A View from the "front line" Implementing Changes that make a Difference

1
A View from the "front line"- Implementing
Changes that make a Difference

• Charlotte Milner
• Access Strategy Coordinator
• Royal North Shore Hospital

2
The Stretch Goal (or dream)

• To achieve a reduction in key performance
  indicators (access block, restricted access and
  off stretcher time) in order to aspire to
• Fairer access
• Quality health care
• Better value
• Job satisfaction

3
Access Block was heading the wrong way..
4
As was the amount of hours spent on restricted
access.
5
Key to Planning the Change

• TOP-DOWN BOTTOM-UP approach was undertaken
  (supportive encouraging involvement) including
  consultations with

• Skilled valued workforce
• Community engagement
• Working partnerships across departments
  professions
• Informed decision making
• Embrace innovation change

6
A Patients Journey Experiences(process
mapping)

• Identify value identify waste
• Multidisciplinary involvement
• Brainstorm ideas
• Individual consultation
• Workshops
• Focus groups
• Give permission to change
• Understanding of cynicism

7
A Patients Journey Experiences(process
mapping) cont.

• Look at the flow from the point of the customer
  - patient journey focussed- easy, comfortable,
  safe, quality
• Trial journey after mapping has been completed
  to see how it feels
• Identify duplication of effort across professions
  bottlenecks/ waits/ queues, e.g. MH or
  documentation

8
Bottlenecks on a Patient Journey Through RNS..
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
Any process has numerous areas that can be
Identified as of in need for changeThat is
the easy part
14
Challenges for Change

• Is the change going to improve our healthcare
  provisions or is it a trend?
• Understanding ownership by key stakeholders
  regarding benefits of change
• Initial project funding team disappear
• Sustainability appears as an after-thought rather
  than as an initial goal
• Infrastructures for change incomplete why do we
  make things so difficult?

15
Challenges for Change cont.

• Whole system change knock on effect on
  processes, structures patterns of healthcare
  e.g. patient journey
• Other activities e.g. mergers, change of
  leaders
• Training development of new skills
• Alignment with core values strategy of
  organisation
• Resistance why we cant vs. why cant we
  e.g. ward layout

16
Risks of Sustainability Spread

• Improvement evaporation effect lack of
  sustainability, where the old familiar ways have
  crept back in as behaviours have stayed the same
  and champions may have moved on
• Islands of improvement great changes
  happening but in isolation, local or national,
  e.g. different facilities achieving gains but no
  one knows about them

17
What Is Sustainability?

• New ways of working improved outcomes become
  the norm
• Attitudes thinking behind altered processes
  have fundamentally changed
• Mainstream rather than added-on
• Continuous improvement in local context
• Holding on to gains

18
Example Rehabilitation Referrals

• Detailed information required by rehab. providers
  pertaining to condition, private cover, goals etc
  prior to transfer
• Form designed to fax as soon as identified
  appropriate record kept
• Fax system will be replaced with electronic
  version, enhancing coordination efficiency
• Appointment of rehabilitation coordinator
• Establishment of a patient flow unit

19
Improving Chances of Sustainability

• Clear benefit to stakeholders
• Training education
• Build in ongoing measurement
• Make it mainstream
• Celebrate, review set the bar higher
• Communication
• Executive clinician involvement

20
What Is Spread?

• Learning change principles adopted by others
  who may benefit across departments
• Actively sharing acting upon changes to improve
  knowledge, processes care
• Spread encourages diversification from original
  change principle adaptation to new environment

21
Adopting Good Ideas

• Encourage change principle rather than solution
• Observe changes in action
• Cohesiveness with current values and culture
• Communication empathy
• Tailor message to audience
• Infrastructure for spread
• Mandated or legislated change

22
Example Dashboard KPIs
23
Key Factors for Success..

• Measurement of key performance indicators
  (accountability)
• Senior management support (visibility)
• Local identification of change (personalise)
• Accountability framework
• Constant effort to embed change (truly hard work)
• Constructive collaboration with employees (local
  ideas will work, those imposed wont)

24
Key Activities for Frontline Success

• Process mapping of a patients journey
• Whats in it for me? diagnosis
• Seek to understand cynicism its all been done
  before
• Encourage refinement of ideas to create workable
  solutions ownership
• Work with values beliefs culture values
• Continued leadership direction, stability
  permission to change

25
Access Block trending towards state target
26
Time waiting for appropriate in-patient bed
decreasing
27
Restricted access reducing
28
ED LOS has halved
29
Whilst activity via ED increases.
30
Todays sustained change becomes tomorrows
resistance to changewe must attempt to achieve
change that is sustainable until a better idea
occurs