The Health Roundtable

<Improving Ambulatory Oncology Services >

Presenter: Margaret HarleyHealth Service: (Melbourne Health)

Innovation Poster SessionHRT1215 – Innovation AwardsSydney 11th and 12th Oct 2012

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KEY PROBLEMS

Patients were waiting for excessive periods prior to their appointment (in the waiting room), and again in the Day Centre itself during their treatment.

Inefficient processes (e.g. duplication, delays, lack of standardisation).

Staff dissatisfaction with the Day Centre physical environment (e.g. lack of privacy, insufficient space)

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AIMS OF THIS INNOVATION

Reduce waiting between appointment time and treatment at Day Centre

Reduce % of ‘non-value add’ activity during treatment episode

Improve patient and staff satisfaction with physical environment

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BASELINE DATA

Wait time

% of ‘non-value add’ activity

Staff satisfaction with physical environment

24020016012080400

Median

Mean

454035302520

95% Confidence Intervals

Summary for Waiting time from Appt

21.88% patients waiting over 60

minutes

Median = 30 minutesTarget Median = 25 min

Average of 26% ‘non value add’ activity across 27 patients

trackedTarget Mean = 15%

Mean staff score 1.8 (n= 27)Target Mean > 2

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KEY CHANGES IMPLEMENTED

1. Transfer of pathology tests from the ward to outpatient pathology services Saving of 660 mins of chair time per day Pathology is now completed by Melbourne Health Pathology

Services (including Hickmans, PICCs and port access) 2. Development of triage guidelines

Medical staff (Haematology & Med Oncology) worked collaboratively to develop a set of triage criteria

This allows for even distribution of appointments based upon clinical need

3. Environmental modifications 5S, painting, re-arrangement of furniture, standardisation, visual

management

Before After

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KEY CHANGES IMPLEMENTED

4. Implementation of a new booking system (BookWise Oncology) Provides data for several key performance indicators

allowing benchmarking between services and improved analysis

Improved visibility of available appointments allows better distribution of bookings

5. Introduction of a central pager for communication of chemotherapy readiness Nurse in charge of each shift carries and serves as

key point of contact for sterile pharmacy, therefore increasing efficiency and decreasing interruptions

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OUTCOMES SO FAR Significant impact on improving patient waiting times Improved communication of chemotherapy readiness Transfer of pathology tests to outpatient pathology therefore

ensuring maximal best use of ‘chair time’ Development of triage guidelines to support clinical

prioritisation of bookings Environmental modificationsKey Measure Baseline Stage Data Target Control Stage Data

Wait time Median = 30 mins

Median = 25 mins

Median = 14 mins

Staff satisfaction with environment

(1= Poor, 2 = Adequate

3= Good, 4= Excellent)

Mean score = 1.8

Mean score = 2.0

Mean score = 2.2

% of ‘non value add’ activity

Mean = 26% Target Mean = 15% Target Mean = 8.58%

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LESSONS LEARNT

Great rewards in working collaboratively with process owners

Small changes can have major impact Consumers enjoy being asked for their input and

can have great ideas IT solutions can take a very long time to

implement

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