The successful implementation of a new model of care requires careful and strategic planning. Some of the speakers from our Developing a 7 Day Health Service conference took the time to share their experience and told us about their organisation’s first steps or considerations when they embarked on their journey towards a 7 day health service.
“Eastern Health was undertaking a significant redesign project introducing a new model of care implemented in ED and general medical services, bringing improved quality and consistency to services delivered across three sites. This included a consistent model of staffing in nursing and medical across the 7 days, and standard daily work practices across 7 days in all units. Our commitment as physiotherapists to join our colleagues was based on two key drivers: 1. Equity of access to the same standard of care for all patients, no matter what time of the week their presentation is, and 2. If physiotherapy wants to be considered a core component of the treating team, we need to be part of this team every day of the week.
The key members of the senior physiotherapy team identified strongly with these two statements, so the question was not ‘if’ but ‘how’.”
Geraldine Millar, Associate Director Allied Health –Physiotherapy (Acting), Eastern Health
“The first steps we had to consider were which of the strategies were the easy wins. Which strategies needed the least work but gave a great benefit? Some of this was due to previous work being done in this area, but primarily with the change in management at the moment it was a time of opportunity. For example, with the afterhours CT and USS in radiology a simple diagnostic was done and the cost of putting a radiographer on was found to be cost neutral with what it was costing the organisation with call in rates. Also, reporting after hours was outsourced to prevent fatigue leave and increased costs. These were examples of the no brainers.”
Brett Sellars, Clinical Nurse Consultant, Business Practice Improvement Officer (BPIO), Gold Coast Hospital
“The first step is to make certain there is a very compelling need to expand services into the weekend. This is a very important step because traditionally it has been much harder to attract staff to work on a weekend compared to a weekday. Plus a weekend service is much more expensive because penalty rates apply.”
Peter Nuttman, Imaging Operations Manager, Melbourne Health
“I think identifying the need for increased services is the crucial first step. Understanding the impact of patients needing care 24/7 in a business that runs only at full capacity during business hours is a significant challenge. These impacts are always assessed across different criteria including risk analysis. The solutions are the easy part, but the barriers can be significant. Personally, I use a model being a triangle of cost/quality/outcome and if the solutions are realistically achievable if the barriers are significant.”
Darren Clark, Nursing Director Medicine & Emergency Department Logan Hospital, Metro South Hospital and Health Service
The first steps for implementing a 7 day service within the organisation was to ensure the management team including the Executive Director were in agreement as to why the organisational change was required. In this instance the rational for change was related to the National Health Reform and in particular how government funded community health services could support the acute facilities in meeting their NEAT and NEST targets. This required not only a change to a 7 day service but to a whole of service redesign to form a post acute service The service initially identified the following key steps:
- Scoping change and developing project plan (including objectives, deliverables, key stakeholders, communication and engagement strategies; risks; resource requirements etc)
- Determining and implementing communication strategies for all levels of staff and key stakeholders (including unions)
- Gaining traction from staff and key stakeholders by including them in most aspects of the service model changes
- Defining new service model
- Determining impact on all levels of staff (including defining new roles, skill mix, skill gaps)
- Determining budget and resource requirements in relation to 7 day service
- Development of an evaluation framework and key performance indicators for the new service model
Kim Fraser, Nursing Director Post Acute Care Service, Metro North Hospital and Health Service
Historic model of care was ineffective for patients, VMOs and WWHS. Patients experienced long waiting periods for general surgery review, VMOs were trying to juggle their elective workload with being on call and WWHS was faced with increasing theatre and medical staff overtime. Elective patients were also being cancelled to fit in emergency cases while emergency sessions were being underutilised during the day.
- First discussed strategies to meet Elective Surgery benchmarks and Emergency Surgery Guidelines with Surgeons via local Theatre Management Group Meeting
- WWHS Executive, Perioperative Nurse Manager and General Surgeons began series of meetings to discuss changing the model of care.
- Funding was sourced from MoH for VMO payments, CNC, Data Manager and Clerical Support.
- WWHS Steering Committee established and consisted of WWHS Executive and Perioperative Nurse Manager.
- Logistics, rules and infrastructure confirmed eg office space, recruitment of team, business rules, Doctors contracts and payment
- WWHS DMS met separately with VMO Surgeons to establish contracts and business rules.
The Consultant Led Model of Care was agreed upon, and the ASU commenced in November 2011.
Sherylle Sheehy, Clinical Nurse Consultant Acute Surgical Unit, Wagga Wagga Health Service
Visit the Developing a 7 Day Health Service conference website to view the full conference agenda and to register.