Whole of Hospital Approach to NEAT

Team Based Hospital Plan
27 Feb 2014
Rodney Smith
Patient Flow Manager
Purpose

Who are we?
Context – NEAT
Bed management project
Achievements
Ongoing challenges

Day/Month/Year

Footnote to go...
Who are we?
•

A Catholic mission and values based organisation founded over 150 years ago by the
Sister’s of Charity, now...
Who are we?
•

Situated in the inner city suburb of Darlinghurst with a diverse mix of socio economic
demographics
•

D&A
...
Who are we?
•

Mission and Values
•

150 yrs worth that provide a framework for what we do and what we want to
achieve

•
...
NEAT is here!
•

NSW MoH NEAT targets
•

2013 – 71%

•

2014 – 83%

•

2015 – 90%

If we improve our systems and processes...
Our Journey – the context
• Stranded Sam – LOS>21 days
• ePJB
•

RED project

•

NEAT ED model of care project

•

Lean He...
Bed Management Project
•

Recognition that in order for NEAT to be achieved we needed to change our bed
management practic...
Background

“Where are we now study” study showed a significant delay in bed
request/allocation/ready
Median time 7:18 hrs...
The Team
Executive Sponsor – Director of Operations
Project Lead/Manager – NM Patient Flow
Project Team:
- Bed Manager
- N...
Navigating Project Management 101
•

Project charter –
•

Goal

•

Deliverables

•

Methodology

•

Interdependence

•

Go...
Diagnostics/Current state
•

VSM current state
•

•

250 issues

Process map AHNM bed management
•

86 issues

•

Data ana...
Current state

Day/Month/Year

Footnote to go here

Page 13
Issues Identified
•

Multiple unnecessary communication (NVA)

•

Lack of processes/business rules regarding handover and ...
Solutions – Process change
•

3 x a day bed management round

Day/Month/Year

Footnote to go here

Page 15
Solutions - Communication
•

All NUM’s/ward areas have mobile phones for patient flow (Quick win)

•

Bed manager mobile a...
Solutions - Transparency
•

Responsibility and transparency around demand/capacity
•

NUM’s and Program Managers receive e...
TAKT time for each ward

27/2/2014

Page 18
Solutions - Pull
•

Pull rather than Push!
•

Once demand is transparent and priorities are set the NUM’s/team leaders can...
Solutions - Leadership
•

Patient flow manager, Bed manager, AHNM provide leadership and mentorship to
NUM’s and team lead...
Implementation
•

Communication strategy
•

Email, posters, presentations (committees), education (wards, managers)

•

DO...
Evaluation
•

Presentation of results to the wards after 6 months

Day/Month/Year

Footnote to go here

Page 22
Wards

Day/Month/Year

Footnote to go here

Page 23
Overall

Day/Month/Year

Footnote to go here

Page 24
Overall NEAT improvement

Day/Month/Year

Footnote to go here

Page 25
Keys to success
•

Executive engagement and commitment

•

Communication strategies

•

Engaging the right people

•

Good...
Where to from here?
•

Further evaluation with staff questionnaires

•

Improve escalation processes

•

Recent acute pati...
Questions

Day/Month/Year

Footnote to go here

Page 28
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Rodney Smith, St Vincent’s Hospital: Creating Team Based Models of Care at St Vincent’s Hospital Sydney

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Rodney Smith, Patient Flow Manager, St Vincent’s Hospital, Sydney delivered this presentation at the 2014 Hospital Bed Management & Patient Flow Conference, Australia's foremost patient flow improvement meeting, showcasing innovative case studies and pioneering best practice in the nation’s hospitals.

Over 150 hospitals and state and federal departments of health throughout Australia and New Zealand have attended this conference over the past years. For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/bedmanagement14

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Rodney Smith, St Vincent’s Hospital: Creating Team Based Models of Care at St Vincent’s Hospital Sydney

  1. 1. Whole of Hospital Approach to NEAT Team Based Hospital Plan 27 Feb 2014 Rodney Smith Patient Flow Manager
  2. 2. Purpose Who are we? Context – NEAT Bed management project Achievements Ongoing challenges Day/Month/Year Footnote to go here Page 2
  3. 3. Who are we? • A Catholic mission and values based organisation founded over 150 years ago by the Sister’s of Charity, now under the stewardship of Mary Aikenhead Ministries, funded by NSW Ministry of Health to provide health care services • 253 acute inpt beds, 41 pall care beds and 31 rehab beds. 27 mental health beds. Outpt clinics including heart and lung, hospital in the home, oncology, HIV/immunology and renal ambulatory care • 10 bed homeless health service and 10 bed and outpt drug and alcohol service Day/Month/Year Footnote to go here Page 3
  4. 4. Who are we? • Situated in the inner city suburb of Darlinghurst with a diverse mix of socio economic demographics • D&A • Mental health • Homelessness • Aged • Middle to upper socio-economic • Major trauma centre with quaternary services: Heart and lung transplant and bone marrow transplant services • 4 Programs – Acute, Heart/Lung, Geriatric/ambulatory medicine, Cancer and immunology and Mental health each with a Director (medical) and manager (nursing) Day/Month/Year Footnote to go here Page 4
  5. 5. Who are we? • Mission and Values • 150 yrs worth that provide a framework for what we do and what we want to achieve • Compassion, Justice, Integrity, Excellence • Ingrained into the culture • Used a driver and basis for change Day/Month/Year Footnote to go here Page 5
  6. 6. NEAT is here! • NSW MoH NEAT targets • 2013 – 71% • 2014 – 83% • 2015 – 90% If we improve our systems and processes we will improve patient care and the target will be met. The driver must be improving patient care and not the target Day/Month/Year Footnote to go here Page 6
  7. 7. Our Journey – the context • Stranded Sam – LOS>21 days • ePJB • RED project • NEAT ED model of care project • Lean Healthcare (2012) • Lean principles • Bed Management Project Day/Month/Year Footnote to go here Page 7
  8. 8. Bed Management Project • Recognition that in order for NEAT to be achieved we needed to change our bed management practices in parallel with other initiatives/projects • Until Nov 2012 the bed manager was fixed and took responsibility for placing pts Day/Month/Year Footnote to go here Page 8
  9. 9. Background “Where are we now study” study showed a significant delay in bed request/allocation/ready Median time 7:18 hrs Mean time 10:00 hrs Issues pertain to back of hospital, patient flow and bed management practices across the board Direct link between bed management and flow out of ED Day/Month/Year Footnote to go here Page 9
  10. 10. The Team Executive Sponsor – Director of Operations Project Lead/Manager – NM Patient Flow Project Team: - Bed Manager - NM Surgery and Renal - Surgical NUM - NM Nursing Workforce (rep AHNM) - NUM ED - PM - NUM Rehab Day/Month/Year Footnote to go here Page 10
  11. 11. Navigating Project Management 101 • Project charter – • Goal • Deliverables • Methodology • Interdependence • Governance • Scope • Start and finish • Team and sponsor • Evaluation • Communication • Risk log Day/Month/Year Footnote to go here Page 11
  12. 12. Diagnostics/Current state • VSM current state • • 250 issues Process map AHNM bed management • 86 issues • Data analysis – NEAT 47% • NEAT staff questionnaire Day/Month/Year Footnote to go here Page 12
  13. 13. Current state Day/Month/Year Footnote to go here Page 13
  14. 14. Issues Identified • Multiple unnecessary communication (NVA) • Lack of processes/business rules regarding handover and transfer of pts from ED • Confusion regarding escalation and response • Inability to contact people (phones not answered) • Inconsistency in bed allocation process in and out of hrs • Variable experience of team leaders and no clearly defined expectations • Lack of a sense of urgency and ownership (hospital wide) • Lack of visibility and knowledge of priorities (ED, Elective, Clinics) • Organisational structure/governance Day/Month/Year Footnote to go here Page 14
  15. 15. Solutions – Process change • 3 x a day bed management round Day/Month/Year Footnote to go here Page 15
  16. 16. Solutions - Communication • All NUM’s/ward areas have mobile phones for patient flow (Quick win) • Bed manager mobile and AHNM mobile diverted from the one land line so there is 24/7 access (Quick win) • Business rules for each access point (ED/Elective/3rd door) were created/updated and placed on a patient flow tab on the clinical web page – accessible to all • iPAD (Bed manager and AHNM) – EDIS, booked admissions, IHT list (Quick win) • Pull rather than push – ETA • New escalation process with roles and responsibilities • Bed meeting short and sharp – with clear structure, expectations and outcome Day/Month/Year Footnote to go here Page 16
  17. 17. Solutions - Transparency • Responsibility and transparency around demand/capacity • NUM’s and Program Managers receive elective admission list day before • Bed Manager has an iPAD with access to EDIS • ePJB and WD have the ED demand at the bottom of the ward screen in a different colour Day/Month/Year Footnote to go here Page 17
  18. 18. TAKT time for each ward 27/2/2014 Page 18
  19. 19. Solutions - Pull • Pull rather than Push! • Once demand is transparent and priorities are set the NUM’s/team leaders can pull patients into the ward beds when ready • Allocation occurs on EDIS and WebDelacy • Tracks time of allocation to transfer • Stops constant calls from ED – “is the bed ready yet?” chant! Helps eliminate horizontal violence Day/Month/Year Footnote to go here Page 19
  20. 20. Solutions - Leadership • Patient flow manager, Bed manager, AHNM provide leadership and mentorship to NUM’s and team leaders during rounds • Provide a sense of urgency and reasons for this ie: good patient care • Conversations around needs of patients and handovers • Set expectations of team leader and NUM roles in patient flow – know what questions to ask to plant the seed (can the pt. sit out to clear the bed) • Visibility and relationships • Creating the culture Day/Month/Year Footnote to go here Page 20
  21. 21. Implementation • Communication strategy • Email, posters, presentations (committees), education (wards, managers) • DO IT! • 2 weeks before the NEAT ED models of care started (Nov 2012) • Commitment – patient flow manager attends first round EVERY day Day/Month/Year Footnote to go here Page 21
  22. 22. Evaluation • Presentation of results to the wards after 6 months Day/Month/Year Footnote to go here Page 22
  23. 23. Wards Day/Month/Year Footnote to go here Page 23
  24. 24. Overall Day/Month/Year Footnote to go here Page 24
  25. 25. Overall NEAT improvement Day/Month/Year Footnote to go here Page 25
  26. 26. Keys to success • Executive engagement and commitment • Communication strategies • Engaging the right people • Good leadership from everyone • Staying within the scope and always going back to the charter objectives Day/Month/Year Footnote to go here Page 26
  27. 27. Where to from here? • Further evaluation with staff questionnaires • Improve escalation processes • Recent acute patient flow workshop to evaluate and continue the process • Maintain the momentum Day/Month/Year Footnote to go here Page 27
  28. 28. Questions Day/Month/Year Footnote to go here Page 28

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