1. Time based targets five years on: The WA perspective and other lessons.  Dr Mark Monaghan

2. 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.

3.  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?

4. 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

5. 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.

6. 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.

7. A quick scan of the data

9. Presentation numbers compared to ED hours of care

10. Access block and mortality

11. Beds saved for ED presentations at Tertiary hospitals

13. 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.

14. 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.

15. 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.

16. The Bell Review  Capacity audit analysis. 25-30%, 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

17. 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.

18. 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).

19. What has happened since  Bed management disassembling and increased clinician involvement.  Services to provide seven day structure – endpoint being equivalent discharge rates to weekdays

20.  Data/CapPlan utilisation for daily clinician bed management.  Some real accountability and ownership is being seen at a hospital level.

21. 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

22. Thanks