The Elective Endoscopy Patient.

Do they need to be included in a

complex care model?

Ian Aldrich

Manager of Redesign

Albury Wodonga Health

“ Once upon a

time in a land

far, far away

there lived two

health

services…”

Albury Base Hospital (NSW)

Wodonga Regional Health Service

(Vic)

Albury Wodonga Health

Albury Wodonga Health

NSW =Newcastle, Sydney, Wollongong or

Nothing South of Wagga Wagga

“Wodonga….isn’t that somewhere in New South Wales?”

Albury Base Hospital (NSW)

Wodonga Regional Health Service

(Vic)

So…Albury Wodonga Health

is truly unique as Australia‟s

first formalised cross-state

health service.

Albury Wodonga Health’s

challenge.

To establish a single entity

with standardised

processes.

Staff motivation for this project:

ABF !

Staff motivation for this project:

Activity Based

Funding?

Staff motivation for this project:

Activity Based

Funding?

Another B---dy

Form !

17 minutes extra per patient on

admission

170 minutes extra per average list

No extra resources

47 pages

Organisation motivation:

• Process not patient focussed

• Desire to consolidate endoscopy to one

campus

• New endoscopy suites

• Plan to establish “dedicated” „scope lists

• Need for standardised process

The start point for this project • Two theatre complexes

• Both performing endoscopy

• Same endoscopists

• Differing process

• Consolidated Elective Surgery Access Unit

• VMO led model

• Endoscopy waitlist of between 700 - 800

The Goal:

• To develop and implement a standardised process for elective endoscopy patients that embraces a “wellness” model

High level – “it’s not broken, we don’t need

to fix it”

GP

Home

VMO AWH ESAU

DPU OT

– all this proves is we are good at

using acronyms

PACU

Simple !

It was necessary to dig

deeper

The Team:

20

Staff in

Total

• Exec. Director of Nursing

• Surgical Operational Director

• Surgical NUM’s

• Surgical Nurses

• Surgical Clerical Staff

• Waitlist Team

• Day Only Staff

• Community Rep.

• Redesign

The “Hi Tech” Tools:

The Rules:

1. Everyone’s opinion and

perception is valued, right and not to be challenged.

2. If in doubt – refer to Rule No. 1

Mapping the endoscopy

journey and identifying

the waste

Map 1 – Referral to Waitlist

Lesson !

Technical is not

necessarily good.

Map 2 – Elective Surgery Clinic

Map 3 – Waitlist to Day of Endoscopy

Waiting

Map 4 – Day of Endoscopy

Map 4 – Sub map – The Diabetic pt.

Variable information

Inconsistent D/C advice

Conflicting brochures

Referral variation

VMO preferences

This is exactly the same

process that a hemi-colectomy

or hip replacement patient

would negotiate !

High level – what had evolved?

GP

Home

VMO AWH ESAU

DPU OT PACU

Each silo working in isolation

Improvement activities in each area – but not unified or coordinated

Value Stream Map

Value added vs. non-value added time

Value added time

Minimum: 240 mins

Maximum: 240 mins

Non-value added time

Minimum: 45 days

Maximum: 831 days

Proposed model of care

Simplified

Standardised

Access Equity

Call centre

- standardisd

Staggered

admission

Standardised

• Decision to remove screening process

• Staggered admission

• Recognition most patients can walk to a

procedure room

• Paperwork now takes less time than the

endoscopy

• Changes to “time out” process

• Discharge time organised at admission

• Standardised discharge information

• Standardised diabetic process

Day of endoscopy improvements

…however

The red, green and blue books

still exist…they have just gone

“underground”

What difference does this model make?

Old New Saving

Minimum 45 days,

4hrs

25 days

3hrs, 10mins 20.04 days

Maximum 831 days,

4hrs

483 days,

3hrs 348 days

Underpinning the new process

Where to from here?

• Trial of new form continues –mixed

feedback to date

• Endoscopy suites due to open in

February

• Further tracking to be done

• Some staff “re-calibration” needed

• Ongoing monitoring

The true benefit of this project

• Excellent staff engagement – good motivators

• Allowed for a “cross-silo” perspective

• Allowed for recognition of the work in each “silo”

• Allowed mangers to see the impact of decisions

• Forming the basis for further standardisation i.e.

cataracts

…finally…the real winner was

that everyone could see the

journey…and never

underestimate the power of…

Thank you

Questions?