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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.
What has this been about?
 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.
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
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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