Epworth Freemasons Surgical pre-admissions redesign project

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201 Epworth HealthCare today

Growth and demand

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10,000

20,000

30,000

40,000

50,000

60,000

70,000

FY2009 FY2010 FY2011 FY2012 FY2013

EHC Medical Separations

EHC Procedural Separations

EF Medical Separations

EF Procedural Separations

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1. What our patients have been saying...

2. What our doctors have been saying...

3. What our data is saying...

4. What the auditors observed...

Project Rationale

Project scope

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“For surgical bookings to achieve a comprehensive and consistent clerical and clinical pre-admission process across both Clarendon Street and Victoria Parade Epworth Freemasons sites to improve

the initial experience for patients and doctors”

Objectives

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• Improve patient & doctor satisfaction

• Improve internal data and reduce data errors

• Act on audit recommendations

• Improve communication and processes

• Reduce duplication and internal causes of delay

How?

• Patients as the customer

• Process focus

• Involve key users as subject matter experts

What do patients want?

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Project methodology PRINCE2 project management:

• Manage by exception

• Focus on products

• Manage in stages

• Emphase engagement and communication

• Identify and actively manage risks and opportunities

Lean approach to process redesign:

• Identify waste and non-value adding steps in the process

• Identify challenges that hinder effective and efficient health care

• Focus on increasing value for patients

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Process mapping

We did a lot of process maps!!!!

(x16 unique processes)

What did we discover?

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1. Independent small teams conducting different clerical and clinical processes

2. 25% non-value add elements

3. Multiple failure modes

How do you achieve embedded change?

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Changes (1)

Overall:

• Create a Patient Service Centre (PSC) for Epworth Freemasons

• Redesign internal processes and remove weaknesses in system

• Centralised processing paperwork: often in real time

Changes affecting patients:

• Enhance existing patient materials and documents

• Clinical screening of patients

• 1 call to patients and use of scripting

• Increased use of staggered admission times

Patient Service Centre

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Changes (2) Technology products:

• Total conversion to electronic theatre scheduler

• Replace manual and time consuming processes

• Updated internet content and SMS reminders

Staff products:

• Staff training materials developed and executed

• New department physical location to resolve 2 site issue

• Relocation of switchboard

• New management structure

• Introduction of scripting

Key issues

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3-month post go live teething problems:

• Underestimated level of staff understanding of the system:

• Higher than expected staff absences and lack of back up resources

• Site separation contributed to underutilised staff and required further process alterations

• Inconsistent approaches to theatre bookings across sites not identified in process mapping

• Processes for last minute ad-hoc patients unclear and required clarification

Outcomes

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1. Improved patient satisfaction and experience

2. Improved doctor satisfaction

3. Reduced error rates and duplication of activities

4. Improved internal processes and communication

5. Other improvements realised

Lessons learned

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• Communicate regularly and clearly

• Be practical about the time required to prepare and enact change

• Ensure that senior management support

• Approach change knowing that people have varying experiences with change initiatives

• Engaging key stakeholders in the project to-be design development

• Strong risk & issue management processes are needed

• Impact of different leadership styles and staff capabilities

• Actively manage scope change

• Project manager as the single project contact

Questions ?