HEAPHY 1 & 2 PLENARY Michael MACKRILL Fri 30 th Aug 2013 Session 3 / Talk 2 13:50 – 14:10 ABSTRACT In Health Care, Patient welfare is the paramount concern, be that in direct care of the patient, the reduction of unnecessary radiation dose or ensuring the most appropriate diagnostic test or therapy plan is used. This presentation will argue that of equal importance are the systems put in place to support the sharp end of practice, be that hospital information systems, resource management or RISPACS. Often the complaint is made when using electronic systems that this wasnt designed by anyone who has ever done the job, or that this just gets in the way of patient care. When HBDHB selected a RIS, the deciding factor was that it was capable of being configured to meet the needs of the site. This presentation will describe how the patient journey and process mapping methodology was used to design a system that allowed positive enhancements to workflow, providing the end with all appropriate information at their immediate disposal, thus improving patient care through better decision making, and assigning tasks to the appropriate person.

RISPACS, The Patient Journey And Its Part In Patient Care Mike Mackrill RISPACS Administrator HBDHB

Design Objectives As little user input as practicable to complete task Information available to the user at point of need No duplicate entry of information Support best practice Assign task at appropriate level

In Times Past Forms Ledgers Folders/Filing Cabinets and Offices

Nothing has Changed Documentation Screens = Forms Worklists = Ledgers/Files Navigation Bars = Filing Cabinets Roles = Offices

Process Mapping The Patient Journey Follow The Form Map the Task Identify what's needed and when Who does what Identify where the information sits Ideal Workflow Fewer clicks the better

Documentation Screens Replace Paper Forms Collect form that have been used Ask the end user what is needed

Worklists Collections of forms into files; Organize your tasks to your workflow Setup specific worklists for specific tasks (e.g. all CT) Worklists set to specific exam statuses (e.g. Scheduled) Only available to specific roles

Navigation Bars Worklists and Actions Specific to Roles Follow on from each other Fewer the better

Roles Job Title What do you do What should you do What are you allowed to do

Design The System Mock Screens Mock Worklists Mock Roles Give it to the Vendor Test, Test, TEST!

What does any of this have to do with Patient care? Capacity; how do you increase it? Increase Staffing Lengthen the Working day Improve the Physical Environment Improve Support Systems Efficiency!

Design Brief #1 As little user input as practicable to complete task Increase in efficiency Task Completed Faster, More time with the Patient, More Patients Seen No detrimental impact on patient experience

Design Brief #2 Information available to the user at point of need No swapping between systems Less time searching Greater Efficiency Fewer Mistakes Improved Clinical Safety No negative impact on the patient experience

Design Brief #3 No duplicate entry of information Reduced possibility of data entry errors Less Time Taken No negative impact on the patient experience

Design Brief #4 Support best practice Make it easy to do your job Less Time Taken Clinical Safety No negative impact on the patient experience

Design Brief #5 Assign task at appropriate level Clinical Safety Dumping Task Risk Where do you think the work ends up?

Waiting Lists 30 patients a day present, 28 done 1 Week = 10 waiting (half a day) 1 Month = 46 waiting (2 days) 6 Months = 276 waiting (10 days) 12 Months = 552 waiting (20 days)

Consequences

Finally Efficiency is not a dirty word Work smarter, not harder Remove unnecessary repetitive tasks Systems should support best practice

Thanks For Listening