ahsfma conference 17 november 2015 · anum or nurse notifies family / friend / ambulance of...
TRANSCRIPT
AHSFMA Conference 17 November 2015
– AHSFMA Conference Lean and what to consider
– Master Class How it’s done!
– Case study
Improving business performance through active management
Promentor – Who we are
• On all state and federal government panels as well as bank panels
• Why are we different?
• A group of ex-CEO’s and senior managers as well as well experienced process Engineers that have run manufacturing and service companies for many years in the past with many years’ experience successfully restructuring and running companies in the real world at operational roles
• Now assist clients taking an active rather than passive role,
• We carry out process improvements with our automotive trained process engineers (Ex-Toyota and others) including implementation which is much more difficult
Hospital Experience
• Booking Office
• Pre Admission Clinic (PAC)
• Central Sterile Supply Department (CSSD)
• Day procedures
• Theatre utilisation
• Imaging & staff rostering
• Processes between teams: • ED to ward to discharge • Surgery to ward to discharge • O&G to ward to discharge
Keep Lean Simple
• Principles. Tools. Application.
• The basic lean principles are common sense.
• Tools formalise common sense.
• Focuses on maximising current circumstances by eliminating waste.
• Optimisation should precede new investment.
Application of Lean Principles
• Case Study of Patient Discharge:
• Overall the objective is to free up assets to deliver more service without more investment
• The more localised objective is to meet the target objective check out time
• Tim is a practitioner, this is the nitty gritty • Look at a ‘familiar’ process, flow chart it in it’s various iterations, look at
further improvements, relate to ‘objectives’ • The intent is to relate the use of lean techniques to improvements which
enable improved results in line with strategic objectives.
• Before you choose to go down the ‘lean path’, understand why.
Case Study – Acute Ward Patient DischargeTim Alderman
Objective – Discharge Patients before 11am
• Clearly define and communicate improvement initiative
• Have valid reasons for undertaking the initiative
• Understand the impact of any change on upstream and downstream processes in the Overall Patient Journey
PRE-ADMISSION ADMISSION TREATMENT
POST HOSPITAL
Reasons for discharging patients before 11am
1. Bed management
2. Accommodate morning surgery patients requiring admission
3. Smooth transition for patients and staff
4. Improved Patient experience
FUTURE STATE
CURRENTSTATE
IDENTIFYWASTE
ELIMINATE WASTE
Lean Tools and Techniques
• There are many lean tools and techniques available. It is imperative with any process improvement initiative to:
• Identify what data currently exists • Define additional data to collect / measure • Utilise the appropriate tools for analysis • Always seek staff input and validation of findings
Lean Tools and Techniques
• Process mapping
• Cause and effect diagrams
• Pareto analysis
• Data profiling
• KPI’s
• Bottleneck analysis
CONTROL
IMPROVE
ANALYSE
MEASURE
DEFINE
Approach
1. Data Analysis of Patient Discharge Times
• Establish what data is available (Patient Medical Records)
• Present data clearly with graphs
and diagrams
• Define current performance
• Set realistic targets
• Refine targets as appropriate
• Understand where you are ANALYSEREFINE
DEFINE
CONTINUOUSIMPROVEMENT
Data Profiling
• 25% achieve target time
• 25% Between 11am & 1pm
• 25% Between 1pm & 3pm
Approach
2. Identification of Blockers Delaying Discharge
• Define all possible delays • Identify long lead time items
for discharge planning
• Collect Pareto Data (Pareto reasons for delay)
• Understand what you can control
ANALYSEREFINE
DEFINE
CONTINUOUSIMPROVEMENT
WAITING ON DOCTOR ROUNDS
WAITING ON AGED
PLACEMENTCARE
WAITING TO BE PICKED UP
BY FAMILY/FRIEND
PATIENTDISCHARGE
EARLY
WAITING ON SUB ACUTE
BED
EXIT MEDICATIONNOT READY/
CHANGED
WAITING ON REFERRALS
WAITING ON RADIOLOGY
PATIENT UNWELL
WAITINGON
PATHOLOGY
WAITING ONACAS
ASSESSMENT
WAITING ONBUILDERS FOR
HOME RENOVATIONS
EXIT SCRIPTSNOT READY/
CHANGED
WAITINGON
PATIENT TRANSPORT
WAITINGALLIED HEALTH
HOME ASSESMENT
WAITING ON BED AT
ANOTHERHOSPITAL
Identified the reasons for discharge delay
Approach
3. Review Discharge Planning
• Commence long lead time items for discharge as early as possible
• Aged care placements
• ACAS assessment
• Home renovations • Allied health assessments
ANALYSEREFINE
DEFINE
CONTINUOUSIMPROVEMENT
Approach
4. Process Map current Discharge Process
• Interview staff or workshop current process • Develop current process map
• Validate process map with staff
• Diagrammatically represent process (optional)
ANALYSEREFINE
DEFINE
CONTINUOUSIMPROVEMENT
Acute Ward Patient Discharge Process (Current)
NURSE DISCUSSES MEDICATIONS WITH
PATIENT
NURSE TAKES PATIENTS BLOOD AND SENDS TO
PATHOLOGY
NURSE FAXES EXIT MEDICATION SCRIPT
TO PHARMACY
PATHOLOGY TEST RESULTS SENT
TO WARD
PHARMACY FILL SCRIPT
WARD CLERK / NURSE NOTIFIED
BED READY
WARD CLERK / NURSE CONTACT BED TEAM TO PREPARE BED FOR
NEXT PATIENT
BED AVAILABLE FOR NEXT PATIENT
BED MANAGER / COORDINATOR
NOTIFIED OF BED AVAILABILITY
DO
CT
OR
BE
D M
AN
AG
ER
/C
OO
RD
INA
TO
RW
AR
D C
LER
KA
NU
MP
AT
HO
LOG
YP
HA
RM
AC
YB
ED
TE
AM
WA
RD
NU
RSE
DOCTOR CONTINUES FROM WARD ROUND TO COMPLETE
DISCHARGE MEDICATIONS AND REVIEW PATHOLGY RESULTS IF REQUESTED
DOCTOR CONTINUES WARD ROUND
WARD CLERK/NURSEORGANISE REFERRALS
MORNING MEDICAL ROUND OF WARDS.
DOCTOR GIVES MEDICAL CLEARANCE TO
DISCHARGED PATIENT
ANUM IDENTIFIES POTENTIAL NEXT DAY
PATIENTS FOR DISCHARGE. (MORNING OF DISCHARGE)
NURSE UPDATES DISCHARGE PAPERWORK THROUGHOUT DISCHARGE PROCESS AND
COMPLETES ONCE MEDICATIONS ISSUED
ANUM OR NURSE NOTIFIES FAMILY/FRIEND/AMBULANCE REGARDING PATIENT
PICK UP
BED TEAM CLEAN ROOM / PREPARE FOR
NEXT PATIENT
PHARMACIST BRINGS
MEDICATIONS TO THE WARD
AND DISCUSSES WITH PATIENT
PATIENT PATHOLOGY TEST
RESULTS AVAILABLE IN WARD
PATIENT DISCHARGED
PATHOLOGY
IN PHARMACY
HOURS
PATHOLOGY PERFORM TESTS AS
SPECIFIED BY DOCTOR
Acute Ward Discharge – Where We Are
MORNING MEDICAL ROUND ORGANISE TRANSPORT
EXIT PRESCRIPTION
PATHOLOGY
RADIOLOGY
X-RAY
PATIENT MEDICAL CLEARANCE
GET MEDICATION
GET PATHOLOGYDONE
BED AVAILABLE
BED TEAM
PATIENT WANTSTO LEAVE
PATIENT FRUSTRATEDWITH DISCHARGE DELAY
PATIENT WAIT
DOCTOR VISITS PATIENTFOR THE SECOND TIME
AFTER COMPLETINGMEDICAL ROUND
GET RADIOLOGY DONE
25% OF PATIENTS DISCHARGED BY 11AM
25% OF PATIENTS DISCHARGED BETWEEN 11AM & 1PM
75% OF PATIENTS DISCHARGED BY 3PM
25% OF PATIENTS DISCHARGED BETWEEN 1PM & 3PM
X-RAY
ACUTE WARD DISCHARGE – WHERE WE ARE
DISCHARGE DAY
Approach
5. Process Map future Discharge Process
• Interview staff or workshop current process • Develop future process map
• Validate process map with staff
• Diagrammatically represent process (optional)
ANALYSEREFINE
DEFINE
CONTINUOUSIMPROVEMENT
NURSE DISCUSSES
MEDICATIONS WITH PATIENT
NURSE COMMENCES DISCHARGE PAPERWORK
EXIT MEDICATIONS
SENT TO WARD OR HELD IN
PHARMACY
CONTINUE TO PREPARE EXIT MEDICATION
NURSE FAXES EXIT
MEDICATION SCRIPT TO PHARMACY
PATHOLOGY TEST RESULTS
SENT TO WARD
PATHOLOGY TEST
SCHEDULED
PHARMACY FILL SCRIPT
WARD CLERK / NURSE
NOTIFIED BED READY
WARD CLERK / NURSE CONTACT
BED TEAM TO PREPARE BED FOR
NEXT PATIENT
WARD CLERK / NURSE
ORGANISES REFERRALS
BED MANAGER / COORDINATOR
NOTIFIED OF BED
AVAILABILITY
DO
CT
OR
BE
D M
AN
AG
ER
/C
OO
RD
INA
TO
RW
AR
D C
LER
KA
NU
MP
AT
HO
LOG
YP
HA
RM
AC
YB
ED
TE
AM
WA
RD
NU
RSE
MORNING MEDICAL ROUND CHECKS PATH TESTS EXIT
MEDS & GIVES MEDICAL
CLEARANCE
DISCHARGE
PATIENTS SEEN
FIRST
DISCHARGE MEDICATION SCRIPTS PREPARED ON AFTERNOON MEDICAL
ROUND READY FOR NEXT DAY DISCHARGE
AFTERNOON MEDICAL ROUND
IDENTIFIES PATIENTS TO BE DISCHARGED
FOLLOWING MORNING
ANUM IDENTIFIES POTENTIAL NEXT DAY
PATIENTS FOR DISCHARGE BEFORE AFTERNOON
MEDICAL ROUND
NURSE TAKES PATIENTS BLOOD AND SENDS TO PATHOLOGY OR ORGANISES BLOOD TO BE
TAKEN EARLY ON MORNING OF DISCHARGE SO RESULTS ARE AVAILABLE FOR MORNING
MEDICAL ROUNDS
PATHOLOGY PERFORM TESTS AS SPECIFIED BY DOCTOR AFTERNOON
PRIOR TO DISCHARGE OR FIRST THING MORNING OF DISCHARGE
DISCHARGE PATIENT PATHOLOGY TEST RESULTS
AVAILABLE IN WARD PRIOR TO MORNING MEDICAL
ROUND
BED TEAM CLEAN ROOM / PREPARE
FOR NEXT PATIENT
ANUM OR NURSE NOTIFIES FAMILY /
FRIEND / AMBULANCE OF PEOTENTIAL NEXT
DAY PATIENT DISCHARGE
ANUM OR NURSE NOTIFIES TRANSPORT PATIENT NOT BEING
DISCHARGED
PHARMACIST BRINGS MEDICATIONS TO THE WARD AND DISCUSSES
WITH PATIENT
PATHOLOGY
IN PHARMACY
HOURS
DAY BEFORE DISCHARGE DAY OF DISCHARGE
NEED VISUAL CUE
FOR PATHOLOGY TO
IDENTIFY TESTS
REQUIRED FOR
DISCHARGE
PATIENTS
NEED VISUAL CUE
FOR PHARMACY TO
IDENTIFY SCRIPTS
REQUIRED FOR
DISCHARGE
PATIENTS
PATIENT DISCHARGED
BED AVAILABLE FOR NEXT PATIENT
Acute Ward Patient Discharge Process (Future)
Acute Ward Discharge – Where We Want To Be
AFTERNOON MEDICAL ROUND
ORGANISE TRANSPORT
ACUTE WARD DISCHARGE – WHERE WE WANT TO BE
EXIT PRESCRIPTION
PATHOLOGY
RADIOLOGY
X-RAY
PATIENT MEDICAL CLEARANCE
CHECK MEDICATION
PATHOLOGY RESULTS
BED AVAILABLE
BED TEAMARRIVE 10.00AM
GET RADIOLOGY DONE
EVERYTHING READY FOR MORNING MEDICAL ROUND.
DOCTOR SEES PATIENT ONCE
11.00AM8.30AM
X-RAY
MORNING MEDICAL ROUND
DISCHARGE DAYDAY BEFORE DISCHARGE
PATIENT PICK UPAND DISCHARGE
Approach
6. Process Map future Discharge Process
• Set initial target of 50% before 11am base on moving the 25% who leave between 11am & 1pm
• Data profile patient discharge time
• Implement initiatives (Internal designated team)
• Publish results
• Refine target as improvements implemented
• Reset target to 75% before 11am
• Based on moving the 25% who leave between 1pm & 3pm
ANALYSEREFINE
DEFINE
CONTINUOUSIMPROVEMENT
What is the Learning?
• How well equipped do you now feel, given a small example and a full case study, to tackle change in your organisation?
• What else might you need?
How About?
• Experience
• Facilitation
• Time
• Priority
• Business as usual
Lean/6o
CONTROL
IMPROVE
ANALYSE
MEASURE
DEFINE• Targets operational efficiency
• Requires well defined problems
• Relies on data analysis – multiple data sources
• Is a discipline that is easy to learn and hard to master
Things To Consider
• Identify waste (especially delays)
• Understand what data is available and how it may be turned into information. Or is it data for data’s sake?
• Identify labour efficiency opportunities (resequencing activities, improve rostering, stop doing non value adds)
• Identify asset utilisation problems. Can you ‘sweat the asset’ more?
• Do the best you can with what you have, before adding investment.
Promentor has offices in the following capital cities to provide outstanding service to our national and international clients.
Melbourne Level 924 Collins StreetMelbourne Vic 3000P +61 3 9639 5099 F +61 3 9639 5088
Perth Level 3 267 St Georges Tce Perth WA 6000P +61 8 9261 7785 F +61 8 9261 7700
SydneyLevel 13 167 Macquarie St Sydney NSW 2000P +61 2 8667 3027 F +61 2 8667 3200
Adelaide Level 5 City Central 121 King William St Adelaide SA 5000P +61 8 8423 4555 F +61 8 8423 4500
Brisbane Level 2269 Ann Street Brisbane QLD 4000P +61 7 3112 5176 F +61 7 3112 5101
[email protected] www.promentor.com.au
Improving business performance through active management.
Improving business performance through active management
Melbourne +61 3 9639 5099
Sydney +61 2 8667 3027
Brisbane +61 7 3112 5176
Perth +61 8 9261 7785
Adelaide +61 8 8423 4555
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© Promentor 2015