1. The Health Roundtable Demand Escalation Planning Presenter: Karen Caldwell : Calvary Healthcare ACT Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012 1 1-1a_HRT1215-Session_CALDWELL_CALVARY_ACT

2. The Health Roundtable KEY PROBLEM  Ineffective Demand Escalation Planning Systems & Processes  ‘Poor Confidence’ = ‘Non-functional’  Unit based escalation plans with no central point of co-ordination  Poor understanding of existing escalation plans  Departmental level  Organisation-wide  Poorly defined response  Roles, Responsibilities, Accountabilities, Governance Escalation Points  Including communication  Purely Reactive, no Strategic Focus  End-stage counter-options / Crisis management  Elective surgery cancellations  Ambulance bypass 2

3. The Health Roundtable AIM OF THIS INNOVATION  To design and implement a functional Demand Escalation Plan (DEPLAN) with operational ‘confidence’  A high operational overview rather than ‘unit’ based planning  Easy to understand, communicate and apply  Involves a strategic component in assessing operational ‘stress’  Has a forward trigger point identification with quick response time  Clearly defined and articulated response matrix  Defined actions with outcome objectives  Line of responsibility & accountability  Integrated into daily operations – part of ‘daily business’ 3

4. The Health Roundtable BASELINE DATA  Qualitative data: Interviews, snap-shots, tag-a-longs  Recurring theme in diagnosis phase of ‘Every Patient in Four Hours’ Access Improvement Program – recognised requirement for structure escalation planning  Recommendation in the Access Improvement Program Solutions Design Report to: ‘Establish a new format for identifying hospital status, escalation triggers, responses, actions and responsibilities’ 4

5. The Health Roundtable KEY CHANGES IMPLEMENTED  Identification of four key whole of organisation indicators of operational ‘stress’, including a strategic (forecast ) element  Indicators based on patient flow methodology 1. Number of admitted patients in the emergency department awaiting a ward bed (service access) 2. Number of patients who remain in hospital for non- medical reasons (service exit) 3. Clinical staffing shortfalls (HR capacity) 4. Forecasted ‘Capacity Gap’ – Predicted Demand vs Capacity (Strategic: Bed Capacity)  Indicators are applied to a risk matrix and assigned a score (based on incident reporting – familiar to organisation) = “DOP Score”  Four individual scores are tallied to provide an operational escalation rating (Green, Amber, Red, Black) DEPLAN RISK MATRIX 5

6. The Health Roundtable KEY CHANGES IMPLEMENTED  Rating linked to an Action & Objective Table  Actions, Roles, Responsibilities, Accountabilities, Governance Escalation Points  Customised operational daily plan depending upon relative contribution of the four indicators  Prioritise resources to ‘problem’ areas  Communicated to senior hospital managed via email/mobile device following Daily Operational Planning Meeting (DOP) – Mon-Sun 6

7. The Health Roundtable OUTCOMES SO FAR: Quantitative & Qualitative Quantitative  Improved average weekly DEPLAN rating from ‘Amber’ to ‘Green’  Improved objective measures for each of the three clinical indictors  Number of admitted patients remaining in ED awaiting bed allocation  Clinical staff shortfalls  Reduction in delayed discharges due to non- medical reasons  Achieved on background of increased organisational activity  18% increase in elective surgical case-load compared to same period 2010  12% increase in ED activity skewed towards increased acuity compared to same period 2010 Qualitative Assessment post implementation phase to ascertain staff agreement/disagreement in the project implementing the DEPLAN, achieving its intended outcome On a scale of 1 – 5; “strongly disagreed” to “strongly agreed”, respectively: Staff response was not ever below a score of 2 = “agreed” 7

8. The Health Roundtable OUTCOMES SO FAR: Identified Trigger Points 8

9. The Health Roundtable LESSONS LEARNT General  Define the problem  Know and maintain your vision and objectives, and communicate these concisely and clearly  Ensure robust change management processes Specific  Customise indicators for your organisation  Use familiar systems¹ to design and implement change (matrix/culture)  Takes time for the ‘objective’ to fit the ‘subjective’; matrix will require fine-tuning ¹Based on & linked to local Hospital Emergency Plan (HEPLAN) – which had previously been awarded ACHS recognition 9