A story of change at Eastern Health, Victoria delivered as part of the NHS Transformathon 2016.

1. Angliss Box Hill Healesville & Maroondah Peter James Wantirna Yarra Ranges Yarra Valley Turning Spectrum
Hospital Hospital District Hospital Hospital Centre Health Health Community Health Point
A story of change in General
Medicine
Eastern Health, Victoria, Australia

3. Our Role & Our Organisation
Eastern Health provides a comprehensive range of high quality:
– acute
– sub-acute
– palliative care
– mental health, drug & alcohol
– state-wide specialist services
– residential care
– community health services
to people and communities that are diverse in culture, age, socio-
economic status, population and healthcare needs.

4. Eastern Health...we are many but we are one !
• 7 acute and sub-acute hospitals
– 3 Emergency Departments
• 2 area mental health services
– multiple community sites and services
– 2 prevention & recovery centres and 2 community care units
– 5 acute inpatient units
• 2 statewide services
– Turning Point and Spectrum - both with bed based services
• 4 residential care facilities
– specialist and general residential care
• 1 community health service
– multiple community accessible outlets

5. Quick Facts on Eastern Health
Last year...in 2014/15, we provided care...
• across six shires spanning 2816 square kilometres
• in a primary population catchment of 750 003 people
• from 65 sites across 21 different locations
• of which 11 of the 21 locations provide 24 hour care
• with the support of 8683 staff and 921 volunteers
• for patients of whom 22% are from a NESB
• in 1358 health service beds and 54 acute@home beds
• at a salary cost of $1164.59 per minute
• at a non-salary cost of $396.10 per minute

6. Quick Facts on Eastern Health
Last year...in 2014/15, we provided care...
• in 1 173 359 patient episodes
• Acute Health
• Ambulatory Care
• Mental Health
• Specialist Clinics
• Sub Acute Health (Acute Aged, Rehabilitation & Palliative
Care)
• for 151 664 people who presented to our EDs
• to 38 654 people who arrived at our EDs by ambulance
• with a daily average of > 850 ambulatory contacts

7. Jane Evans, Director, Organisational Redesign and
Performance Excellence
Evan Newnham, Acting Director, General Medicine,
Gastroenterologist
Philippa Blencowe, Director of Nursing, Midwifery and
Operations, Associate Program Director of Emergency
and General Medicine, Box Hill Hospital, Eastern Health
Jude Boyd, Associate Director, Allied Health,
Occupational Therapy
Dan Fleming, Nurse Unit Manager, Ward 6.1
Maria Vissariou, Nurse Unit Manager, Ward 6.2

8. Finding our why

10. Variation is the enemy of quality*
Length of Stay
*Attributed to Edward Deming (1980) in: Chang W. Kang, Paul H. Kvam (2012) Basic Statistical Tools for
Improving Quality

11. And…
• General Medicine units - 2-3 ward rounds per week
• No cap on Gen Med numbers leading to dangerous
workload levels for junior and senior staff (30+ patients
per registrar)
• Poor weekend discharges
• Variation in daily assessment and care planning in
general medical wards across 3 sites in both process
and documentation
• Delays in referrals made to sub-acute and ambulatory
/community services to support complex discharge
planning

12. What did we do
• Rapid improvement event
– Facilitated meeting of all involved parties over 2
days
– 4 competing models developed and adjudicated
– Composite model agreed by all participants
– Enabled ‘buy-in’ by all involved and empowered
the implementation of changes.
• Standard model implemented across all sites on the
same day (17th
June 2013)

13. Key Changes Implemented
• Ward-based multidisciplinary teams
• Agreed standard daily work (7 days per week)
– Consultant-led handover
– Daily multidisciplinary team ‘huddle’ around the Patient Journey
Board
– Defined Consultant led ward rounds for every patient, every day
– Daily multidisciplinary team meeting to document care plan for
every patient, every day
• New Initial Patient Assessment Form
• New daily care plan form
• Easy transfer from ED to ward
• All changes made were cost neutral with no compromise to teaching
and training

15. Allied health response
• The changes in general medicine forced additional
reform in allied health.
• Physio, OT, SW reorganised existing rosters to provide
weekend service
• Pharmacy extended service to Sundays
• ASERT (Ambulatory Subacute Early Response Team)
created to provide streamlined point of contact and,
evaluation and acceptance of patients into all
subacute, rehab and community services.

16. The result

17. Average Length of Stay
2012/13 2014/15 Saving
Box Hill 7.29 6.47 0.82
Maroon
dah
6.35 4.75 1.6
Angliss 4.16 4.2 -0.04
EH 6.12 5.32 0.8

18. Bed days
2012/13 2014/15 Saving
(beds)
Box Hill 25027 22755 6
Maroon
dah
30023 24344 16
Angliss 10758 12104 -4
EH 65772 61308 18

19. Separations
2012/13 2014/15 Differen
ce
Box Hill 3433 3517 84
Maroond
ah
4728 5125 397
Angliss 2586 2882 296
EH 10747 11524 777

20. Relative Stay Index
2012/13 2013/14 2014/15
Box Hill 119 88 94
Maroon
dah
113 89 85
Angliss 86 81 86

21. Mortality (per 100 separations)
19% improvement

22. Quality of care

23. Readmission rate

24. The changes made to the General Medical Model of care in 2013 have
overall improved the quality of care for our patients.

25. The changes made to the General Medical Model of Care in 2013 have
overall improved the communication between team members (medical,
nursing, allied health) in general medicine.

26. Other Benefits- patients
• Patient Experience Improvements:
– Communication
– Discharge planning (patient centred)
• Continuity of Care (7days)- greater senior
staff presence
• Improved patient flow as discharges
spread across all 7 days

27. Other Benefits- staff
• Junior staff empowerment
• Enhanced education
– meetings structured around model timings
• Optimised training and mentoring
opportunities
• Teamwork
– Ease of escalation
– Predictability and Efficiency

28. 28th
January 2016

29. Average Length of Stay
2012/13 2014/15 Saving
Box Hill 7.29 6.47 0.82
Maroon
dah
6.35 4.75 1.6
Angliss 4.16 4.2 -0.04
EH 6.12 5.32 0.8

30. 2015 at Box Hill
• Moved to new hospital Oct 2014
• Larger floor foot print
• Increase in presentations ED
• LOS static compared to other sites
• RE focus

31. What are we doing?
• Review processes
• Ensure process in place for disposition
• Provide local leadership to re-focus and
engagement of staff a PRIORITY
• Review data
• Follow

32. What is working
• Its all about the leadership
• Daily engagement of all staff
• Visibility of leadership and data
• Use improvement methodology
• Created interest in the improvement work
from other specialties

34. Jane Evans, jane.evans@easternhealth.org.au
Evan Newnham, evan.newnham@easternhealth.org.au
Philippa Blencowe,
philippa.blencowe@easternhealth.org.au
Jude Boyd, jude.boyd@easternhealth.org.au
Dan Fleming, daniel.fleming@easternhealth.org.au
Maria Vissariou, maria.vissariou@easternhealth.org.au