Judy Willis
System Relationship & Framework Branch
NSW Ministry of Health
Redesign to achieve
National Elective Surgery
Ta...
Overview
 The NSW Strategy for NEST
 Booking Office & Waiting List Management
 Pre Admission processes
 Operating Thea...
National Elective Surgery Targets (NEST) -
NSW
Part 1: Stepped improvement in the number of patients treated
within the cl...
NEST Part 2 – Reduction in Long Waits
Cat 31/12/11 31/12/12 31/12/13 31/12/14 31/12/15
1 0 0
2 39 29 20 10 0
3 130 98 65 3...
NEST – Things to consider
 The more overdue patients you treat = less percentage
treated on time (calculated when patient...
$209.2M from the National Elective Surgery
Target (NEST) Facilitation & Reward Funding
Year Facilitation Reward (part
1)
R...
NEST Strategies
NSW Strategy
Booking Office and
Admission Process
Pre Admission
Operating Theatre
Efficiency
Models of Care &
Discharge
Pr...
Booking Office & Waiting List
Management
 Clear policy and business rules
 RFA Management
– Appropriate CPC
– Treat in t...
Admission Procedures
 Staggered Admission times
 Day of Surgery Admissions
maximised
 Short stay surgery maximised
 Ut...
Pre-Admission Assessment
 All Patients complete a Patient Health questionnaire (PHQ)
 All PHQs are screened and triaged ...
Operating Theatre Suite & PARU
 Leadership
 Operating Theatre/Room efficiency & safety
 1st case on time starts
 Turno...
First Case on time Start Projects
Concord
Hospital
Poster
Models of Care
Recommended from Surgery Futures Project (2010)
 High Volume Short Stay surgery
 Specialist Centres
 Eme...
HVSSS Model
• High Volume Short Stay Surgery (HVSSS) is defined
as planned surgery/procedures requiring admission for
up t...
Specialty Centres
Specialist surgery met through development of
formal specialist centres with:
• Clearly delineated refer...
Emergency Surgery
 Standard-hours scheduling where
clinically appropriate;
 Load balancing of standard-hours
operating t...
Embedding the new models
 Funding to establish model with a
requirement to provide regular progress
reports
 Surgery Red...
Aims
 To give project leads the skills & knowledge to
successfully implement the model or initiative
 Network with other...
 31 participants have completed (Nov 11 & May 12)
 Another 20 staff to undertake program in Dec 2012
 Topics: Patient f...
Other initiatives
 NSW Surgical Services Taskforce sponsorship
– Reward payments for performing hospitals (COAG funds)
 ...
Goal
 To ensure all Elective Surgery patients are treated within
the recommended timeframe
 Improve our processes & prac...
The Surgery Program
Bookings & Admission
Preadmission
Peri operative
Processes
Post op care &
Discharge
Further information
ARCHI
http://www.archi.net.au/resources/delivery/surgery/predictable-
surgery/7
National Health Reform...
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Redesign to Achieve NEST in NSW

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Judy Willis, Principal Policy Advisor - Surgery, from NSW Ministry of Health delivered this presentation at the 2012 Elective Surgery Redesign Conference. For more information about our wide range of medical and health events covering a broad range of industry issues, please visit www.healthcareconferences.com.au

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Redesign to Achieve NEST in NSW

  1. 1. Judy Willis System Relationship & Framework Branch NSW Ministry of Health Redesign to achieve National Elective Surgery Targets (NEST) The NSW Experience
  2. 2. Overview  The NSW Strategy for NEST  Booking Office & Waiting List Management  Pre Admission processes  Operating Theatre Efficiency  Models of Care – High Volume Short Stay – Specialist centres – Emergency Surgery  Other initiatives
  3. 3. National Elective Surgery Targets (NEST) - NSW Part 1: Stepped improvement in the number of patients treated within the clinically recommended time. Time Cat 1 % Cat 2 % Cat 3 % Baseline 92.3 86.6 89.4 By Dec 2012 96 90 92 By Dec 2013 100 93 95 By Dec 2014 100 97 97 By Dec 2015 100 100 100 YTD Cat 1% Cat 2% Cat 3% Sept 2012 94.6 90 92.2
  4. 4. NEST Part 2 – Reduction in Long Waits Cat 31/12/11 31/12/12 31/12/13 31/12/14 31/12/15 1 0 0 2 39 29 20 10 0 3 130 98 65 33 0 Part 2: A progressive reduction in the number of patients who are overdue for surgery, particularly patients who have waited the longest beyond the clinically recommended time. AV Days waited above the urgency category timeframe on 31/12/12 Zero Cat 1 overdues Av wait over benchmark no more than 29 days
  5. 5. NEST – Things to consider  The more overdue patients you treat = less percentage treated on time (calculated when patients are admitted)  A few months of poor performance can mean you never make the Part 1 target all year. Consistent performance is a must...  Having no overdue patients at the end of the month doesn’t mean you will make NEST Part 1  1 day overdue is as bad as 10 days or 50 days overdue in Part 1 but to meet Part 2 average no. days over needs to be less that average target days on 31/12 each year
  6. 6. $209.2M from the National Elective Surgery Target (NEST) Facilitation & Reward Funding Year Facilitation Reward (part 1) Reward (part 2) 2010/11 $114.9M - - 2011/12 $31.1M - - 2012/13 - $7.9M $7.9M 2013/14 - $7.9M $7.9M 2014/15 - $7.9M $7.9M 2015/16 - $7.9M $7.9M TOTAL $146M $31.6M $31.6M *National Partnership Agreement (NPA) on Improving Public Hospital Services, pg 17 & 29 http://www.coag.gov.au/docs/nap_improving_public_hospital_services.pdf If you don’t meet the target for a period the reward repayment gets added to the next period, although can’t roll over the last year
  7. 7. NEST Strategies
  8. 8. NSW Strategy Booking Office and Admission Process Pre Admission Operating Theatre Efficiency Models of Care & Discharge Processes NEST
  9. 9. Booking Office & Waiting List Management  Clear policy and business rules  RFA Management – Appropriate CPC – Treat in turn  Escalation Systems  Staff Training Program  Documentation & Record keeping  Communication (internal with other departments)  Communication (external with VMOs & patients)  Auditing Systems
  10. 10. Admission Procedures  Staggered Admission times  Day of Surgery Admissions maximised  Short stay surgery maximised  Utilise High Volume Short Stay Surgical principles  Established process for direct surgical admission
  11. 11. Pre-Admission Assessment  All Patients complete a Patient Health questionnaire (PHQ)  All PHQs are screened and triaged for PAC  Anaesthetic support for PAC  Available PAC places to meet demand  Patient expectations – Process knowledge – Expected LOS Pre-Admission
  12. 12. Operating Theatre Suite & PARU  Leadership  Operating Theatre/Room efficiency & safety  1st case on time starts  Turnover time  Time Out  Equipment/radiology/pathology  Cancellations on Day of Surgery minimised  Capacity  Planning – weekly review of advance operating theatre lists  Utilisation of technology - RFID Peri operative Processes
  13. 13. First Case on time Start Projects Concord Hospital Poster
  14. 14. Models of Care Recommended from Surgery Futures Project (2010)  High Volume Short Stay surgery  Specialist Centres  Emergency Surgery
  15. 15. HVSSS Model • High Volume Short Stay Surgery (HVSSS) is defined as planned surgery/procedures requiring admission for up to 72 hours. It includes both Day only and Extended Day Only Surgery • Builds on the established Extended Day Only Model
  16. 16. Specialty Centres Specialist surgery met through development of formal specialist centres with: • Clearly delineated referral roles within a geographic region • Clinical and research leadership provided throughout the catchment • Operates within a network of services • Provides access to a high level of expertise • Concentrating high cost resources such as highly complex interventional radiology and other medical imaging and surgical support services
  17. 17. Emergency Surgery  Standard-hours scheduling where clinically appropriate;  Load balancing of standard-hours operating theatre sessions with emergency surgery demand;  Streaming of elective and emergency surgery in hospitals;  Reallocation of surgery resources appropriate to roles of the designated hospitals;  Safe interhospital transfer processes; and  Specific emergency surgery KPIs
  18. 18. Embedding the new models  Funding to establish model with a requirement to provide regular progress reports  Surgery Redesign Training Program for project leads  LHD Performance framework
  19. 19. Aims  To give project leads the skills & knowledge to successfully implement the model or initiative  Network with other project leaders who are implementing same or other models (emergency surgery & specialist Centres)  Cement an ongoing relationship between the Ministry and Project leads  Have a project plan completed by the end of the 5 day course. Surgery Redesign Training Program
  20. 20.  31 participants have completed (Nov 11 & May 12)  Another 20 staff to undertake program in Dec 2012  Topics: Patient flow, Handover, Business case writing, Understanding data, clinical protocol development  Project management skills (1 day- Fundamentals of project management)  Implementation skills (2 day Accelerated Implementation Methodology Training) – a methodology which focuses on the human elements of change Surgery Redesign Training Program
  21. 21. Other initiatives  NSW Surgical Services Taskforce sponsorship – Reward payments for performing hospitals (COAG funds)  Monthly Surgery Manager Teleconferences  LHD Self Assessment Checklist  Site Visits  Articles in the Surgery News (bimonthly newsletter)
  22. 22. Goal  To ensure all Elective Surgery patients are treated within the recommended timeframe  Improve our processes & practices to: – reduce delays & cancellations – Improve efficiency – Improve patient experience
  23. 23. The Surgery Program Bookings & Admission Preadmission Peri operative Processes Post op care & Discharge
  24. 24. Further information ARCHI http://www.archi.net.au/resources/delivery/surgery/predictable- surgery/7 National Health Reform http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/ Content/npa-improvingpublichospitals-agreement- toc~schedule-a Ministry Contacts Judy Willis juwil@doh.health.nsw.gov.au

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