Fiona Stanley Hospital

EMM Conference
25th March 2013
Di Mantell General Manager
Fiona Stanley Hospital
Presentation Outline
• Background to Fiona Stanley Hospital
• Engaging with non clinical executives...
Background - Project scope

• Project budget $2 billion, including $255.7 million of
Federal Government funding for State ...
Background - Project scope

2014/2015
(demand modelling data)
Emergency presentations

88,568

Outpatient attendances

440...
Background - Key services and facilities

• Full range of acute medical and surgical services
• State burns service
• Stat...
In the beginning...

Delivering a Healthy WA

Fiona Stanley Hospital Project

6
July 2009 – The cleared site
Delivering a Healthy WA

Fiona Stanley Hospital Project

7
January 2013 – the current progress
Delivering a Healthy WA

Fiona Stanley Hospital Project

8
Fiona Stanley Hospital
Map of the Site
Main Hospital
State
Rehabilitation
Service

Pathology

Decked Car
Park

Education

...
Background - Facilities Management (FM)

• The State has a Facilities Management Contract in place with Serco for the prov...
Fiona Stanley Hospital
Facilities Management (FM)
Hard Facilities Management

Soft Facilities Management

Technology and S...
Engaging with non clinical executives to drive major clinical change

So we had a Plan:
• We wanted an Electronic Medicati...
Engagement
• is a two-way process involving organizations working to engage employees and the latter
having a degree of ch...
Engagement for clinicians is well described

Erlandson and Ludeman (2003) argue that:
when administrators talk about physi...
Engagement for administrators is not [well described]!

Ottawa Hospital Canada & Hewitt Associates:
“A physician is consid...
Engaging with non-clinician executives to drive major clinical
change – or How do we get what we want?
• Despite clinician...
EMM – Engaging with stakeholders

• We knew many clinicians remained keen
– WA Therapeutic Advisory Group – were engaged
–...
EMM – Engaging with non-clinical executives to drive major change

Stakeholders each had a different focus:
• GM Finance –...
Building a Business Case

• there is a large amount of clinical research and emotion about what is wrong with the
traditio...
Building a business case

• A number of reports had been published citing recommendations with respect to
processes, proce...
Fake doctor steals drugs
by: Paul Lampathakis

From: The Sunday Times

May 05, 2012 4:38PM

http://www.perthnow.com.au/new...
Building a business case – Pushing those buttons
• Taking note of the specific focus of each of the executives how do you ...
Building a business case – Pushing those buttons

•
•

Summary of Quantifiable Financial Benefits
The following table sets...
Building a business case & – keep pushing [those buttons]

Corporate
– get accurate, quantifiable data that will measure s...
Sustaining Staff Buy in & Engagement throughout the process

Delivering a Healthy WA

Fiona Stanley Hospital Project

25
EMM – Sustaining momentum

• The FSH and NCH will provide WA hospitals with the confidence to begin
adopting systems.
• WA...
EMM – Sustaining momentum

• You have to believe in the vision
• You have to be prepared to fight for what you believe in
...
Remember Why YOU did it

Because someone has to believe
Someone has to break the mould
Someone has got to set the new stan...
Disbelief in magic can force a poor soul into believing
in government and business.
Tom Robbins

Thank you – questions?

D...
Delivering a Healthy WA

Fiona Stanley Hospital Project

30
Upcoming SlideShare
Loading in …5
×

Di Mantell, Fiona Stanley Hospital Project: Managing The Challenges Of Change: Promoting Electronic Medication Management Systems And Sustaining Staff Buy In Throughout

1,857 views

Published on

Di Mantell, A/Director Facilities Management, Fiona Stanley Hospital Project, WA delivered this presentation at the 2013 Electronic Medication Management conference. It is Australia’s only conference to look solely at electronic prescribing and electronic medication management systems. For more information on the annual event, please visit the conference website: http://www.healthcareconferences.com.au/emedmanagement

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

No Downloads
Views
Total views
1,857
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
37
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Di Mantell, Fiona Stanley Hospital Project: Managing The Challenges Of Change: Promoting Electronic Medication Management Systems And Sustaining Staff Buy In Throughout

  1. 1. Fiona Stanley Hospital EMM Conference 25th March 2013 Di Mantell General Manager
  2. 2. Fiona Stanley Hospital Presentation Outline • Background to Fiona Stanley Hospital • Engaging with non clinical executives to drive major clinical change • The challenges in building a business case with little quantifiable data • Sustaining staff buy in and engagement throughout the project. • Questions? Delivering a Healthy WA Fiona Stanley Hospital Project 2
  3. 3. Background - Project scope • Project budget $2 billion, including $255.7 million of Federal Government funding for State rehabilitation service • 783 beds, including 140-bed State rehabilitation service • 83% single patient rooms in main hospital • 6,300 rooms in the main hospital • 16 wards (24 beds each) • 29 imaging rooms • 16 theatres plus two shelled • 135,000m2 gross area (excluding car parks) • 15 kms from Perth CBD – easy to access • Practical completion 23 December 2013 Delivering a Healthy WA Fiona Stanley Hospital Project 3
  4. 4. Background - Project scope 2014/2015 (demand modelling data) Emergency presentations 88,568 Outpatient attendances 440,264 Inpatient separations 55,236 Staff FTE Beds 2,800 clinical 1,100 non-clinical 783 (643 + 140 tertiary rehabilitation) Operational Commencement in April 2014 85% of activity for FSH will come via the Emergency Department Delivering a Healthy WA Fiona Stanley Hospital Project 4
  5. 5. Background - Key services and facilities • Full range of acute medical and surgical services • State burns service • State rehabilitation service • State-of-the-art emergency department • Comprehensive cancer services • Renal transplantation and dialysis services • Mental health facility with mother and baby unit • Obstetrics, neonatology and paediatric services • Onsite pathology facility and diagnostic support services • Western Australian Institute for Medical Research Delivering a Healthy WA Fiona Stanley Hospital Project 5
  6. 6. In the beginning... Delivering a Healthy WA Fiona Stanley Hospital Project 6
  7. 7. July 2009 – The cleared site Delivering a Healthy WA Fiona Stanley Hospital Project 7
  8. 8. January 2013 – the current progress Delivering a Healthy WA Fiona Stanley Hospital Project 8
  9. 9. Fiona Stanley Hospital Map of the Site Main Hospital State Rehabilitation Service Pathology Decked Car Park Education Mental Health Decked Car Park Delivering a Healthy WA Fiona Stanley Hospital Project 9
  10. 10. Background - Facilities Management (FM) • The State has a Facilities Management Contract in place with Serco for the provision of facilities management and for all non clinical services for Fiona Stanley Hospital This contract was awarded to Serco in July 2011 • Serco is responsible for the delivery of 28 integrated non-clinical services which each have a service specification and key performance indicators. • Serco undertake all procurement for FSH [$441m] • Serco provide ICT infrastructure which links to WA Health Information Network [ICT] Delivering a Healthy WA Fiona Stanley Hospital Project 10
  11. 11. Fiona Stanley Hospital Facilities Management (FM) Hard Facilities Management Soft Facilities Management Technology and Support Services Management & Integration* ICT Services Estates** Energy & Utilities Cleaning Patient Catering Electronic Records Management Health Records Management & Clinical Coding Grounds Maintenance Pest Control Internal Logistics Linen* Scheduling & Billing Audio Visual Services Help Desk & Communications Safety & Incident Management Patient Entertainment System Human Resource Management – Clinical Staff Waste Management Vehicle & Traffic Management* Pre-Operations – includes FFE procurement Transitional Property Management External Patient Transport Sterilisation Supplies Management Reception Managed Equipment Service For Development Child Care Delivering a Healthy WA Fleet Management *Part of the services scope (distribution & car parking) ** Includes traditional Building Management services Fiona Stanley Hospital Project 11
  12. 12. Engaging with non clinical executives to drive major clinical change So we had a Plan: • We wanted an Electronic Medication Management [EMM] system • An EMM that would provide – enhanced patient safety – efficient business processes – improved governance • And if we also achieved – a paper-less environment – HMSS level 7 – data capture for future ABF – All of that – that would be awesome!!!! Delivering a Healthy WA Fiona Stanley Hospital Project 12
  13. 13. Engagement • is a two-way process involving organizations working to engage employees and the latter having a degree of choice as to their response • is measurable, with some variability in the evidence gained by different measurement tools • correlates with performance and innovation. MacLeod and Clarke [2009] Delivering a Healthy WA Fiona Stanley Hospital Project 13
  14. 14. Engagement for clinicians is well described Erlandson and Ludeman (2003) argue that: when administrators talk about physician engagement, they are generally speaking in code for what they would like physicians to do but cannot get them to do; but when physicians speak about engagement, they are speaking in code for what they already give that is not appreciated, valued or supported by the administration. Ref: Medical engagement Too important to be left to chance John Clark [2012] Delivering a Healthy WA Fiona Stanley Hospital Project 14
  15. 15. Engagement for administrators is not [well described]! Ottawa Hospital Canada & Hewitt Associates: “A physician is considered to be engaged when they display all three of the following engagement behaviours: • consistently SAY positive things about the organisation as a place to practice • intend to STAY and continue practice at the organisation • STRIVE to achieve above and beyond what is expected in their daily role It was acknowledged that engagement takes time, and that disengagement has the potential to be sudden and precipitous. NHS Institute and the Academy (2011) Delivering a Healthy WA Fiona Stanley Hospital Project 15
  16. 16. Engaging with non-clinician executives to drive major clinical change – or How do we get what we want? • Despite clinicians having been “cut off at the precipice” a number of times and many years of talking and planned business cases at WA public hospitals. • The Executive Team need to be convinced [by the FSH Project Team] of clinician engagement and consultation in the EMM proposal. • So what did the clinicians want: – Nursing and pharmacy sought automated dispensing cabinets – Intensivists sought a Clinical Information System – Parts of the oncology community wanted software but had not been able to organise themselves – Pharmacists didn‘t believe robotics would be funded and so it wasn't seriously considered – Computerised medicine carts were not considered at all – FSH needed a paperless solution to integrate into the Electronic Health Record Delivering a Healthy WA Fiona Stanley Hospital Project 16
  17. 17. EMM – Engaging with stakeholders • We knew many clinicians remained keen – WA Therapeutic Advisory Group – were engaged – Many clinical forums were established for ICCIS, Oncology – Chief Pharmacists’ Forum – were very interested – Department of Health – Pharmaceutical Services Branch – had a watching brief • Health Information Network [ICT] – may be interested if it didn't’ distract from their already enormous workload to “stand up” FSH – this was not their priority • SMHS Executive – needed to be convinced • New Children’s Hospital EMM Project Team were keen to leverage off FSH work Delivering a Healthy WA Fiona Stanley Hospital Project 17
  18. 18. EMM – Engaging with non-clinical executives to drive major change Stakeholders each had a different focus: • GM Finance – quantifiable savings / ABF data / ROI / funding source • GM Safety, Quality and Performance – decreased medication errors, S&Q focus • GM Corporate Operations – budget containment and stock management • Area Director of Nursing and Midwifery – ease of staff to adapt to a new system • Area Director of Clinical Services – time taken to train doctors • Executive Director Strategy and Corporate HIN – systems integration and impact other clinical systems. on • Clinicians – when can we have it? Delivering a Healthy WA Fiona Stanley Hospital Project 18
  19. 19. Building a Business Case • there is a large amount of clinical research and emotion about what is wrong with the traditional medication system • there is less information that is accurate/ auditable, quantifiable and defensible • our proposal was to articulate a Medication Management model that could be applied across a number of sites & understood by non clinicians – as we were to solve all things for all people • the dilemma of being a brand new site is the potential to leverage innovation at FSH for other sites – the disadvantage is, if it doesn’t work for everyone then no one may get anything • the business case was to include: – pharmacy automation – software o Specialised – ICU & Oncology o Generalised – Electronic Prescribing & Medicines Administration (EPMA) o System Integration o Return on Investment report – with harvestable and non-harvestable benefits Delivering a Healthy WA Fiona Stanley Hospital Project 19
  20. 20. Building a business case • A number of reports had been published citing recommendations with respect to processes, procedures, governance and technology. – Deloitte. Robotic Dispensing Automation in Pharmacy; Sydney, 2010 – Australian Commission on Safety and Quality in Health Care. Electronic Medication Management Systems — A Guide to Safe Implementation, 2nd edition, ACSQHC, Sydney, 2012 – CCC Misconduct Procedures in WA Public Sector Health – OAG Report July 2012 – Review of Controls over pharmaceuticals 2012 Delivering a Healthy WA Fiona Stanley Hospital Project 20
  21. 21. Fake doctor steals drugs by: Paul Lampathakis From: The Sunday Times May 05, 2012 4:38PM http://www.perthnow.com.au/news/fake-doctor-steals-drugs/story-e6frg12c-1226347618575 Delivering a Healthy WA Fiona Stanley Hospital Project 21
  22. 22. Building a business case – Pushing those buttons • Taking note of the specific focus of each of the executives how do you push that button? • You utilize all of the information that has been amassed & you focus it – not waffle; but make it poignant • Financial – get accurate, quantifiable data – demonstrate harvestable benefits – demonstrate how this data can be applied to Activity Based Funding modelling – be honest if some benefits are not harvestable – demonstrate a pathway for implementation that can be linked to a funding source – is this a one off payment or a journey piece? – invest in expertise in developing the ROI to make your case defensible – a degree of independence will assist your case Safety, Quality and Performance – get quantifiable solutions that will reconcile findings from all of the previous reviews – demonstrate the systems audit capability – articulate how medications will now be delivered in a closed loop system Delivering a Healthy WA Fiona Stanley Hospital Project 22
  23. 23. Building a business case – Pushing those buttons • • Summary of Quantifiable Financial Benefits The following table sets out the quantifiable financial benefits over the 10 year assessment period. Each benefit is identified either as ‘harvestable’ (i.e. that is deliver cash savings) or ‘non-harvestable’, where the realised financial benefit is reinvested to deliver further non-financial benefit (e.g. medical and nursing time savings, which are not expected to result in real reductions in such staff, however will enable greater staff focus on safety and quality). R ef Be nefit 1 Reduction in adm itted patient costs as a result of a reduction in adverse drug events. Reduction in costs associated with re-admissions as a result of improved medication reconc iliations on discharge. Reduction in holding costs of stock on hand due to dispensary efficiencies. Reduction in w ard drug costs due to improved tracking and contr ol of drugs. Reduction in medical practitioner time associated w ith manual medication processes. Reduction in nurs ing time associated w ith manual medication processes. Reduction in pharmacist s taffing costs as a result of efficiencies in drug dispensing. Reduction in pharmacy tec hnician and pharmacy assistant staffing costs as a res ult of efficiencies in drug dispensing. Increased PBS revenue due to improved claim ing of PBS scripts. 2 3 4 5 6 7 8 9 Delivering a Healthy WA Ha rves ta ble (Yes / No ) Yes Yes Yes Yes No No Yes 1 Yes 1 Yes Fiona Stanley Hospital Project 23
  24. 24. Building a business case & – keep pushing [those buttons] Corporate – get accurate, quantifiable data that will measure stock levels – Increased security system for medication management & legible records – Governance process to address corporate obligations identified in a number of reviews Area Clinical Leads [Nursing, Medical and Allied Health] – standardized approach to medication administration – “foolproof” tracking of medications administered • enhanced patient safety Chief Executive – get quantifiable solutions that will reconcile findings from all of the previous reviews – demonstrate how investing in this system will save patient’s lives – how will this provide my executives the data they need to do their job Delivering a Healthy WA Fiona Stanley Hospital Project 24
  25. 25. Sustaining Staff Buy in & Engagement throughout the process Delivering a Healthy WA Fiona Stanley Hospital Project 25
  26. 26. EMM – Sustaining momentum • The FSH and NCH will provide WA hospitals with the confidence to begin adopting systems. • WA experience will collectively grow: – HIN – understand the systems & integration layer – Clinical staff – skilled & competent – Governance groups – delivery of safe patient care – Cost effective patient care – Accurate costings per episode of care • EMM solutions and CLMM will be the norm not the exception Delivering a Healthy WA Fiona Stanley Hospital Project 26
  27. 27. EMM – Sustaining momentum • You have to believe in the vision • You have to be prepared to fight for what you believe in • The timeframes will be crazy • If you can’t explain it to people– then you might as well be talking in tongue OMG & ROFL • You should utilise everything at your disposal – clinicians who want it – FM who can procure it – someone who is prepared to keep pushing the message Delivering a Healthy WA Fiona Stanley Hospital Project 27
  28. 28. Remember Why YOU did it Because someone has to believe Someone has to break the mould Someone has got to set the new standard for WA Health Because patients deserve it Delivering a Healthy WA Fiona Stanley Hospital Project 28
  29. 29. Disbelief in magic can force a poor soul into believing in government and business. Tom Robbins Thank you – questions? Delivering a Healthy WA Fiona Stanley Hospital Project 29
  30. 30. Delivering a Healthy WA Fiona Stanley Hospital Project 30

×