Patient Flow Collaborative

Department of Human Services

Patient Flow Collaborative

Process Templating

Rowena CliftMick KirbyBallarat Health Services

Objectives Breakout Session Objectives Breakout Session

• Introduce use of process templates in system redesign

• Review of NHS applications• Present a case study of our experience

BackgroundBackground

• Presentation by Helen Bevan NHS Modernization Agency

• Use of Process Templating in 10 High Impact Changes

Time to look from a new Time to look from a new perspective - Day Oncologyperspective - Day Oncology

Day Oncology (Background)Day Oncology (Background)

• Day oncology request for more EFT– Clerical staff

• Rationale:– Increased workload– No data supplied to support this– Observation of the unit

• Appeared busy• Disorganised

• We went in search of data to support claim

Day Oncology AttendancesDay Oncology Attendances

0

50

100

150

200

250

Day Oncology Attendances2004_05

2003_04

2002_03

2004_05 114 154 150

2003_04 214 185 159 157 128 171 167 156 146 140 141 144

2002_03 210 180 212 244 198 200 229 184 178 188 232 177

July AugustSeptemb

erOctober

November

December

January February March April May June

Day OncologyDay Oncology

• Workload had in fact decreased• Background

– Resignation of oncologists– Decreased throughput– Attendances had not reached previous numbers

• Why did they believe they were busier?• Why did observation suggest they were

busier?

Day OncologyDay Oncology

• Met with staff from oncology• Attempted to identify core business• Establish areas that were impinging on

their ability to deliver core business• Template a typical day for oncology

Day Oncology Process TemplateDay Oncology Process Template

8 181312 1611 1710 15149TIMELINE

Patient treatment time

Staff Shift hours

Oncology clinics

Home Visits

Oncology clinic: staff called on forvarious tasks - educ, appt, path, prep

histories, chaperone.No nursing staff allocated to this clinic.

AM staffmember arrives0800 hrs prepshistories, path,stats, phones,

primes IVs, drugchecks

Where possiblethe 0800 staff visithome pts on wayto work. On dayof observationstaff arrived at

1000 hrs

Home visits attendedduring quieter period

After patients left:time utilised on

histories for nextday, path, stats

ONCOLOGY PROCESS TEMPLATE

Process TemplateProcess Template

• What can you identify from this template that may be impacting on the staff workload?

• What further information would you require?

• 5 minute group discussion.

8 181312 1611 1710 15149TIMELINE

Patient treatment time

Staff Shift hours

Oncology clinics

Home Visits

Oncology clinic: staff called on forvarious tasks - educ, appt, path, prep

histories, chaperone.No nursing staff allocated to this clinic.

AM staffmember arrives0800 hrs prepshistories, path,stats, phones,

primes IVs, drugchecks

Where possiblethe 0800 staff visithome pts on wayto work. On dayof observationstaff arrived at

1000 hrs

Home visits attendedduring quieter period

After patients left:time utilised on

histories for nextday, path, stats

ONCOLOGY PROCESS TEMPLATE

What did we learn?What did we learn?

• What did template reveal– Scheduling practices– New department location

• Co located OPD

• Same Work Practices

• Further questions revealed– Increased OPD clinic numbers– New Oncologists

• New practices– Home Oncology Service– Drop Ins!!– Lack of education and quality activities

Day Oncology Process Day Oncology Process TemplateTemplate

• Previous template followed the department structure.– Identified core business– Identified non core activity

• Repeated template– Asked staff to document what they did over

typical shift– Put this into a template

ONCOLOGY PROCESS TEMPLATE

Staff Process TemplateStaff Process Template

DAY ONCOLOGY WARD STAFF WORKLOAD ANALYSIS

PT CARE TIME52%

OPD Activity8%

WARD CLERK DUTIES26%

WARD ASSISTANT DUTIES2%

OHC PROGRAM9%

PREPARATION BY NURSE3%

PT CARE TIME

OPD Activity

WARD CLERK DUTIES

WARD ASSISTANT DUTIES

OHC PROGRAM

PREPARATION BY NURSE

• What does this template show us?

Staff Process TemplateStaff Process Template

DAY ONCOLOGY WARD STAFF WORKLOAD ANALYSIS

PT CARE TIME52%

OPD Activity8%

WARD CLERK DUTIES26%

WARD ASSISTANT DUTIES2%

OHC PROGRAM9%

PREPARATION BY NURSE3%

PT CARE TIME

OPD Activity

WARD CLERK DUTIES

WARD ASSISTANT DUTIES

OHC PROGRAM

PREPARATION BY NURSE

ResultsResults

• Core business only 50% of staff time

• Impact of non nursing clerical duties

• Impact of OPD– No extra resources– Increased clinics 5 per

week from 2– 80% inc. in attendances

DAY ONCOLOGY WARD STAFF WORKLOAD ANALYSIS

PT CARE TIME52%

OPD Activity8%

WARD CLERK DUTIES26%

WARD ASSISTANT DUTIES2%

OHC PROGRAM9%

PREPARATION BY NURSE3%

PT CARE TIME

OPD Activity

WARD CLERK DUTIES

WARD ASSISTANT DUTIES

OHC PROGRAM

PREPARATION BY NURSE

Outpatient Activity DataOutpatient Activity Data

0

20

40

60

80

100

120

Oncology OPD no Radiation2004_05

2003_04

2002_03

2004_05 87 114 107

2003_04 75 63 56 89 81 77 70 76 98 83 103 92

2002_03 48 72 51 55 59 42 56 79 73 61 100 71

July AugustSeptem

berOctober

November

December

January February March April May June

What will we do?What will we do?

• Clerical staff request approved– Just appointed

• Opportunities now for further practice changes.– Scheduling– Staff profile

Process TemplateProcess Template

8 181312 1611 1710 15149TIMELINE

Team LeaderOncology clinics

Home Visits

Oncology clinic:Where possiblethe 0800 staff visithome pts on wayto work. On dayof observationstaff arrived at

1000 hrs

Home visits attendedduring quieter period

ONCOLOGY PROCESS TEMPLATE

Ward clerk

Clinical Staff 1

Clinical Staff 2

SchedulingScheduling

• Same patient mix• Applied

appointments and templated

• Spread workload over shift

• Staff ratio applied

8 181312 1611 1710 15149TIMELINE

Team LeaderOncology clinics

Home Visits

Oncology clinic:Where possiblethe 0800 staff visithome pts on wayto work. On dayof observationstaff arrived at

1000 hrs

Home visits attendedduring quieter period

ONCOLOGY PROCESS TEMPLATE

Ward clerk

Clinical Staff 1

Clinical Staff 2

StaffingStaffing

• Created Team Leader role– Triage Drop In patients– Deal with OPD requests– Provide support to clinical

staff• Inc workload• Breaks• Education• Quality avtivities

8 181312 1611 1710 15149TIMELINE

Team LeaderOncology clinics

Home Visits

Oncology clinic:Where possiblethe 0800 staff visithome pts on wayto work. On dayof observationstaff arrived at

1000 hrs

Home visits attendedduring quieter period

ONCOLOGY PROCESS TEMPLATE

Ward clerk

Clinical Staff 1

Clinical Staff 2

StaffingStaffing

• Ward Clerk– Employed during OPD

times– Relieved clerical

activities from nursing staff

8 181312 1611 1710 15149TIMELINE

Team LeaderOncology clinics

Home Visits

Oncology clinic:Where possiblethe 0800 staff visithome pts on wayto work. On dayof observationstaff arrived at

1000 hrs

Home visits attendedduring quieter period

ONCOLOGY PROCESS TEMPLATE

Ward clerk

Clinical Staff 1

Clinical Staff 2

Process SummaryProcess Summary

• Received request• Asked for evidence

– Need evidence to support claim• Included staff and observed practice

– Staff buy in imperative– Asked staff to identify issues

• Process Templated– Allowed clearer view of issues– Identified issues not evident earlier on– Only a part of the process

• Identified issues• Met with staff• Made recommendations• Starting to implement recommendations

Questions

?