Healthcare

Outpatients improvement

Healthcare

Outpatients improvement

This client operates a large hospital in Australia and provides state-of-the-art medical care to a large metropolitan area. The hospital employs more than 7,200 staff and treats over 650,000 outpatient a year.

The hospital is currently undertaking a major service redesign programme known as TEMPO. The Tempo programme has a number of key targets to develop, implement and evaluate sustainable solutions to improve access to and experience for patients through:

Achieving 80% of the National Emergency Access Target (NEAT) for general medical patients (patient discharge within 4 hours). Reducing the average length of stay by five per cent for acute medical patients. Reducing outpatient waiting lists by redefining referral pathways. Build a redesigned workforce by up-skilling the project team, key clinicians and staff involved in the project in the principles and methodology of clinical service redesign.

Results

Improved patient satisfaction: 92% of patients wait less than 3mins to check in and 84% have no wait to check out from Outpatients. “Simple changes make the biggest difference”
Change in Letter Suite, incorporating double-sided printed resulted in an estimated saving of $21,000 per annum recurrent
Patient experience: 100% of patients now rate their experience in CSOS as ‘Good’ or better (‘Excellent’=84%). “Both staff and patients get excited about improved results.”
Reduced waitlist: 7% reduction in Review patients seen by a Consultant. 3% increase in Slots available for Plastics patients per month
Reduced Data Processing: Interim stage of correcting consultant templates to current working practice has released 290hrs/ month of additional clinic time
Plastics patients, increase in clinics time from 2 days per week to four. Patients will receive Standardised care

Observations

Cancellations (both Patient and hospital initiated) have increased substantially over the past 12 months from approx.. 15% to 25%. 29.5% of these cancellations are hospital initiated.
Mismanagement and lack of accountability results in poor clinic utilisation, and poor patient satisfaction in terms of wait.
Outpatients has excessive hospital initiated cancellations and low staff satisfaction.
Lack of visual management results in individuals not knowing their targets, not being held accountable and a lack of transparency across the department.
Targets are not set and met, and therefore there is no culture of continuous improvement.
Staff are not empowered to make decisions that affect and improve their workplace.
Clinics are consultant led, therefore consultant capacity is not maximised for complex quaternary/ tertiary patients, which is impacting on overall wait list.
Patient queue for long period at Outpatient front reception (>14mins at peak times of day).
‘Batching’ of patients into 1 clinic rather than streaming into more clinics resulting in clinic flow delays and access issues.
Follow-up calls to patients to confirm an appointment known as a DNR is estimated to cost
$42,000 per month excluding Medical Officer costs).
Administration staff dissatisfaction and stress impacting on process adherence.
Time wasted and cost associated with recalling charts to complete patient check in and check out processes.
Appointment times for review patients are an average of 24 mins against a template time of 15 minutes. Net effect of this is 768 patients we could be seeing if we spent 15 minutes instead of 24 minutes.
Appointment times for new patients are an average of 19 mins against a template time of 30 mins.
New and review do not balance out.
Outpatients are not meeting the standards of Cat 1, Cat 2 and Cat 3.
Current activity is however sufficient to meet demand.

Objectives

Developed a Current State Value Stream Map from arrival to discharge.
Identified problems/issues and bottlenecks preventing the smooth and timely flow of patients through the pathways, that were transferred onto the VSM’s.
Collected and analysed supportive data for waitlist.
Initially 6 projects and 33 countermeasures were identified to achieve the key outpatient department objectives.
Created PMO walls for project control and to provide transparency for the improvement process.
Developed visual management systems for Outpatients to help change poor behaviour and drive performance.
Coached the core team during all phases of the project and carried out audits of their lean knowledge.
Developed a comprehensive schedule of activities for all the Outpatients improvement projects and individual project control board in the working area.
Delivered a full suite of training, transferring knowledge to the core team at the appropriate moment during the project timeline.

Actions

Knowledge transfer has been very successful.
Where there has been good clinical engagement, projects have reached the trial and evaluation stages more rapidly.
Simple Lean methodology does and can work, providing robust solutions to issues.
Despite significant management changes, on the whole the project teams have made reasonable progress.
Non clinician engagement was very good; most staff were very keen to make positive changes and had a number of improvement ideas.
The team is now looking for improvements beyond the bounds of the original project.
Communications, understanding of roles and cooperation with external providers has been enhanced due to the nature of some of the projects.

Healthcare