Sustaining change • Incomplete RFA forms and SMS confirmation data

reported monthly at staff and divisional meetings. • Specialty Waitlist Report tabled at HoD meetings. • Patient notification of planned date of admission and

cancellations reported at monthly divisional, HoD and departmental meetings.

• Customised waitlist management strategies to be identified across all surgical specialties.

• Second phase of elective surgical booking redesign to progress with Pre-Admission Clinic Redesign Project.

Conclusion • 100% of surveyed patients post solution implementation

stated that they had a positive experience with the bookings process and services at Westmead Hospital.

• Staff have appreciated the consultative and collaborative approach throughout the project redesign phases.

• There has been a positive effect on workplace culture as demonstrated in the staff and patient evaluations.

Acknowledgements • Sue Henderson, Operations Director, Division of Surgery and

Anaesthetics, Westmead Hospital; Project Sponsor • A/Prof Gary Morgan, Clinical Director, Division of Surgery and

Anaesthetics, Westmead Hospital • A/Prof Andrew Brooks (HoD Urology), Dr Mauro Vicaretti (HoD

Vascular), Dr Lissa Buenaventura (Anaesthetics/PAC), Clinical Leads

• Margaret Wall, Surgical Access and Waitlist Manager, WSLHD • Emma Clarke, Director Service Improvement, WSLHD • Dr Tony Pang (General surgeon), Anne Cresswell, Gloria

Wojtun, Dr Matt Stanowski(Urology fellow), Clementia Yap, Project Team Members

Contact Brian Julien: Brian.Julien@health.nsw.gov.au Carmen Hoffmann: Carmen.Hoffmann@health.nsw.gov.au Phone: (02) 8890 6623

Diagnostics Case for change Patient experience required improvement as demonstrated by: • 900 (19%) of patients are given 1-7 days notice of

their Planned Date of Admission (PDA). • 1600 (50%) of cancellations occur with only 1-7 days

notice prior to their PDA. • 4000 patients PDA is re-scheduled.

(data from May 2014-April 2015)

Goal Achieve a patient focused approach to improve the patient experience by timely communication with patients regarding their PDA.

Objectives • ≥95% of our Clinical Category 2^ and 3# Vascular and

Urology patients will have >7 days notice of their planned procedure date by March 2016 (Vascular 71.5%, Urology 77.1% as at April 2015).

• ≥85% of our Vascular and Urology patients who have their procedure cancelled by the hospital will receive >7 days notice of the cancellation by March 2016.

^procedures clinically indicated within 90 days #procedures clinically indicated within 365 days

Method • Booking and Admissions Tracking (2hrs) • Day-Only Ward Tracking (16hrs) • Recommendation for Admission (RFA) Process

Mapping (4hrs) • Data Analysis (12 month KPIs) • Policy and Guideline Reviews (4hrs) • Patient Interviews (n15) • Patient Journey Mapping (n15) • Staff Interviews and Surveys (n35) • Issues Prioritisation (3hrs)

Improving Surgical Access for Patients Elective Surgical Bookings Redesign Project

Brian Julien & Carmen Hoffmann Project Leads, Division of Surgery and Anaesthetics

426

1601

498 650

DOSC 1-7 8-14 >14

Num

ber o

f Occ

urre

nces

Number of Days prior to allocated Date of Surgery

Cancellations and Rescheduling Timeframe for Westmead Hospital Elective Surgical patients

1 May 2014 - 30 April 2015

Source: iPM TH58

Issue Solution Results Waitlist Policy Compliance - Limited awareness of current specialty and surgeon

specific waitlist KPIs identified in surgeon survey. - Limited awareness of MoH Waitlist Policy.

Generation of monthly Specialty Waitlist Report sent to Head of Department (HoD).

Specialty Waitlist Report evaluation survey shows that: • 100% of HoD state that the report easily

identifies the next treat in turn patients, helping plan elective surgical lists.

• 100% of HoD would recommend this report to other organisations.

Development of local Policy Compliance Procedure document.

Document developed to identify local governance for waitlist management.

900 (19%) Clinical Category 2/3 patients given a surgery date 1-7 days prior to PDA - Under booking of surgical list. - Unable to readily identify suitable patients to fill surgical

vacancy at short notice. - Identified patients on short notice list were not clinically

suitable. - From 15 surgical specialties, only Urology and ENT

theatre lists are facilitated by Admissions and Bookings.

RFA forms stamped with “Short Notice List” tick box.

13.5% of stamped forms returned have been completed post implementation.

Admissions and Bookings facilitated theatre list.

August 2015 to March 2016 average percentage of Clinical Category 2/3 patients given a surgery date >7 days prior to PDA: • Urology: ↑92.5% (from 77.1%) • Vascular: ↓64.0% (from 71.5%)

Incomplete RFA forms - Approx. 30 RFA forms per month submitted to bookings

office with missing mandatory minimum data set. - Time wastage of admissions and bookings staff following

up missing mandatory minimum data set.

Incomplete RFA for Clinical Category 2/3 patients not accepted.

Returned Cat 2/3 RFAs/month July 2015 to March 2016

Month Jul Aug Sep Oct Nov Dec Jan Feb Mar

Tally 24 5 3 3 5 8 1 4 7

Averaging 4.5 returns/month since August implementation

1600 (50%) Cancellation and Rescheduling of patients occur 1-7 days prior to PDA - Patient not available, no longer requiring surgery or

treated elsewhere.

SMS reminder/confirmation sent to patients 10 days prior to their PDA.

Implemented since December 2015: • Average responses: 54% (n691). • Approximately 55 less incoming phone calls

to bookings and admissions office per week. • 100% of patients surveyed satisfied with SMS

service.

= Bottleneck in the process

This has been a great cultural change for this hospital. We have empowered the surgeons to be more responsible with the surgery that they perform at Westmead.

All the staff have been amazing! The SMS fantastic; it reminded me about my surgery, plus I live in the country, so I didn’t have to spend a lot of money on a phone call.

We’ve become more efficient; it feels a lot calmer around here, and we do a lot less chasing up. We can concentrate on getting it right for our patients!

0%

100%

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Perc

enta

ge

Vascular and Urology Elective theatre bookings 2015-2016 >7 Days PDA notice given to Category 2/3 patients

UrologyVascularTarget (95%)

Lessons Learned during Implementation Phase: Specialties with higher urgent procedures (Emergency and Cat 1) patients are difficult to apply the elective surgery waitlist management solutions to, due to theatre access and scheduling, as evident with the Vascular specialty.