1. “The solutions are not simple…management needs to initiate a strong team effort to develop systems and processes that work but mostly to believe and inspire that it can be done.” NSW Health “Access at NSW public Hospitals-Key Strategies”, October 2003 p.2 Health System Redesign

2. The Power of Three Demand- Capacity- Process redesign - change management Supply, Management & Balance Health System Redesign

3. Why Redesign? Historically Health systems have focused on the problem rather than the process utilised “book case” responses for “here & now” issues “borrowed” responses for other environments spent money without really trying! Health System Redesign

4. Historically Health systems have grafted new processes on to outdated systems reactive to crisis not proactive to core business little appreciation or understanding of the “numbers” Why Redesign? It is not necessary to change. Survival is not mandatory --W. Edwards Deming Health System Redesign

5. Key principles A whole of system strategy - locally owned Staff “preheated” to change & engagement Strong leadership, advocacy & management commitment Excellent local program & project management Utilising front line staff as key designers Resource the effort! Health System Redesign

6. Key Learning’s Lets talk revolution not restoration Know what solutions are “quick” & what takes time Engagement at all levels is key to success Marketing the product Acknowledging the need for flexibility – some solutions may not work & that’s OK, change it to something that does! Acknowledging that “bad days” will still occur BUT they will be less & we will be in control One of the advantages of being disorderly is that one is constantly making exciting discoveries. --A. A. Milne Health System Redesign

7. Common Mistakes Lack of local & overarching leadership Failure to acknowledge the “change readiness” of an area Failure to see past the horizon Having “off the shelf” solutions without customising to the local environment Organisational amnesia tempting the organisation with the “next big thing” rather than sustaining & building upon success NO local executive ownership past solution design Health System Redesign

8. Common Mistakes Failure to resource the effort – access block, patient safety, recruitment & retention all cost the organisation Bending to demands, lack of human capacity and a “changing the deckchairs” attitude Cherry picking solutions Failure to acknowledge redesign is hard work! & there will be push back! It is common sense to take a method and try it; if it fails, admit it frankly and try another. But above all, try something --Franklin D. Roosevelt Health System Redesign

9. Recipe for Success Build solutions for your environment Utilise external redesign experts Live it, breathe it, believe in it Find a driver, a dreamer and a doubter – use them as your leadership team It doesn’t “finish” Make it simple not sexy Make it “local”but consistent, we are not as “special” as we would like to believe! Health System Redesign

10. A word on using external expertise WE OWN The program, the projects, the system The problems The solutions The relationships The structure & the focus The responsibility for spread & sustainability Health System Redesign

11. A word on using external expertise THEY OWN The methodology THE PARTNERSHIP PROVIDES A new way of doing things The ability to up skill our managers Opportunity to involve front line staff in a new way Health System Redesign

12. Does it really work? An example Nepean Hospital 350 beds Regional Trauma Centre Presentations >42,000/yr 16% increase in admissions 7% increase in ambulance presentations 8% increase in presentations BUT Access Block continues to decrease following redesign: 03/04 51% 04/05 40% 05/06 (ytd) 32% Health System Redesign