1. The Health Roundtable 3-3b_HRT1215-Session_MILLNER_CARRUCAN_WOOD_ADHB_NZ Orthopaedic Service Excellence – Implementing Management Operating Systems Presenter: Sandi Millner Health Service: Adult Orthopaedics, Auckland District Health Board Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012 1

2. The Health Roundtable KEY PROBLEM  The New Zealand national elective service performance indicators require services to have no patients waiting for first specialist assessment or surgery longer than 5 months by June ‘12 and 4 months by June ‘14.  There will be significant financial penalties incurred by Auckland District Health Board if there is not 100% compliance to the elective service performance indicators.  Adult Orthopaedic Services was seeking a way to:  Support leaders to understand their performance  Help leaders to meet their targets  Build effective teams to sustain improvement.  Adult Orthopaedic Services at Auckland District Health Board has seen significant growth in demand for elective surgery, while demand for acute services has remained flat during 2011/12. 2

3. The Health Roundtable AIM OF THIS INNOVATION  Key Aim: To have a system of having performance improvement work aligned with strategy deployment. Essentially we needed to have confidence that our teams had a supportive structure to deliver results that was:  Aligned  Visible  Responsive.  A requirement of this system was to enable the bringing together of information, forums and work practices to support effective decision-making.  The Service Excellence programme focuses on the end to end patient experience. There was a need for Orthopaedic leaders to see the whole patient journey and develop competency in sustaining continuous daily improvement. 3

4. The Health Roundtable BASELINE DATA  Improvements gained in the last 18 months were:  17% increase inpatient discharges on previous year  12%decrease in average outpatient clinic appointment costs – saving $583 000  70% of patients with fractured neck of femurs were arriving in surgery: compared to 40% 18 months prior  Average length of stay in orthopaedic wards had reduced by more than two days  15% increase in number of patients attending outpatient clinic  90% patients arriving in wards from hospital Emergency Department: compared to 45% 18 months prior. 4

5. The Health Roundtable KEY CHANGES IMPLEMENTED  Strategy deployment  A ‘mother’ A3 report outlines how Adult Orthopaedics will continuously improve the provision of timely care to patients and best patient and staff experience, tracking operational performance  An 180/90 day plan defines timeframe and resource  Drivers and Measures  A score card illustrates areas of focus and targets that Adult Orthopaedics seeks to shift its performance  Decision Making Forums  A Weekly Production Meeting supports utilisation of theatre, patient accessibility to Clinician, and drives the delivery of elective surgical performance indicator compliance  A Management Operating System(MOS) fortnightly meeting increases visibility and responsiveness of Key Performance Targets, increases awareness of system wide activities and projects, and escalates and agrees action for key issues, risks and opportunities. This benefits Adult Orthopaedics and Auckland District Health Board to deliver and align strategy and respond to new challenges  Preparing roles and responsibilities  Daily Leader Standard work supports clinic and ward focus to develop problem solvers.  Continuous improvement events 5

6. The Health Roundtable KEY CHANGES IMPLEMENTED cont…  These Overarching Principles informed the implementation:  “Status at a glance” – increase visibility and transparency of performance  “Action” – a drive towards ‘Concern, Cause, Countermeasure’ thinking  “Discipline” – clearly defined roles and accountability  “Alignment” – improve alignment across patient services and wider organisation  “Purpose” – focusing on leading and managing the organisation  “PDCA” – ongoing review and improvement 6

7. The Health Roundtable OUTCOMES SO FAR Define the goal to reduce number of patients waiting for surgery While Average length of stay reduces in Ward 75 & 77 – there is no increase in patient readmission rate. Step change in improvement as goal is redefined 7

8. The Health Roundtable LESSONS LEARNT  An essential step change occurred when Orthopaedic leaders defined the key goals, and subsequent measures to evaluate progress. Efficiency measures previously aligned to organisational productivity were redefined to align to the experience of all patients. E.g. A step change from “Bed requests from Emergency Department will be 30mins for an inpatient bed, once bed is requested”  Problem-solving techniques that employ ‘Concern, Cause and Countermeasure thinking’ utilise the expertise of health care team members and patients.  Monitoring of Key Result Areas guides everyone towards same purpose and ideal – particularly when targets are achieved.  Amongst a background of well intended change and improvement, a Management Operating System (MOS) is changing the way we manage and lead the Orthopaedic Service.  This strategy further supports how visual management, assists healthcare teams to communicate how and what to continuously improve; team members are able to make sense of multiple priorities.  Essentially health teams are better positioned to prioritise and pursue improvement. 8