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Victorian Maternity Record (VMR) Pilot – a Change Management project Leanne Holmes 25 th HIMAA National “SEE- CHANGE” conference Four Points by Sheraton.

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Presentation on theme: "Victorian Maternity Record (VMR) Pilot – a Change Management project Leanne Holmes 25 th HIMAA National “SEE- CHANGE” conference Four Points by Sheraton."— Presentation transcript:

1 Victorian Maternity Record (VMR) Pilot – a Change Management project Leanne Holmes 25 th HIMAA National “SEE- CHANGE” conference Four Points by Sheraton Hotel Geelong July 28 th 2005

2 MISSION

3 project plan Plan/ Document DesignConsult Pilot Disseminate / TrainEstablish/Manage Secure host Dec04 Establish project team & management strategies Mar – Aug 04 Establish Reference Group May –Aug 04 M1 M2 M3 Write project plan Apr – Aug 04 Progress Reports Ongoing M4 M5 Initial design criteria written & approved Apr 04 M6 Initial Design Options May 04 M7 Methods approved May – Aug 04 Complete pre Pilot consultation Jun - Dec 04 Consultation during Pilot Feb 05 – Dec 05 M11 M12 Communication Strategy Written & Approved Feb 06 Dissemination strategy developed & approved Feb 06 M20 M21 Sites Agreed & Approved Apr 04 – Nov 04 M14 Survey/ process evaluation completed Jun 05 – Feb 06 Pilot methods sites Jun - Dec 04 M15 Pre Pilot Nov - Dec 04 M16 Pilot Jan 05 – Dec 05 M18 Preliminary site visits Feb 05 M19 M17 Final Draft Dec 05 Pilot Record Dec 04 EHR Plan Feb 06 M8 M9 M10 M13

4 Consultation with women - Consumer Workshops Women carry itWomen carry it Women read itWomen read it Women keep itWomen keep it Consumer- friendly languageConsumer- friendly language 78% of participants agreed it would be useful to carry a hand held record78% of participants agreed it would be useful to carry a hand held record

5 Using the Generic information booklet with the VMR Even non English speaking women thought including booklet about medical tests was useful

6 Consultation with clinicians -Scenario workshop Clinicians test the VMRClinicians test the VMR Identify strengths and weaknessesIdentify strengths and weaknesses Hospital and GP will takes copies for their recordsHospital and GP will takes copies for their records

7 Information booklet Carry Wallet

8 VMR Page 1-4 Women can write in the 1 st four pages : DemographicsDemographics Appointment detailsAppointment details Birth preferencesBirth preferences

9 VMR Instructions for clinician and women Women must consent to carry itWomen must consent to carry it Frequently asked questions includedFrequently asked questions included

10 . Clinician notes p Maternity History and Examination Tests and Investigations Progress through pregnancy Labour & Birth Baby Summary Discharge and Going Home Glossary of clinical terms

11 Progress through pregnancy Giroform high quality carbonless paperGiroform high quality carbonless paper ISO 9001 compliantISO 9001 compliant NCR copies in triplicateNCR copies in triplicate WOMEN KEEP THE ORIGINAL!WOMEN KEEP THE ORIGINAL!

12 Labour & Birth Summary

13 Baby summary

14 Going home

15 Additional Notes Use as progress notesUse as progress notes –antenatal in ER –post natal in ward –GP rooms Pads of 50 in triplicatePads of 50 in triplicate Use writing guardUse writing guard

16 VMR poster Display on doctors/clinic waiting room wallsDisplay on doctors/clinic waiting room walls Reminder to women to bring their VMRReminder to women to bring their VMR

17 pilot process 7 sites Sunshine, Mercy, Angliss, Mildura, Orbost, Kyneton, Seymour health & other professionals midwives, obstetricians, GPs, paediatricians, managers, health information, emergency staff, allied health, interpreters & translators, graphic designers, packaging experts, change management and group facilitation consultants, medico legal, policy/DHS/MSAC, project managers, IT experts, software designers, students, clinical educators, public relations, RANZCOG, ACMI, GPDV, consumer reps women

18 Pilot plan Establish Prepare BeginMonitor Close Establish pilot management strategies Dec 04 - Feb 05 P2 Schedule & timelines Nov 04 - Feb 05 Select Pilot sites Dec 04 P1P1 Set aims and measures Jan – Mar 05 P4 Design Processes Jan – Feb 05; Ongoing P5 Introduce VMR Feb - May 05 P6 Process Evaluation Feb 05 – Dec 05 P10 Final Recommendations Apr05 - Feb 06 P12 Survey staff Dec 05 – Feb 06 P11 P3 Collect data Mar - Dec 04 P7 Consult & inform Feb 05 – Dec 05 P9 Identify and act on issues Mar - Dec 04 P8

19 Process mapping- what stays & what goes? Pre-pilot Map 1 prior to VMR Pilot Map 2 changes after VMR Post Pilot Map 3 final changes after using the VMR over time.

20 Action Research This Pilot is based on what is known as an “action research” improvement method.This Pilot is based on what is known as an “action research” improvement method. The strength of action research is its responsiveness and the ability to turn unpromising beginnings into effective endings by converging on an appropriate outcome over time.The strength of action research is its responsiveness and the ability to turn unpromising beginnings into effective endings by converging on an appropriate outcome over time. The VMR is encouraging pilots to innovate and change their current work practicesThe VMR is encouraging pilots to innovate and change their current work practices

21 Plan, Do, Study and Act cycle (PDSA) The pilot sites are encouraged to apply PDSA cycles to their processes to assist them with learning and reflection. People identify issues and actions. Site teams respond with a plan of action (PLAN).Site teams respond with a plan of action (PLAN). The plan is actioned for a period of time (DO).The plan is actioned for a period of time (DO). This may involve measuring or observing. They study and reflect on the effects (STUDY).This may involve measuring or observing. They study and reflect on the effects (STUDY). They act again. (ACT).They act again. (ACT). PDSA cycles are built around issues identified from the ‘floor’, and from the routine measurement of progress towards aims.PDSA cycles are built around issues identified from the ‘floor’, and from the routine measurement of progress towards aims.

22 Example of an issue: “The VMR is taking longer to complete” could mean??? It takes longer but it is worth it.It takes longer but it is worth it. Consultations were too short prior to the VMRConsultations were too short prior to the VMR Documentation was lacking previouslyDocumentation was lacking previously It takes longer because people are still getting used to it. When familiar it will take less time.It takes longer because people are still getting used to it. When familiar it will take less time. It takes longer because women are asking questionsIt takes longer because women are asking questions It takes longer because the midwives are repeating what the doctor/GP has done.It takes longer because the midwives are repeating what the doctor/GP has done. POSSIBLE SOLUTION: Change to appointment times

23 “Change is complicated by the fact that organizations are social systems whose participants have identities, relationships, communities, routines, emotions and differentiated powers. Thus managers must be alert to how a change will conflict with existing social systems and routines.” Harvard Business Essentials, Managing Change and Transition 2003 Change

24 “The primary difficulty with change… is that it is 10% logical/physical and 90% social/emotional.is that it is 10% logical/physical and 90% social/emotional. No matter how much we try to justify our proposed change with logic...or resources, change is tough because it is primarily cultural in nature.No matter how much we try to justify our proposed change with logic...or resources, change is tough because it is primarily cultural in nature. Cultures are primarily emotional, not logical.Cultures are primarily emotional, not logical. Those of us who value logic like to explain our preferences from a sensible framework but when it all boils down, emotion runs deep.”Those of us who value logic like to explain our preferences from a sensible framework but when it all boils down, emotion runs deep.”

25 Future impact on Health Information Services? Women carry VMR  reduction in clinic preparation time Women keep VMR  reduction in filing space Women read their VMR  less FOI requests Standard forms design (Statewide) reduction in forms design responsibilities for HIM’s NCR Copies kept in medical record  need to review medico legal legislation

26 Leading Change with the VMR THE VMR project is about leading change The VMR project provides an opportunity to change and innovate in the workplace The VMR project identifies staff resistance but also staff readiness The VMR project provides an opportunity for us to step back and look at the way we do things! The VMR has the promise of new vision, streamlining structures and provides a catalyse for people towards a common goal – provision of better health care for our women.

27 The VMR has changed my thinking! Initially I thought : that this was a forms design project – WRONG!that this was a forms design project – WRONG! that only an electronic health record would solve all our paper record problems – WRONG!that only an electronic health record would solve all our paper record problems – WRONG! Women felt empowered in their decision making when having a baby – WRONG!Women felt empowered in their decision making when having a baby – WRONG! I now know: there is a lack of CONSISTENT information available for women about maternity carethere is a lack of CONSISTENT information available for women about maternity care HIM’s should review their role as forms design experts and custodians of medical records.HIM’s should review their role as forms design experts and custodians of medical records. HIM’s should embrace the notion that there is a place for personal hand held records in the future!HIM’s should embrace the notion that there is a place for personal hand held records in the future! change requires greater consideration of the social influences within ourselves and our organisation rather than just the logical influences.change requires greater consideration of the social influences within ourselves and our organisation rather than just the logical influences.

28 Evaluation and findings This pilot is well underway across 7 sites.This pilot is well underway across 7 sites. 1,500 women are carrying the VMR so far.1,500 women are carrying the VMR so far. 95% of woman are consenting to carry it95% of woman are consenting to carry it No lost records were reported in May or June.No lost records were reported in May or June. A final evaluation will be undertaken in February 2006.A final evaluation will be undertaken in February Only after feedback is received from all consumers and staff will a decision be made about whether to implement state-wide.Only after feedback is received from all consumers and staff will a decision be made about whether to implement state-wide. Watch this space!!

29 Thank you: Jo Campbell (03) Leanne Holmes (03)


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