Clinical Services Admin Clinical Services Admin TeamTeamOrganisational ReviewOrganisational Review

BackgroundBackgroundThe Clinical Services Admin team was last formally reviewed in 2003. Since this time, BreastScreen SA (BSSA) has implemented many changes that have affected workflow and roles in this area.

In 2015, formal reviews were conducted of the CS Admin team, as well as other areas directly affecting this team – for example the new Assessment model.

Digital Mammography System Wide Review RecommendationsRef Recommendation Action

42 A review of the clinical and management team structure, staffing, roles and performance review and development practices to enhance their ability to maintain high performance with a specific emphasis in providing a strong culture of learning and patient safety.

• Organisational structure review• Review of all J&P’s of all

coordinators• Implementing Heads of Unit (HOU)

for Medical Officers. Nurse Counsellors, Radiologists, Pathologists, Surgical.

• KPI’s will be included in the J&P such as expectation that HOU will contribute to organisational Quality Improvement plans and will implement and monitor individual Quality Improvement plans for Clinical Staff.*

Background cont…Background cont…Review of Administration Processes

The aims of the administration review were to review of administration processes within the Clinical Services area aimed to improve the quality, efficiency and effectiveness of work flow within the area by: 1.Streamlining work tasks within the admin team in order to create the most efficient workflow

2.Identifying any gaps within the workflow, and assigning to the appropriate admin team member

3.Identifying admin tasks currently performed by the Nurse Counsellor or Medical Officer teams that may better fit with the admin team

4.Determining the appropriateness of the FTE currently assigned to the admin team

5.Reviewing succession planning for the admin team

6.Identifying any further development needs for the BRAIN client information system to assist with a more efficient work flow

7.Identifying any IT solutions that contribute to a more efficient work flow

Background cont…Background cont…Review of Assessment Clinic Model

The key recommendations to be adopted by BreastScreen SA include:•Two x 4 hr sessions, assessing 12 women per session, with women being scheduled 3 clients at a time • staggered rostering of staff needs to be considered as the span of

the assessment clinics is greater than 7.5 hours• A critical role is to have sufficient administrative support available to

type reports and letters later in the assessment clinic for those women having biopsy procedures.

•Multi-disciplinary (MDT) discussion of all women biopsied before Results Clinic • administrative assistance required to support the preparation of the

MDT discussions, typing reports up after post-discussion and for the Results Clinic

•A pre-assessment pack for clients to consider & complete at home • Clinical Services administrative staffs’ new responsibility to check the

client’s details, providing her with the consent form and the relevant information to be completed in the waiting room. A process for referral to the Nurse Counsellor/Medical Officer would be in place for women who request additional clinical information or need assistance due to a co-morbidity or disability.

Background cont…Background cont…Review of Assessment Clinic Model cont…

•Two calcification cases to be assessed per clinic, including one in the first group and one in the second group

•Reduced paperwork for the radiologists, by the removal of dictated reports for clients• Positive impact on the CS admin team by reducing workload in the

clinic

•Improved flow – less duplication

•Deferring carbon and axillary assessment to the Results Clinic

Recommendations from ReviewsRecommendations from ReviewsReview of Administration Team1.Streamlining work tasks within the administrative team in order to create the most efficient workflow2.Identifying any gaps within the workflow, and assigning to the appropriate administrative team member

•Administrative / executive support to the Clinical Director•Minute secretaries to CS committees•Data entry of assessment and treatment information and integration with Clinical Coding requirements – work spanned across two departments

Recommendation:

•Create a new full-time position to provide administrative support to the Clinical Director, and administrative/secretarial support to Heads of Units and Clinical Services committees/meetings

•Realign 3 x FTE from the Screening Support team to the CS Admin team  

Recommendations from Reviews cont…Recommendations from Reviews cont…Review of Administration Team

3. Identifying administrative tasks currently performed by the Nurse Counsellor or Medical Officer teams that may better fit with the administrative team

•Coding• Shifting coding from SSU QA Officer and Medical Officers, to CS Admin team. • Treatment data collection and coding has shifted to Clinical Services QA Admin’s

role A trial was successfully implemented using FTE from TAG funding to employ clinical coders

 •Nursing Administrative tasks moved to the administrative team

• Generate and post confirmation letters for clients booked into the Assessment clinic.

• Sending email confirmations and information/consent packs• Generating appointment lists and bookings reports• Generating invitation letters to the Assessment Clinic• Booking interpreters for assessment clients• Completing Patient Assisted Travel Scheme (PATS) forms for clients• Setting up booking slots in the database

 Recommendation: •Create a new full-time position to provide dedicated administrative support to the Nurse Counsellors and Medical Officers

•Continue to work with these teams to realign more administrative work to the Clinical Services administrative team

Recommendations from Reviews cont…Recommendations from Reviews cont…Review of Administration Team4. Determining the appropriateness of the FTE currently assigned to the administrative team

Existing FTE:• 5 permanent FTE is assigned to the administrative team currently

• 1 x Coordinator• 1 x QA Administrator• 3 x Admin Officer/Receptionists• No casual pool for relief, no team leaders, no official coding positions, no PA to Clinical

Director• 2 temporary FTE (from TAG funding has been assigned to the administrative team currently)

• 1 x Clinical Coder• 1 x Admin Officer, Clinical Services

 Additional work tasks:

• Realignment of work from clinical staff to the administrative team• Introduction of PA position to support the Clinical Director• Requirement for full-time receptionist in the Assessment clinic• Requirement for clinical coding positions  

Recommendation:

•FTE to be increased in the CS Administrative team to manage the increase in workload attributed to the realignment of administrative and coding tasks within the area, increased throughput in the assessment and results clinics, as well as the introduction of a Personal Assistant and Clinical Coder position 

Recommendations from Reviews cont…Recommendations from Reviews cont…Review of Administration Team

5. Reviewing succession planning for the administrative team

•No effective succession plan is in place for this team given the limited number of staff in the current staffing complement. •No effective backfill for staff is available if someone is on leave. •No career progression pathways are available due to the flat structure•Coordinator is responsible for all CS staff•1 x Coder supervised by SSU team, 1 x Coder supervised by CS team Recommendation

•Introduction of a Casual pool, to allow for succession planning and to cover work in times of staff absence, but also for peaks in work (eg special projects)

•Introduction of Team Leader roles, to better support teams, allow for more seamless backfill of duties and career progression opportunities  

Recommendations from Reviews cont…Recommendations from Reviews cont…Review of Administration Team

6. Identifying any further development needs for the BRAIN client information system to assist with a more efficient work flow

•Assessment appointments – Nurses•Assessment module – direct data input of information by clinical staff (currently 3 x FTE assigned to this from SSU team members•Letters manually typed by CS staff – if synoptic report information can be captured in real time, letter generation can occur from BRAIN directly without the need for manual letter creation (and hence double-handling of information) 

7. Identifying any IT solutions that contribute to a more efficient work flow

•Changes to letter processes implemented to automate letter type•Introduction of new contact event types so letter production can be automated, and not manually generated Recommendation

•Identify and log requests for new IT work and BRAIN development through internal processes 

Existing CS Organisational Existing CS Organisational StructureStructure

Why restructure?Why restructure?

• Admin review of Clinical Services – shift of admin tasks

• External Assessment Review completed

• Existing structure does not allow for succession planning

• Introduce efficiencies in workflow by minimising duplication of tasks

• Increase performance of unit and individuals

• Clear reporting lines / support from managers

• Career progression opportunities

Proposed Structure Proposed Structure (pending (pending

consultation)consultation)

• Coordinator, Clinical Services

• 3 x Team Leader / admin streams reporting to the Coordinator, Clinical Services

• New PA to Clinical Director role

• Coding team

• CS Admin team

General overview of rolesGeneral overview of roles

PA to Clinical Director

•Personal Assistance to Clinical Director and Heads of Units (including Surgery, Radiology, Medical Officer and Nurse Coordinator)

•Committee secretary to various CS committees and meetings

•VMS responsibility including:• Rosters• Timesheets for clinical staff• Credentialing• Recruitment• PD expenses and claims

•Providing admin assistance to monitor and update Policies, Processes and Work Instructions

• Backfill Coordinator during absences (shared with other Team Leader roles)

General overview of rolesGeneral overview of roles

Coding Team

• 1 x Team Leader • Line Management responsibility for Coding team• “Expert” coder – advice to business on requirements, update forms etc• Liaise with clinical staff re: coding updates, changes, issues etc• Some clinic work (Ax coding and MDT) – per roster• Backfill Coordinator during absences (shared with other Team Leader and PA

roles)

• 2 x Coders• Coding work in clinic per roster (some morning, some afternoon clinics

and some MDTs)• Coding Ax, Tx, IC paperwork• Backfill Team Leader during absences

• 2 x DE / Coding• DE of Ax, Tx, IC paperwork• Collection of data for Triple Audit• Backfill Coders during absences

General overview of rolesGeneral overview of roles

CS Admin Team

• 1 x Team Leader • Line Management responsibility for CS Admin team incl PR&D• Training CS admin staff• Rosters• Timesheets• Backfill Coordinator during absences (shared with other Team Leader and PA

roles)

• CS Admin team• Clinic prep, assessment clinic reception and typing, core results• Nurse admin support• Slides, Ax Out, Gustav, GP Evenings, Admin minutes, Film copies• Rotational roster to cover morning and afternoon clinics• Backfill Team Leader and/or PA to CD during absences

• CS Casual Pool• As above• Learn functions of Data Entry Coding roles to backfill when required• Learn functions of PA role to backfill when required

General overview of rolesGeneral overview of roles

Benefits to staff and Benefits to staff and businessbusiness• This restructure is expected to have the following benefits:

• Increased performance

• Improved accuracy

• Improved communication

• Specialised knowledge

• Reduction in training / retraining staff

• Clear reporting lines

• Increased support for admin staff from management

• Opportunities for career progression

• Increased administrative support for clinical staff (nurses, medical officers, Clinical Director and Heads of Units)

• No agency staffing required – backfill is managed within the newly established casual pool

What does this mean for What does this mean for me?me?• A restructure!? - am I at risk of losing my job?

• Do I have to apply for my job?

• What support will there be for me?

• Information sessions (team meetings)

• 1:1 meetings (by request)

• Workshops (incl. interview skills, recruitment processes as required)

• Access to EAP support

What does this mean for What does this mean for me?me?CS Admin Team

•The restructure creates more positions in the area and therefore does not see any redundancy with existing CS Administration staff.

•There are currently 3 x permanently appointed staff within this team and 2 x existing vacant permanent administrative positions.

•J&PS will require a review to reflect the duties that are currently performing in these roles.

•Agency staff, who have worked with the CS Administration team for some time now, will be directly appointed to the casual pool.

•All remaining vacancies, both temporary and permanent, will be advertised following SA Health recruitment procedures.

What does this mean for What does this mean for me?me?SSU Team (RAX)

In line with the review recommendations the following is proposed:

•2 x FTE to realign from BSSC17 Admin Officer, Reading and Assessment to this new position

• There are currently 6.0 FTE appointed to the Administrative Officer, Reading and Assessment team

• An internal EOI will be sent to all permanent staff in this role, inviting them to transfer to the CS Admin team new role

• If more than 2.0 FTE express an interest in this change, interviews will be held to determine who is appointed

What does this mean for What does this mean for me?me?SSU Team (ROT)

In line with the review recommendations the following is proposed:

•1 x FTE to realign from BSSC09 Administrative Officer, Rotation to the BSWC03 Administrative Officer, Clinical Services

• There are currently 11.8 FTE appointed to the SSU Administrative Officer, Rotation team

• An internal EOI will be sent to all permanent staff in this role, inviting them to transfer to the Admin Officer, Clinical Services role

• If more than 1.0 FTE expresses an interest in this change, interviews will be held to determine who is appointed

TimeframesTimeframes• Letter for Unions advising of impending changes

• Letter advising of restructure posted to staff (perm)

• Feedback - online, email, in person

• Review of J&PS

• Ongoing information sessions as this progresses

• Appointment to casual positions

• Advertise new positions then recruit (internal BSSA)

• Goal completion date - end June 2016

QuestionsQuestions