Many organisations keep the secrets of their success hidden. However, a group of Victorian health services are doing just the opposite, and are reaping the rewards through shared learnings and experiences.
Public hospital staff across Victoria work tirelessly to deliver the best patient care possible. While each hospital has a unique patient profile, and its own specific challenges, a group of hospitals are working collaboratively towards significant and sustainable improvements in emergency care access, and better patient outcomes.
The Improving Emergency Access Collaborative
Countless studies have shown that the wait in an emergency department has a direct impact on patient outcomes. In a bid to achieve reduced waiting times, the Improving Emergency Access Collaborative (the Collaborative) was established. This 12-month initiative began in October 2016, and is a partnership between health services, Better Care Victoria, and Health Service Policy and Commissioning—within the Department of Health and Human Services.
Working with 11 Victorian health services, the Collaborative aims to achieve a length of stay in emergency departments of four hours or less for 81 per cent of patients. This means patients are either discharged or admitted within four hours of presenting at the hospital, 81 per cent of the time.
Encouraging project ownership
Overall, the project involves hospitals examining their data, and identifying areas for improvement.
Project Manager Karen Rog, from Western Health, says the collaborative model has enabled improvements to be made, in a way that staff are excited about.
“We looked at our data to determine what challenges needed addressing, and then we sought feedback from various staff involved in the workings of the emergency department,” she says. “We then asked them how the proposed changes would influence their role, and their daily tasks.
“By involving a number of different staff members, we have built a team who are able to make their own decisions and recommendations, based on improvement methodologies.
“This in turn has meant that staff have taken ownership in making sustainable change, through their own problem-solving abilities.
Identifying the real problems
Timothy Chiu, Operations Manager at Western Health, believes solving the real problems impacting patient flow is vital to facilitating sustainable changes to the system.
“We’re very good at assuming we know what the problem is, but often what we think is the issue, isn’t the real problem at all,” he says. “However, by continuing to ask questions, and asking ‘why?’, we’re able to pinpoint the root of the issue, and therefore come up with solutions that will actually make a difference.”
Collaborating, not competing
Dr Dean Pritchard, Deputy Director of Emergency at Northern Health, says the Collaborative model has reinforced the need to work together, rather than in isolation, in order to deliver the best outcome for all Victorians accessing the public health system.
“Through this initiative, we’ve developed some valuable relationships with other hospitals,” he says. “It’s allowed us to showcase local triumphs within the health system, which all Victorians will benefit from. So why should we keep those things secret?”
The benefits of shared experience
Key to the success of the project is regular peer-to-peer networking and workshops, where staff can share their experiences, and learn from each other.
Nick McInnes, Project Lead at Peninsula Health, says pockets of innovation exist right across Victorian health services. However, due to these services often operating in ‘silos’, others aren’t aware of them.
“One of the fantastic benefits of the Collaborative is the sharing of innovative ideas. This helps us to determine which processes we might implement, in order to make a difference in our own hospital,” he says.
All experiences are valid
Patricia O’Neill, Emergency Department Nurse Manager at Frankston Hospital agrees that sharing experiences can make a huge difference, but adds that being honest about what didn’t work, is just as important.
“We’re constantly asking: ‘What are the problems, and how are we going to solve them?’” she says. “Hearing about approaches that didn’t work is really important, because it saves us from making those mistakes.”
Supported by coaches
The Collaborative grants participating health services access to industry coaches. These improvement science specialists work with health services to identify constraints and blocks in patient flow. They also offer support during the testing and trialling of new ideas and initiatives.
Those participating in the Collaborative have found tremendous value in being able to discuss key challenges with industry coaches.
“The industry coaches have been a great source of information and support,” says Rog. “It’s been extremely valuable to be able to bounce ideas off them, as well as learn from their vast knowledge.”
Improvements across the entire patient journey
One of the expectations of the Collaborative is that improvements flow across the entire patient journey, rather than being limited to emergency departments. Through the Collaborative, hospitals have been able to identify key issues that impact emergency department waiting times and patient flow. A common issue is the flow throughout the rest of the hospital.
“Over the last 12 months, we’ve certainly gained a greater appreciation of how congestion throughout the hospital—in wards and at discharge—affects the flow of the emergency department,” says Pritchard.
In order to address similar issues, Peninsula Health has introduced their ‘Countdown to Discharge’ program.
McInnes explains: “By moving our discharge time to earlier in the day, we know we have capacity in the wards for emergency patients that present,” he says. “However, in order to facilitate earlier discharge, we needed to improve our communications with everyone who is involved in the patient’s care.
“What started as a desire to reduce emergency waiting times has actually had a knock-on effect throughout the whole hospital, and we are beginning to see improvements in some of our data.”
Ongoing, sustainable change
While the Collaborative itself runs for 12 months, it aims to have a statewide impact on access to timely emergency care. It’s expected that the health services will sustain improvements and continue on the improvement trajectory. Furthermore, experiences and lessons learned will be shared more broadly across the health sector to encourage further improvements.
Pritchard says he’d like to think that past the scope of the project, hospitals will continue to collaborate in order to come up with innovative ideas that will benefit all Victorians.
“There is no textbook for this,” he says. “But the more we learn from each other, the more we can improve patient flow, and patient outcomes.”