Time based targets five years on: The WA perspective

and other lessons.

Dr Mark Monaghan

What has this been about?

Enhancing access to care for acute patients and making access to care a central component of excellent clinical care.

Replacing processes that are burdened with waste and protectionism, and thereby reducing morbidity, length of stay and mortality.

Creating a more effective system to cope with increasing demand.

Instilling the concept that hospital beds are a valuable resource that we as clinicians have a responsibility to utilise in the most efficient way possible.

What has this been about?

Key achievements – WA Program

Implementation of large scale, statewide change program

Establishment of redesign capacity across the system

Invested over $40M in solutions Leading the nation in emergency access reform

Where are we now?

In terms of numbers and targets, the WA State NEAT performance in high 70‘s, with our tertiary site performance stalled or deteriorated slightly.

Where are we now?

From a hospital clinician perspective it has created an improved work environment that persists despite challenges in maintaining tertiary performance.

The concept of the need to flow patients efficiently has been embedded to a significant degree. It is part of our language now.

A quick scan of the data

Presentation numbers compared to ED hours of care

Access block and mortality

Beds saved for ED presentations at Tertiary hospitals

What happened in 2012?

Transition from project teams to hospital executive ownership.

Consequent lack of drive of solutions and solution review.

Significant ED demand. Ministerial focus on NEST.

So what did we do about this performance trajectory?

We attempted to rally managerial and clinician engagement, however we were struggling to know where to start.

The Minister for Health commissioned an external review –The Bell Review.

The Bell Review

Daily accountability /core business Data Bed management structure/ outliers/ the

clinician’s role Consultant lead service-weekend performance Align multi-professional teams for timely

treatment and decision making ED discharge stream perfomance, decreased

patient moves within ED.

The Bell Review

Capacity audit analysis. 25-30%, half of which is under hospital control.

Simplified points of access to specialties. Acute unit structure and staffing. “a safe haven”,

with focus on inclusion rather than exclusion criteria.

Appropriate IT solutions

The Bell Review

Essentially, the take home message was that if you want this to be successful, you have to get serious and run it like a professional business should run.

What has happened since

Executive restructuring was already occurring in several of our tertiary sites. This is occurring across all tertiary sites now.

This includes leadership training, greater time allocation to divisional heads, JDF changes to incorporate NEAT accountability (eg FSH).

What has happened since

Bed management disassembling and increased clinician involvement.

Services to provide seven day structure –endpoint being equivalent discharge rates to weekdays

Data/CapPlan utilisation for daily clinician bed management.

Some real accountability and ownership is being seen at a hospital level.

Some general observations to consider

ED versus Inpatient reform. Flogging the discharge stream The admission stream dilemma. Direct admissions, inpatient occupancy and the

core role of the ED The future of NEAT The ministerial drive effect

Thanks