1. Health Innovation Exchange
Dr Tony O’Connell
Director-General
Queensland Health 1

2. Qld OOS
Occasions of Service delivered in Queensland graph (Total occasions of service from 2008/09 to 2010/11)
Some ability here to discuss the differences between the way Queensland commit to delivering outpatient services in comparison to other states

3. Queensland OPD waiting lists
Despite providing this high volume of activity, Queensland continue to struggle to meet demand with our waiting lists. Some of these patients are waiting on lists for periods of up to 7 years….delayed treatment in the ambulatory setting is an important patient safety problem resulting in what we know can be:
delayed diagnosis for life threatening conditions eg. Bowel cancer
Unnecessary disease progression eg. Glaucoma (which ultimately creates more costs for the patient and the health system)
Negative impact on quality of life

4. Queensland Context
Qld is very transparent and publically reports the number of patients waiting for a new specialist OPD appt. The graph is the results of the March manual count, which is a snapshot in time and shows that the majority of people waiting are Category 2 and Category 3 patients – considered to be non-urgent.

5. What do we need to do to improve the delivery of services for patients?

6. Services designed around pt needs- Patient flow core principles
Improving the patient journey
Increasing access to services
Delivering best practice
Enabling principles
Promoting
innovation
Delivering process improvement
Effectively engaging
Providing leadership
Driving accountability
System-wide priorities
Efficient use of emergency department resources — Patients should only stay in the emergency department for the minimum time needed to safely assess, stabilise and transfer care or discharge home safely. ED stay should be less than six hours for admitted patients and even less for non-admitted patients.
System-wide governance — Patient flow is a system-wide issue affecting the entire facility and requires commitment and leadership of the hospital executive, with cascading responsibilities throughout the organisation.
Appropriate bed management practices — Active bed management assists with the delivery of quality care and hospitals should ensure that policies, procedures and governance arrangements are in place to support this practice.
Efficient discharge processes — Estimated dates of discharge (EDD) improve patient management and the patient’s journey. Patients should have a discharge date estimated early in their admission.
Identifying patient flow problems — Diagnostics help identify patient flow issues and select interventions. Hospitals need to understand their problems and underlying causes before initiating solutions.
Measuring and monitoring performance — An operationally sustainable process for evaluating and monitoring performance is necessary to ensure accountability and appropriate action.

7. Imperatives/Principles
Developing a culture within the system which focuses on improvement of the patient journey and experience
Promoting openness and accountability regarding Qld Health performance and working with general practice to design joint solutions
Spreading and sustaining redesign, innovation and good performance

8. Outpatient Flows 1 2 3 4 Managing demand Building capacity Discharge
Today is about LHHN’s/GP and QH working together to support innovation which provide a better service for patients. In the 4 key areas of outpatient flow, there are infinite possibilities which may be achieved through partnership models.
1. To manage demand
The development of clear referral criteria to support the referral of the appropriate patients to QH OPD departments
Reporting transparently about the possible waiting times so that patients and GPs can make informed choices about where to access care
Better managing patients when they are in the system by developing innovative models of care
Shared care models with GP’s and allied health providers
Innovative projects with GPs who may wish to work within the OPD system supporting specialists eg. Metro North GP project
Discharge
The following slides…..
We know that 75% of all OPD appointments are for review patients
We know that from the auditing that we have done many of these patients return for no change in their plan of care or medications…..we need to increase discharge of these patients back to their GP for more appropriate comprehensive management of their condition
What do QH need to do to support GPs to be able to manage this cohort of discharged patients? 3 4
Discharge
Service delivery models 8

9. Transparency and reporting
Promoting transparency regarding the way Qld delivers health services to both patients and clinicians
Only two states in Australia currently report on their ability to meet outpatient demand - WA and Queensland
Reporting transparently about the possible waiting times so that patients and GPs can make informed choices about where to access care

10. Delivering process improvement
This graph displays the Statewide breakdown of new and review patients OOS between 2008/09 and 2010/11. It is
In 2010/11, the proportion of new patient OOS was 24% and the proportion of review OOS was 76% .

11. Chart Audit of Clinic
There is scope to improve outpatient service delivery and increase capacity for new case appointments to be seen. A chart review recently undertaken in a specialist outpatient clinic has revealed some interesting findings. For example, the audit identified that of the total number of appointments, 26 percent of patients did not need to return for review, and 39 percent failed to attend their clinic appointment. Therefore, the chart audit demonstrated that 65 percent of clinic time was consumed with non-value added activities. This information is a powerful tool for clinicians to understand service delivery constraints and identify opportunities for improvement.
How can General Practice and QH work together to support improved utilisation of this valuable resource? 11

12. Health Reform will support innovation to provide improved access to care
Local Health and Hospital Networks accountable to both community and Government
Clinician and consumers decide how resources are best allocated
Decision making regarding resource allocation is devolved to LHHN’s with increased accountability for performance to the Government and community. Each LHHN will be an independent statutory body run by its own Governing council. Local decision making will be strengthened by requiring LHHNs to have strong clinician, consumer and community engagement to ensure decisions are responsive to local needs and priorities.
LHHNs will be responsible for aligning the mix of services provided to local needs and priorities. It is expected that LHHNs will have the flexibility and incentive to innovate and to pursue quality, efficiency and improved integration across the health system.