Kim Edwards, Shanae Fletcher, Solange Villagran · 2017. 8. 23. · Kim Edwards, Shanae Fletcher,...
1
Acknowledgements ACS Clinical Staff John Atkinson, Mathew Eldridge & Raelene Costello Mr Barry Hunter, Mr Christoph Groger, Mr Bill Davies Conclusion We still have a way to go… Four ‘in scope’ solutions were identified and rolled out at single sites. While each of these solutions has had some positive impact on internal processes, this impact has not been as significant as anticipated in terms of patient flow. The current measurement of our objectives are demonstrating this. We found that big problems most likely need big solutions. And there have been lessons learned along the way… The Redesign methodology, robust diagnostics phase and large data collections for this project are being used for future service planning and other projects. Case for change Increased team caseloads by 55% in 18 months Patients waiting longer to be seen or not seen at all. Frequent appointment changes Care may not be meeting needs Decreased clinical time available Diagnostics Results Kim Edwards, Shanae Fletcher, Solange Villagran Mental Health Services Coffs Harbour (CH), Port Macquarie (PMQ) and Kempsey (KMP) Goal To improve the flow and patient journey through the MNCLHD Mental Health Acute Care Services Objectives: By July 2017… Methods Sustaining change Solutions are included in standard Mental Health Service local procedures All solutions are to be rolled out across all three sites One unused solution is being developed into a large scale LHD project while another is being considered in the “Productive Communities” improvement project Contact Kim Edwards, CNC3 0413 175 281 [email protected]. nsw.gov.au ACS Patient Flow Data analysis Process Mapping Patients complaints (n=7 ) Staff Interviews (n=12 ) KPI Development Root Cause Analysis Focus Groups Staff Surveys (n=6) Start Length of Stay (LOS) PMQ & KMP = 62 days Readmit at Coffs = 20% Gap LOS +18 days PMQ & KMP Readmit rate = <7% CH Expected LOS PMQ & KMP = 28 days Readmit rate at CH ≤ 13% PMQ & KMP: Average 30-40 days to complete discharge. Extra 12-22mins of data entry for every referral Only 32% eligible referrals are triaged “How come a different person comes each time?” Patient “We are taking everybody” Staff member The team found a fractured patient journey with a number of issues at steps along the way. Access & Entry Assessment Care Planning & Treatment Review Discharge Removing & updating data collection at CH = SAVING staff nearly 1.5 hrs per week based on average number of weekly referrals Keyworker allocations at PMQ had a small impact on workload initially. The Cohort Clinics had a significant impact on face to face contacts & key requirements which may have increased the daily tasks. 0% 50% 100% 150% 200% 250% Mar‐16 Jun‐16 Nov‐16 Mar‐17 Jun‐17 ACS PMQ: Proportion of Due Vs Overdue Daily Tasks March 2016‐June 2017 PMQ Target Limit 0 50 100 150 200 250 300 350 400 450 500 No. Face to Face Service Events ACS PMQ: Face to Face Service Events April 2016‐June 2017 0% 20% 40% 60% 80% 100% 120% Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐17 Jun‐17 ACS PMQ: Keyworker Allocation & completion of key clinical requirements % Keyworker Allocated % MH Reviews % Care Plans % HoNOS Together, the Keyworker allocations and cohort clinics resulted in an improvement in undertaking key clinical tasks, which is a measure of a more organized patient journey Solutions 0 10 20 30 40 50 60 70 80 90 Nov‐16 Dec‐16 Jan‐17 Feb‐17 Mar‐17 Apr‐17 May‐17 Jun‐17 Percentage of Total Discharges KMP: Proportion of Referrals Out & Triage or Assessment Only Referrals to External Organisations Target 20% Triage or Ax Only Service Mapping Streamlining Systems Cohort Clinics Adding Keyworkers Care Planning & Treatment Review Discharge At KMP, service mapping to match people with care needs resulted in the number of assessment only referrals being well above target. However, the number of transfers to external services remained well below. This indicates that pre- treatment triaging processes may be more effective at service matching than post- treatment at transfer of care and highlights issues where ACS relies on external service resources to maintain effective patient flow. Current Length of Stay (LOS) PMQ = 78 days LOS @ KMP = 71 days Readmit at CH remains at 20% So far…
Transcript of Kim Edwards, Shanae Fletcher, Solange Villagran · 2017. 8. 23. · Kim Edwards, Shanae Fletcher,...
-
AcknowledgementsACS Clinical Staff
John Atkinson, Mathew Eldridge & Raelene Costello
Mr Barry Hunter, Mr Christoph Groger, Mr Bill Davies
Conclusion
We still have a way to go…
Four ‘in scope’ solutions were identified and rolled out at single sites.
While each of these solutions has had some positive impact on internal processes, this impact has not been as significant as anticipated in terms of patient flow. The current measurement of our objectives are demonstrating this.
We found that big problems most likely need big solutions.
And there have been lessons learned along the way…
The Redesign methodology, robust diagnostics phase and large data collections for this project are being used for future service planning and other projects.
Case for changeIncreased team caseloads by 55% in 18 months
Patients waiting longer to be seen or not seen at all.
Frequent appointment changes
Care may not be meeting needs
Decreased clinical time available
Diagnostics
Results
Kim Edwards, Shanae Fletcher, Solange VillagranMental Health Services Coffs Harbour (CH), Port Macquarie (PMQ) and Kempsey (KMP)
GoalTo improve the flow and patient journey through the MNCLHD Mental Health Acute Care Services
Objectives: By July 2017…
Methods
Sustaining changeSolutions are included in standard Mental Health Service local procedures
All solutions are to be rolled out across all three sites
One unused solution is being developed into a large scale LHD project while another is being considered in the “Productive Communities” improvement project
ContactKim Edwards, CNC3 0413 175 281 [email protected]
ACS Patient Flow
Data analysis Process MappingPatients complaints (n=7 ) Staff Interviews (n=12 )
KPI DevelopmentRoot Cause Analysis Focus Groups
Staff Surveys (n=6)
Start
Length of Stay (LOS) PMQ &
KMP = 62 days
Readmit at Coffs = 20%
Gap
LOS +18 days PMQ &
KMP
Readmit rate = /JPEG2000ColorACSImageDict > /JPEG2000ColorImageDict > /AntiAliasGrayImages false /CropGrayImages false /GrayImageMinResolution 300 /GrayImageMinResolutionPolicy /OK /DownsampleGrayImages false /GrayImageDownsampleType /None /GrayImageResolution 300 /GrayImageDepth -1 /GrayImageMinDownsampleDepth 2 /GrayImageDownsampleThreshold 1.50000 /EncodeGrayImages true /GrayImageFilter /DCTEncode /AutoFilterGrayImages true /GrayImageAutoFilterStrategy /JPEG /GrayACSImageDict > /GrayImageDict > /JPEG2000GrayACSImageDict > /JPEG2000GrayImageDict > /AntiAliasMonoImages false /CropMonoImages false /MonoImageMinResolution 1200 /MonoImageMinResolutionPolicy /OK /DownsampleMonoImages true /MonoImageDownsampleType /Bicubic /MonoImageResolution 1200 /MonoImageDepth -1 /MonoImageDownsampleThreshold 1.50000 /EncodeMonoImages true /MonoImageFilter /CCITTFaxEncode /MonoImageDict > /AllowPSXObjects false /CheckCompliance [ /None ] /PDFX1aCheck false /PDFX3Check false /PDFXCompliantPDFOnly false /PDFXNoTrimBoxError true /PDFXTrimBoxToMediaBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXSetBleedBoxToMediaBox true /PDFXBleedBoxToTrimBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXOutputIntentProfile () /PDFXOutputConditionIdentifier () /PDFXOutputCondition () /PDFXRegistryName () /PDFXTrapped /False
/CreateJDFFile false /DefaultDocumentLanguage (English: UK) /Description > /Namespace [ (Adobe) (Common) (1.0) ] /OtherNamespaces [ > /FormElements false /GenerateStructure true /IncludeBookmarks false /IncludeHyperlinks false /IncludeInteractive false /IncludeLayers false /IncludeProfiles true /MarksOffset 6 /MarksWeight 0.250000 /MultimediaHandling /UseObjectSettings /Namespace [ (Adobe) (CreativeSuite) (2.0) ] /PDFXOutputIntentProfileSelector /NA /PageMarksFile /RomanDefault /PreserveEditing true /UntaggedCMYKHandling /LeaveUntagged /UntaggedRGBHandling /LeaveUntagged /UseDocumentBleed true >> > ]>> setdistillerparams> setpagedevice
