HEAPHY 1 & 2

PLENARY

Michael MACKRILL

Fri 30th Aug 2013

Session 3 / Talk 2

13:50 – 14:10

ABSTRACTIn Health Care, Patient welfare is the paramount concern, be that in direct care of the patient, the reduction of unnecessary radiation dose or ensuring the most appropriate diagnostic test or therapy plan is used. This presentation will argue that of equal importance are the systems put in place to support the sharp end of practice, be that hospital information systems, resource management or RISPACS.Often the complaint is made when using electronic systems that ‘this wasn’t designed by anyone who has ever done the job’, or ‘that this just gets in the way of patient care’. When HBDHB selected a RIS, the deciding factor was that it was capable of being configured to meet the needs of the site. This presentation will describe how the ‘patient journey’ and ‘process mapping’ methodology was used to design a system that allowed positive enhancements to workflow, providing the end with all appropriate information at their immediate disposal, thus improving patient care through better decision making, and assigning tasks to the appropriate person.

RISPACS, The Patient Journey And Its

Part In Patient Care

Mike Mackrill RISPACS Administrator HBDHB

Design Objectives

As little user input as practicable to complete task

Information available to the user at point of need

No duplicate entry of information

Support best practice

Assign task at appropriate level

In Times Past

Forms

Ledgers

Folders/Filing Cabinets and

Offices

Nothing has Changed

Documentation Screens = Forms

Worklists = Ledgers/Files

Navigation Bars = Filing Cabinets

Roles = Offices

Process Mapping The ‘Patient Journey’

Follow The Form

Map the Task

Identify what's needed and when

Who does what

Identify where the information sits

Ideal Workflow

Fewer clicks the better

Documentation Screens

Replace Paper Forms

Collect form that have been used

Ask the end user what is needed

Worklists

Collections of ‘forms’ into ‘files;

Organize your tasks to your workflow

Setup specific worklists for specific tasks (e.g. all CT)

Worklists set to specific exam statuses (e.g. Scheduled)

Only available to specific roles

Navigation Bars

Worklists and Actions

Specific to Roles

Follow on from each other

Fewer the better

Roles

Job Title

What do you do

What should you do

What are you allowed to do

Design The System

Mock Screens

Mock Worklists

Mock Roles

Give it to the Vendor

Test, Test, TEST!

What does any of this have to do with Patient care?

Capacity; how do you increase it?

Increase Staffing

Lengthen the Working day

Improve the Physical Environment

Improve Support Systems

Efficiency!

Design Brief #1

As little user input as practicable to complete task

• Increase in efficiency

• Task Completed Faster,

• More time with the Patient,

• More Patients Seen

• No detrimental impact on ‘patient experience’

Design Brief #2Information available to the user at point of need

No swapping between systems

Less time searching

Greater Efficiency

Fewer Mistakes

Improved Clinical Safety

No negative impact on the ‘patient experience’

Design Brief #3

No duplicate entry of information

Reduced possibility of data entry errors

Less Time Taken

No negative impact on the ‘patient experience’

Design Brief #4

Support best practice

• Make it easy to do your job

• Less Time Taken

• Clinical Safety

• No negative impact on the ‘patient experience’

Design Brief #5

Assign task at appropriate level

Clinical Safety

Dumping Task

Risk

Where do you think the work ends up?

Waiting Lists

30 patients a day present, 28 done

1 Week = 10 waiting (half a day)

1 Month = 46 waiting (2 days)

6 Months = 276 waiting (10 days)

12 Months = 552 waiting (20 days)

Consequences

Finally

Efficiency is not a dirty word

Work smarter, not harder

Remove unnecessary repetitive tasks

Systems should support best practice

Thanks For Listening