wireless computers, lockers Lead Executive approval Communications plan Identify audience groups impacted by change Lead Executive approval Determine communication needs Lead Develop communication messages Lead Deliver communications Lead Gather feedback Lead Measurement and reporting Agree benefits Lead/MAC Determine KPIs to support benefits Lead/MAC Define measurement approach Lead Develop measurement tools Lead Measure and report progress Lead Inpatient unit based clinical pharmacy services - implementaton Timeline: Week 1Draft for discussion only – Not for distribution – Gold Coast Health Service District Risks: • Failure to gain support for clinical pharmacy services will further contribute to Pharmacy staff burnout resulting in excessive sick leave and turnover • Lack of space at Southport Key Solution: [summary headline of the solution topic] Implementation team Team role Team member Day per week Total weeks Sponsor Jane Hancock 0 Project lead Trudy McGovern 1 8 Team member Liz Coombes 0 Team member Linda Stockwell 0 Team member Balaji Hiremagalur 0 Team member Paula Duffy – to confirm 0 Implementation team Team role Team member Day per week Total weeks Sponsor Jane Hancock 0 Project lead Trudy McGovern 1 8 Team member Liz Coombes 0 Team member Linda Stockwell 0 Team member Balaji Hiremagalur 0 Team member Paula Duffy – to confirm 0 Parallel projects: PJP projects: • Co-ordination of care and communication • Transit Unit • Transport External • Medication Services Queensland – review of statewide medication discharge procedure (postive impact) • eHealth Other resource requirements: • Clinical pharmacy service – approx 16 FTE HP3/4/5 pharmacists to GCUH transition to cover existing beds • Computers, phones, lockers KPI‟s • Organisational KPI‟s • Readmission rates • Length of Stay • Solution KPI‟s • Medication error rate • Time to complete medication discharge • Quality of medication list in EDS • Pharmacist ratios • Patient KPI‟s • Patient experience Quick Wins (operational milestones thought to deliver specific benefits within eight weeks of operation). • Simplifying the medication discharge procedure to reduce time and improve quality of the discharge Dependencies: • Medical and nursing staff to follow revised medication discharge procedures • Adequate capacity to orientate, train and supervise pharmacists Updated solution statements reflecting latest thinking developed by working parties and Sponsors Detailed work break down structure for the implementation including: • Duration of tasks (in weeks) • Owners of tasks • Dependencies • Milestones Outline business case for the implementation including: • People involved in implementing and estimated time commitments • Other, non staff resources required (eg. IT) • Discussion of risks and dependencies for the implementation • Quick wins and benefits • Related projects
  • 14. 14 Before any project can be mobilised, a number of key steps must be completed. Mobilisation check list 14 Checklist for Executive Sponsor Mobilisation of Solution Implementation  Project Lead identified and availability confirmed  Working party members identified and availability confirmed  Additional resources identified and confirmed  Change Readiness assessment for mobilisation: oEnvironment oStakeholders oCommunication oResources oSchedule oGovernance oRisk  Funding and resource requirements defined (if applicable)  Funding and resource secured (if applicable)  Competing interests identified  Risks identified and mitigation strategies in place
  • 15. 15 Solutions in action
  • 16. 16 Implementation road map 16 The recommended phasing of implementation starts with the strategic enablers and quick wins, as planning and preparation starts for the next phase. 0-3 months 3-6 months 6-9 months 9-12 months 12-18 months Prepare & Plan Implement Prepare & Plan Implement Evaluate, Monitor & Manage Strategic Enablers Evaluate, Monitor & Manage 2 - Team based care coordination and communication 1 - Patient Flow Strategy and Infrastructure Implement Evaluate, Monitor & Manage 3 - Bed management standard business rules 4 - Improve Category 2 and 3 emergency patient journey 5 - Early identification of Subacute patients 6 - Demand management for transportation services 7 – In-patient Unit Rounds & Communication 8 - Medical officer referrals business rules 9 - Allied health referral coordination 10 - Standard discharge process and tools 11 - Medical imaging systems realignment 12 - surgical pre-admission clinic service redesign 14 - Transit unit review and model of care development 13 – In-patient unit based clinical pharmacist 15 - Weekend activity and service alignment Phase 1 Solutions Phase 2 Solutions Phase 3 Solutions
  • 17. 17 17 Project Board Project Team Working Party 1 Working Party 2 Working Party 3 Responsibilities include: • Review and endorse implementation plans • Sponsor the implementation of initiatives and supporting solution teams •Support solution teams and review solution status reports • Consider and approve resourcing requests • Design and implement risk Mitigation strategies. Responsibilities include: • Provide program leadership and support to the assigned sponsors and project leads (responsible owners) • Organise and facilitate establishment of working parties • Report overall program progress to project board and executive sponsor • Monitor compliance with readiness assessments, timeframes and implementation plans • Provide program management and utilise deep knowledge of hospital processes and peoples to lead delivery of implementation activities •Escalate overall program issues, risks and dis-benefits to the executive sponsor Accountable Executive (Sponsor) •. Responsible Officer (Project Lead) Working Party Members Managing Implementation Consumer on board
  • 18. 18 So did it work for consumers? We hit our NEAT, NEST and budget targets……or did we miss the point!
  • 19. 19 So what do consumers want or Complain about!!! Consumers • Communication - To he listen to and respected - To be kept in the picture • They expect to wait!!! Complaints • Poor communication • Poor treatment • Poor access Hospitals • NEAT • NEST • Budget • MORI • SAC events • Standardized mortality
  • 20. 20 How do we measure it?Patients consented in hospital Followed up in phone interview Open standardised questions Theme then classified • 3 methodologies choosen - Feedback after visit - Real time interview - PET Measurements
  • 21. 21 Patient Experience Trackers Ask the same questions to staff and patients to identify gaps eg do you know your estimated day of discharge
  • 22. 22 So what have we done ? “In ED from 10am until 8.30pm-that is a long day” “Signage is awful” “I was left in a soiled bed and PJs for some time” “The nurse to nurse “handover” of information about me was wrong” Implemented NEAT Decluttered and Rewritten signs Intentional hourly ward rounds Patient included in hand over So what else
  • 23. 23 What are the main lessons learnt •What patients want may be different to what is perceived •Current KPI cannot capture the consumers needs •There is significant overlap in some KPIs •Fixing entire systems benefits both consumers and staff
  • 24. 25 Can we Beat Disney at their own game Can we beat Disney at their own game?
  • 25. 2626 Thank you

×