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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
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