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.

 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. What has this been about?

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 %, 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