The Development of the ACT Health ‘Walk-in Centre’

Susan Hayward Project Manager

The Australian Capital TerritoryDemographic Summary

Population2009: 352 189Projected for 2059: 557 443Number of people over 65 is projected to increase from 10.2 to 21% by 2059

Health ServicesTwo public emergency departments managing over 100,000 people annually

Shortage of General Practitioners

“Across Australia and in most industrialised countries, health systems are under enormous pressure caused by an ageing population, the impact of new technologies, escalating global workforce shortages, and increasing consumer demands¹”

We need to plan, adopt new approaches, and change or modify our models of care and the way that we work.

The Problem

¹ACT Health: Your Health-Our Priority (2008)

The development of a brand new model of health care that puts nurses at the forefront of consumer focussed primary care service using the latest information technologies

A Walk-in Centre.

The Solution

The Concept of a Walk-in Centre

• A Walk-in Centre (WiC) is a primary health care service designed to provide fast, free access to health advice and treatment in a clinic-style environment

• WiCs are nurse-led and designed to treat minor injury and illness, on a one-off basis, in an accessible location.

The ACT Walk-in Centre

• WiCs in the ACT aim to relieve the pressure on public hospitals, provide faster access to treatment and to develop an innovative approach to the problem of workforce shortages.

The ACT Walk-in Centre

The development of a WiC Model of Care progressed through 5 phases:

• Phase 1: Background research (including a review of the British model)

• Phase 2: Community consultation• Phase 3: Development of the Model of Care• Phase 4: Opening of the service to the community• Phase 5: Independent evaluation.

Phase 1Background research (including a review of the British

model)• WiCs have been operating in the United Kingdom for more

than 10 years. In July 2008, a team funded by ACT Health travelled to the UK to observe the structure and operations of established National Health Service WiCs

• Ten sites were inspected in areas that most closely resemble the size and demographics of the ACT, namely Bristol, Bath and Exeter. Sites in London were also visited as they provide a number of different care models in a variety of urban settings.

Phase 2

Community consultation• Following the UK site visits, ACT Health conducted a feasibility

study with the publication of a discussion paper and organised community fora calling for feedback and ideas

• The decision to progress the concept to the development stage was based on overall community support for a WiC in the ACT.

Phase 3

Development of the Model of Care (MoC)• The approach used for designing the WiC was based on ACT

Health’s MoC Design Framework and underpinned by Project Management methodology

• A MoC can be described as a ‘prescription for providing evidence based care to every patient, every day, through integrated clinical practice, education, research and accountability’.

Phase 3Development of the Model of Care (MoC)The MoC Design Framework includes:• The aims and underpinning principles of service delivery• A ‘recipe’ for the elements of care (building, people, systems),

caring, and providing patient and family centred care• The how, what, why and when of care delivery• Information about unit flows, where patients come from and

go to, and the linkages needed for patient treatment• The multiple services and service relationships required for

positive patient outcomes and individualised care.

Phase 3

FunctionalRequirements

Project Definition Plans

Architectural input, Building Design

ConstructBuilding Move In

Part 1MoC

Part 2 MoC

Part 3MoC

Commence new

MoC

Model of Care

Building Design

FunctionalRequirements

Project Definition Plans

Architectural input, Building Design

ConstructBuilding Move In

Part 1MoC

Part 2 MoC

Part 3MoC

Commence new

MoC

Model of Care

Building Design

Development of the Model of Care (MoC)

Phase 3

Increasing level of detail

Step One

Step TwoStep Three

Part 1 Model of CareThe Big Picture

• Services Provided• Aims & Principles• Overview & ExamplesPurpose: Guide user group discussions & architectural direction

Part 2 Model of Care

Detail Design / Gap Analysis

• Workflow analysis • Patient and staff perceptions• Clinical requirements• Enablers• Gap analysis between proposed

and current MoCPurpose: Guide development of change management and human resource strategies and operational level design

Part 3 Model of Care

Operational Level Design

Incorporates detailed informationpertaining to • Role design• Staffing profiles• Implementation staging• Clinical service policies,

procedures, business rules etc• Training needs and planPurpose: Provide the service with a model of care that can be implemented within the clinical area

Development of the Model of Care (MoC)

Phase 3Development of the Model of Care (MoC)WiC specific MoC considerations:• Governance• Service scope and business rules• Clinical requirements• Information technology (including specialist software)• Legislation changes• Workforce requirements (including training)• Building and infrastructure• Communication and marketing requirements.

Phase 3

Development of the Model of Care (MoC)Establishment of 5 Working Groups:• Clinical Services• Workforce• Information and Communication Technology (ICT)• Building and Infrastructure• Marketing

Phase 4

Opening of the service to the community• The first public nurse-led Walk-in Centre opened to the ACT

community on 18 May 2010.

Phase 5

Independent Evaluation• ACT Health has engaged the Australian Primary Health Care

Research Institute (APHCRI) at the Australian National University to conduct an independent evaluation of the ACT Health walk-in centre. This evaluation will provide feedback on the WiC’s effectiveness in terms of its structure, processes and outcomes.

Outcomes to date

The ACT now has:• New opportunities for the community to access timely health

care for minor illness and injury• New ways of using the health care workforce• New ways of using technologies to promote safe and

consistent health care• New types of relationships with a variety of health care

professionals built around the individual needs of the client• A new approach to health care that empowers the client to

seek the right type of health care at the right time.