kylie lindsay, queensland health: adopting a whole of state approach to reduce surgical waiting...
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Kylie Lindsay, Manager – Surgical Improvement Program, Queensland Health delivered this presentation at the 2013 Elective Surgery Redesign Conference. The National Conference focussed solely on assisting Australian Hospitals to meet the National Elective Surgery Target, including: Streamlining Surgical Pathways Improving Access & Patient Experience Reducing Waiting Times Incorporating Latest Technological Innovations For more information on the annual event, please visit the conference website: http://www.healthcareconferences.com.au/electivesurgeryTRANSCRIPT
Presented by: Kylie Lindsay Manager, Surgical Improvement Program, Department of Health, Queensland
Department of Health
2nd largest state 3rd highest popula2on ¼ Australia’s land mass
1/3 Australia's indigenous popula2on
64% popula2on live outside Brisbane greater metropolitan area
17 Hospital and Health Services
Category 1 89% 89% 100%
Category 2 81% 77.1% 87%
Category 2 91% 88.7% 94%
Category 1 0 87 0
Category 2 67 137 45
Category 2 61 136 41
current state
If we just go for Part 1 and treat the in-‐2mes….
The only way to achieve Part 1 and Part 2 with our exis2ng long wait situa2on is to go for Part 2 (poten2ally at the expense of Part 1) and aim to achieve both Part 1 and 2 in the out-‐years
To do this, we must:
1. treat the longest wai2ng 10% cohort 2. then con2nue to treat from the end of the list to
reduce the average overdue days
If we go for Part 2 and treat the long waits first….
If we go for Part 2 and treat the long waits first….
Then we can maintain Part 2 achievement and go for Part 1….
Performance Management Framework Data repor2ng and monitoring
Inves2ng in increased surgical ac2vity Enabling technologies to improve performance
Fostering innova2on and redesign Strengthening clinical engagement
Performance Management Execu2ve Commi^ee (PMEC)
Rela2onship Management Group (RMG)
Deputy Director General mee2ngs
Escala2on process
Performance accountability
Outcome focused
HHS SLAs: − KPI 1.5: reduce the number of long wait category 1s (related outcome)
− KPI 2.5: treat elec2ve surgery pa2ents in turn (ac2on)
− KPI 2.6: shorter maximum wait for elec2ve surgery (outcome)
− KPI 2.8 – reduce the number of long wait category 2s & 3s (related outcome)
Hospital performance website − h^p://www.health.qld.gov.au/hospitalperformance/
Suite of reports − ESMPR
− Vital Signs − Checklist
At the end of each month, iden2fy longest wai2ng pa2ent in the state and liaise with site to ensure pa2ent is booked for surgery
At the end of each month, liaise with each site re theatre dates for 10% cohort pa2ents, and if an2cipated unable to treat, arrange treatment at alternate facility.
Iden2fying the largest number of long waits by facility enables the DoH to iden2fy areas for targeted investment.
Enable sites to monitor YTD elec2ve surgery ac2vity against NEST Part 1b requirements.
85% of pa2ents treated in 2me despite this not being a focus for Queensland in 2012.
Individual facility Individual specialty Individual surgeon
Longest wai2ng pa2ent NEST performance Treat in turn
Accountable for individual performance
Iden2fies categorisa2on alignment with NSW guidelines
Iden2fies if in 2me pa2ents in a lower category where treated before a higher urgency category
Iden2fies what propor2on of pa2ents were treated in turn
Iden2fies the longest wai2ng 2meframe for each specialty
Iden2fies what the 2meframe would be if 60% of pa2ents were treated in turn
Orthopaedic wait 2mes (long procedures) 40 months (status quo)
12 months (treat in turn) 8 months (treat in turn and standardised categorisa2on)
Iden2fy demand − Long waits by facility and specialty
Iden2fy cause − Wait list management processes − Demand/supply imbalance
Targeted investment − Addi2onal internal capacity − External outsourcing -‐ encumbered − External outsourcing – open market
Surgical Equipment Program − Business Rules developed − EOI process − Demonstrate increase in surgical ac2vity or establishment of new service
Opera2ng room management informa2on system (ORMIS 7) − 38 hospitals − Improve standardisa2on − Statewide benchmarking and repor2ng
Electronic surgical booking form
Short Message Service (SMS) − Outpa2ent appointments − Surgery date reminders (trial)
Improved pa2ent experience Is PAC required? Ready for surgery?
Iden2fied reasons for delays in OT start 2me Consent not signed Equipment
Availability Improved discharge planning
Scalpel The Produc2ve Opera2ng Theatre (TPOT) Queensland Ins2tute of Clinical Redesign (QuICR) Local Redesign Prac22oners
Annual Redesign Forum Showcase local projects Spread the word
Selec2on criteria methodology 9 sites – 90% long wait pa2ents Funding for site project leads Op2on of consultancy firm
Redesign support officer from the DoH/CARU
30 weeks Cohort 1 (4 sites) to finish December 2013 Cohort 2 (5 sites) to finish June 2014
4 cohorts − Surgical − Medical − Mental Health − Integrated care
129 par2cipants 17 Chief Opera2ng Officers
82 redesign projects Increased local redesign capability
SWAPNET – Periopera2ve NUMs
Elec2ve Surgery Coordinators
State-‐wide Surgical Advisory Commi^ee
Standardised Categorisa2on Advisory Panel
Suitability screening – ASA – BMI
– Mul2ple comorbidi2es – Age considera2ons – Support at home – Distance from hospital
– Psychological
Criteria led discharge
Standardisa2on of processes
Roles and responsibili2es
Wait list management processes
What reports to run
Frequency Repor2ng lines
Enables repor2ng and escala2on of issues
Captures emergency surgery ac2vity
Assists DoH with decisions regarding targeted investment
Category 1 89% 89% 100% 95%
Category 2 81% 77.1% 87% 77%
Category 2 91% 88.7% 94% 80%
Category 1 0 87 0 23
Category 2 67 137 45 145
Category 2 61 136 41 121
34% decrease in UC 2 long waits
Reduc@on of 2,000 long wait pa@ents YTD 2013 (31%).
23% decrease in UC 2 long waits
Kylie Lindsay Manager
Surgical Improvement Program
Clinical Access and Redesign Unit
Department of Health Queensland
[email protected] Phone: 07 3646 9768