Patient Flow Collaborative Learning Session 3

Department of Human Services

Patient Flow Collaborative Learning Session 3

WHOLE SYSTEM ACCESS

Bellarine Room 4

Marcus Kennedy and Prue Beams

Department of Human Services

A whole system approach to acute care management

Breakout session 4Bellarine Room 4

9.40 – 10.35

Siva Sivarajah Executive Director – Rosebud Hospital, RAPCS, & Allied HealthExecutive Sponsor – Peninsula Health PFC, Peninsula Health

9th February, 2005

PresentationPresentation

A WHOLE SYSTEM APPROACH TO PATIENT FLOW MANAGEMENT

AimsAims

• How we got started

• Challenges to date and in the future

• Key strategies

• Early achievements & activities to date

• Lessons learned

• Next steps

How we got startedHow we got startedThe first six monthsThe first six months

• Key stakeholders chosen from the quality area

• Multiple collaboratives underway at same time

• Facilitator could not provide a focussed effort due to workload commitments

• Minimal communication about the PFC

• Brainstorming sessions across Peninsula Health

• Small project focussed

How we got startedHow we got startedThe second six monthsThe second six months

• Change in key stakeholders

• Executive Sponsor Vision – Major Change Initiative

• A facilitator that could provide a focussed effort

• Increased co-ordination & communication

• Regular meetings with new PFC Executive Team

• Multiple project teams built

• Gained increased PH Executive support

How we got started - How we got started - The first six monthsThe first six months

Who was involved?

−Peninsula Health wide brainstorming• Patients• Frontline staff • Departmental Managers

Reactions?

– Have done it before– Good, let’s get this right

How we got started - How we got started - The second six monthsThe second six months

• Collation of Brainstorming results into Priority Areas

• Identifying Priority Area Leaders

• Refining Priority Areas

• Re-aligning Priority Area Leaders to Priority Areas

• Turning major trends into projects

• Linking into work already done for quick wins

• Submerge PFC into Day to Day Business

Peninsula Health Peninsula Health PFC Executive TeamPFC Executive Team

Executive Sponsor - Siva Sivarajah

Facilitator - Eddie Dunn

Priority Area Leader’s (PALs)

• Priority Area 1 - Dr Susan Sdrinis & Shamala Jones

• Priority Area 2 - Jane Poxon & Robert Barker

• Priority Area 3 - Di Jamieson & Kate MacRae

• Priority Area 4 - Jan Child & Lyn Jamieson

Priority AreasPriority Areas

• Optimise patient flow from the Emergency Department

• Eliminate delays for patients awaiting surgery

• Optimise bed utilisation across all sites

• Facilitate consistent systems and processes across Peninsula Health

Whole System ApproachWhole System Approach

Peninsula Health

Services

FrankstonAcute

Rosebud,RAPCS & Allied Health

Psychiatry Community

Optimise patient flow from the Emergency Department

Eliminate delays for patients awaiting surgery

Optimise bed utilisationacross all sites

Facilitate consistent systems andProcesses across Peninsula Health

Whole System ApproachWhole System Approach

Priority Areas Priority

Area 1Priority Area 2

Priority Area 3

Priority Area 4

PA1 - Projects

PA2 - Projects

PA3 - Projects

PA4 - Projects

Guiding StatementGuiding Statement

“A delay in the discharge of

one patient means a delayed admission for another.”

Guiding PrinciplesGuiding Principles

• Patient focussed

• Improved patient outcomes

• Right patient, place, resource, time and clinician

• Prompt access

• Optimal flow

• Enhance professional networks and relationships

• Efficiency

Key Strategies – Key Strategies – Co-ordinationCo-ordination

• Have a vision

• Build an Executive Team from multiple disciplines

• Agree on a direction and Priority Areas

• Meet regularly and empower PALs

• Encourage accountability through regular reporting

Challenges – Challenges – Co-ordinationCo-ordination

• Needed to bring all PFC info to date together

• Needed to provide up to date information

• Needed to develop consistent tools for all to use

• Needed to “Pinch with Pride” and share

Key Strategies – Key Strategies – Co-ordinationCo-ordination

• Have a central point for all information and make available all information from all projects

• Disseminate information

• Format tools that could be used across multiple projects

• Communicate, communicate, communicate

Challenges -Challenges -CommunicationCommunication

• Needed a co-ordinated approach

• Needed to use the same language

• Needed a signature / design

• Needed to be simple, understandable & effective

• Needed to be targeted

• Needed to be planned

Key Strategies -Key Strategies -CommunicationCommunication

• Develop a Public Folder for all PFC Teams/participants

• Executive Sponsor – “Paving the way for success”

• Standing Item on Operational Executives meeting

• Fortnightly PAL meetings

• Engaged Peninsula Health’s Public Relations Unit

• Quarterly four page newsletter and monthly update

Next steps -Next steps -CommunicationCommunication

• Develop a PFC Intranet site with a “Score Chart”

• Update Internet site

• Road show

• Maintain the central point of documented evidence

• Orientation programme presentation

CommunicationCommunication

“This is bureaucratic gobbledegook to clinicians. I have NO IDEA what a patient flow collaborative is, something to do with Urology perhaps?”

(Peninsula Health Medical Officer December 2004)

Early AchievementsEarly Achievements

• Focus on quick wins

• Identified established work that could link with PFC

• Targeted projects from Brainstorming Analysis

• High Level Executive Support

• Team approach

Activities to dateActivities to date

• ED / Radiology

• Emergency Streaming

• Direct RAPCS admissions from ED

• Allied Health Pre-discharge Home Visits

• Patient Transfers and Transport

Activities to dateActivities to date

• LOS and Early Discharge

• Volunteers

• Incident Management

• Theatre Utilisation Project

Future ActivitiesFuture Activities

• Communication and referral processes between ED and Inpatient Units

• Orthopaedic Streaming

• Neuro Streaming

• Weekend Discharges

Future ActivitiesFuture Activities

• Multiple patient assessments

• High Risk follow up

• Transfer of Medical Records across sites

• Ward Clerk and PSA roles

Future ChallengesFuture Challenges

• Gaining participation of medical officers

• How to involve more frontline staff in the process

• Keeping staff motivated

• Managing the growth of activity

Critical to SuccessCritical to Success

• High level management support• Clinicians fully engaged• Clinical Leadership• Team work• Communication & mass involvement of staff and

healthcare partner organisations• Improvements must involve structures, processes &

patterns

Questions

?

Morning TeaMorning Tea

Meet us back here for

Workforce strategy developmentWorkforce strategy development

at 10.50

Department of Human Services

Workforce strategy developmentWorkforce strategy developmentRight People, Right SkillsDHS workforce design strategy

Breakout session 4 Bellarine Room 4

10.50 – 11.45

Jennifer ColbertWorkforce Strategy and Regulation, DHS

9th February, 2005

Department of Human Services

Right People, Right SkillsDHS workforce design strategy

Jennifer ColbertService & Workforce Planning

Human services workforce Key challenges

• Factors impacting workforce supply–Changing workforce demographics–Changing working patterns & mobility–Shrinking pool of workforce entrants–Increasing specialisation & entrenched professional ‘silos’ lead to fragmentation of care

• Factors influencing workforce demand–Increasing service demand–Changing technology and evolving models of care–Increasing client complexity

Human services workforce Enablers for change

• Getting national/state/local approaches & outcomes

• Engaging with the VET, tertiary & post tertiary education sectors

• Overcoming professional/industrial legacies• Adjusting workforce expectations• Acceptance of learning from overseas• Getting investment in workforce development• Willingness to embrace change

National workforcestrategic framework

• Established to guide national investment in health workforce• Allows better identification of workforce priorities

that would benefit from national approaches• Provides capacity to promote collaboration

between jurisdictions and reduce duplication

• Work plan for 2004-05 includes:• Nationally consistent medical registration project• AMWAC Studies in surgical specialties• Alternative workforce planning approaches• Improving workforce data

Developing a Victorian action plan

• Key areas to be progressed include:• Increase workforce supply• Improve workforce distribution• Improve workforce data & analysis• Explore opportunities for role redesign

• Combination of short, medium and long term strategies required

Health workforce:Strategies & solutions

Attract locally trained international students

Supplement existing overseas recruitment strategies

Expand strategies to encourage re-entry

Increase funding for clinical placements

Fund growth in early graduate positions

Expand recruitment & retention strategies in priority services & occupations

Establish alternative approaches to management & allocation of early graduate & vocational training positions

Fund projects to design & influence curriculum

Support skills mix projects

Expand training & utilisation of certificate trained staff

Fund local workforce innovation projects which pilotwork roles &/or design

HE

AL

TH

WO

RK

FO

RC

E

Improve workforce

supply

Improve workforce

distribution

Redesign the

workforce

Short term Medium term Long term

Workforce StrategiesIntegration

Supply and demand studies

Education strategy and

liaison

Role design

Quality and safety

Recruitment and retention

strategies

Distribution strategies

National strategies

Professions

MedicineAllied Health

VET Trained

Nursing

Role review & design:Principles

• All role changes should improve the patient journey through the health care system

• Ideally, follow on from service review • Allow professional staff to work at their

training level – delegate technical and irrelevant work

• Expand use of trained support staff • Maintain safety and quality

Role review & design:Education & training

• Improve liaison with higher education & VET sectors – tailor curricula to roles

• Explore alternative education models – deliver skilled workers more efficiently

• Encourage articulation between VET & higher ed – career paths and career flexibility

Role review & design:Skills mix projects

• Undertake statewide pilots to identify effective approaches and tools

• Support local innovation, existing and proposed

• Priorities for 2004-05:         Extended roles for allied health assistants;         Support roles in acute care;         Support roles in rehabilitation;         Extended roles in eye care (building on the Victorian

Ophthalmology Services Service Planning Framework;         Support and professional roles in mental health;         Extended allied health professional roles.

Role review & design:Methodology

Identified need

System mapping

Identify service gaps

Knowledge through policy work & projectsCalls for expressions of interestDHS Workforce CommitteeApproach from DHS Divisions

Evaluate Effect on patients

Effect on service

Effect on new/redesigned workforce

Amend/develop training

Regulation

Supervision

Indemnity

Assessment of competencies

ReorganiseRole

redesignNew roles

Role review & design:Governance

DHS WorkforceCommittee

Other project steeringgroups

Health project steeringgroups

Project teams

Project teams

Workforceredesign strategy

& coordination

Health WorkforceRedesign

Reference Group

Medical AdvisoryCommittee

Allied HealthAdvisory

Committee

Nursing AdvisoryCommittee

Higher EducationLiaison

CommitteeDHS

DHS VET Liaison& Co-ordination

Group

Role review & design:Going forward

• More information please – forums, visits to services

• Call for expression of interest from health services for redesign pilots

• Communication, consultation & ongoing liaison with stakeholders

• Formation of reference groups & teams• Development of redesign tools

DHS workforce design strategy:Interested? Questions?

Contact:Email [email protected] 03 9616 7872

Team Presentations11.45– 1.00

Prue’s ClusterPrue’s Cluster Bellarine Room 4Bellarine Room 4

•Peter MacCallum Cancer CentrePeter MacCallum Cancer Centre

•Northern HealthNorthern Health

•Bendigo Healthcare GroupBendigo Healthcare Group

•Western HealthWestern Health

•Box Hill HospitalBox Hill Hospital

Tabletop presentationsTabletop presentations

The aim of this session is to;• Promote discussion• Share “Peer to Peer” practical

experiences of innovation• Increase energy for change and shared

learning• Spread ideas between teams

Session formatSession format

• 2 teams per table• Team A has 10 minutes to share

experiences with team B• Whistle blows• Team B has 10 minutes to share

experiences with team A• Rotation 1• Continued….

Session formatSession format

Time Activity Rotation1200-1210 10 minutes

Peter Mac presents to Box HillNorthern presents to Western ABendigo presents to Western B

1210 –1220

10 minutes

Box Hill presents to Peter Mac

Western A presents to Northern

Western B presents to Bendigo

1220 – 1230

10 minutes

Peter Mac presents to Western A

Northern presents to Western B

Bendigo presents to Box Hill

Rotation 1

1230 – 1240

10 minutes

Western A presents to Peter Mac

Western B presents to Northern

Box Hill presents to Bendigo

Session formatSession format

Time Activity Rotation1240 - 1250

10 minutes Peter Mac presents to Western B

Northern presents to Box Hill

Bendigo presents to Western A

Rotation 2

1250 - 1300

10 minutes  Western A presents to Bendigo

Western B presents to Peter Mac

Box Hill presents to Northern

LunchLunch

Meet us back here for

How to successfully engage VMO’s

at 2.00

Department of Human Services

How to successfully engage Visiting Medical Officer’s

Breakout session 4 Bellarine Room 4

2.00-2.45

Susan NoomeNUM, Murwillumbah Hospital &

Mary MitchelhillNational Medication and Safety Breakthrough Collaborative Service Improvement Lead

ObjectivesObjectives

• At the end of this session you will have shared ideas and developed an understanding of how to:– establish relationships with VMO’s– attract VMO Participation – best use VMO’s availability and role within

your organisation– engage and sustain VMO involvement

The RelationshipThe Relationship

• As in any relationship building exercise there are crucial steps that need to be followed

finding the desirable targets, developing interest maintaining the interest long enough to move into the

commitment factor then onto the hard work of

maintaining the relationship.

Desirable TargetsDesirable Targets

• Good bed partners, positive attitude, lots of energy that will help bring it home

• Accommodate, especially for the necessary evils – for some things to work and have a future, certain key people need to be involved

• Reliable workers, doers not procrastinators

Developing InterestDeveloping Interest

• Promote the concept to the selected key stakeholders, don’t try and sell the whole package first up

• Start with the positive drivers and influential players and move on to others later

• A particular individual may be your hardest conquest but could have the greatest influence once on board

Developing interest……cont.Developing interest……cont.

• However, restrict time wasting on intractable people, get some runs on the board

Developing interests…cont.Developing interests…cont.

• Modes of communication:Corridor conversations, element of surprise, keep it short and sweetTheir committee meetings, take the idea to them and present it yourself. They won’t have time to come to youEmails ????? Easily deletedMail, hardcopy ????? Are they read?

Exercise – 5 minutesExercise – 5 minutes

Discuss modes of communication you have used when working with

VMO’s?

Which of these was most effective?

Maintaining the interestMaintaining the interest

• Run with the idea when it’s hot. Don’t put it out there then wait for months before you move on it

• Do some ground work and follow up on the corridor conversations. It shows you listened to what they had to say even if you are now presenting evidence to dispute it

• Don’t start a committee until you’re ready to do the work

Maintaining the interest..contMaintaining the interest..cont

• Give the desired participants, including the evils, the choice- be on the committee or be a liaison consultant for the group.

• Not participating is not to be offered as an option

Maintaining the interest..contMaintaining the interest..cont

• Pat feathers don’t ruffle them……not yet

Commitment factorCommitment factor

• We NEED them and what they can offer

• Be prepared to do the leg work, feed it back, via the corridor, their meetings, grand rounds, even via your own committee meetings (the one they’re members of)

• Set short, concise, realistic time frames

Commitment factor ……cont.Commitment factor ……cont.• Common rules for committee meetings

Meeting time is set around their availabilityThey may need feeding Have an agenda with a timeline attached and person responsible Ensure everyone gets their agenda earlyHave a ruthless chairperson who won’t allow you to gabble onSet outcomes, don’t defer anything to the next meeting

Commitment factor …..cont.Commitment factor …..cont.Misconceptions:• Give them a job and they have to be involved• Everyone is busy, we all have the same

available time• If someone is prepared to do all the work then

we should let them

Maintaining the relationshipMaintaining the relationship

• Promote the outcomes via breakfast trolley during grand rounds etc

• Book a time slot at their monthly/bi-monthly meetings but keep it short

• Keep them up to date with any changes in person, as well as via email or internal mail

• They are happy to be reminded, so …….

Maintaining the Maintaining the relationship ..…contrelationship ..…cont

• Nag, Nag, Nag, Nag, Nag, after all, this is a valued relationship and they always appreciate a gentle reminder

Exercise – 10 minutesExercise – 10 minutes

Spend a couple of minutes listing ideas and solutions you have heard today.

• At your table, share the ideas about how you can develop and maintain VMO involvement?

• What would most suit your type and size of organisation?

In Summary…In Summary…

• VMO’s are integral team members• Attracting, establishing and maintaining

relationships are key to effective team participation

• Find the right communication mode and don’t waste time or opportunities

• Get them involved and keep up reminders…

Questions

?

Afternoon TeaAfternoon Tea

Meet us back in the Plenary for

Statewide strategic innovation

at 3.00