Leadership and Sustainable Change: Process mprovement ... · Leadership and Sustainable Change:...
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The Newfoundland and Labrador (NL) Provincial Colorectal Cancer Screening Program was announced in the spring of 2010. The Department of Health and Community Services (DoHCS) announced a Provincial Wait Time Management Strategy to look at wait times and improve access to Endoscopy services. Central Health Regional Endoscopy Waitlist Management Working Group was formed to assist in the development of a regional waitlist management strategy for endoscopy to improve access to Endoscopy services. The Goals: • Standardized provincial referral form for all Endoscopy services. • Explore methods to utilize capacity, improve access and reduce wait times. • Define and measure the demand for Endoscopy services. • Define key performance indicators and measure outcomes. • Early engagement of key stakeholders was central in implementing change and achieving goals. • Communication strategies focused on all key stakeholders. • Action plans and process maps were developed outlining key changes. • Strong and committed leadership at provincial, regional, and facility level. • Bottlenecks and inefficiencies existed with no process to validate current waitlist. • Significant system redesign was needed to improve overall efficiency and manage growing waitlists. • Existing capacity underutilized; 1 Room vs. 2 Room Models. • Lack of standardized referral form. • Lack of Central Intake. • Late starts and early finishes. • Demand surpassing throughput. • By implementing Central Intake the RHA was able to better evaluate referral practices and measure referral volumes. • True demand for service was determined through validating the waitlist. • Standardizing the referral form and process based on established guidelines. • Improving access by redesigning patient flow and implementing 2 room model (2 physicians, 2 rooms). • Decision-makers and staff took ownership and implemented and evaluated recommendations thoroughly. Referral • Lack of standardized form (including urgency bands) • Inconsistent booking prac;ces • Waitlist valida;on required Endoscopy Consult • No standard process of receiving referrals • No consistency in HOW referrals were triaged among 5 physicians • Waitlists varied, months to > 2years Endoscopy Department • Late starts and early finishes (underu;lized capacity) • 2 rooms, 1 physician (increased idle ;me) • No ability to increase recovery beds • Aging reprocessors, 56 minute machine reprocessing ;me To improve accessibility and reduce existing wait times, several options were presented to the Regional Endoscopy Waitlist Committee. The following options for increasing clinic capacity were evaluated: • Increase physician capacity: Impact of adding three physicians to the Endoscopy service and implementing the 2 room model. • Redesign patient flow to prep patients in waiting room and walk to procedure room to eliminate patients admitted to “bed” prior to procedure. • Process to book all Urgents as referral is received. Key Performance Indicators Central Health-CNRHC Key performance indicators were developed by the DoHCS in collaboration with the RHA to measure efficiency, accessibility, and effectiveness. • All referrals (excluding Urgents) are entered into a pending list and booking process occurs from pending list (Meditech). • Booking for new patients accommodates referral volume by type, next available, and physician specific requests. • Wait times are calculated from electronic scheduling module based on timely entry of referrals. • Physicians (Endo) screen all referrals based on standardized urgency bands. • Significant improvements in Urgent Colonoscopies in both the 50th and 90th percentiles. Organizational Outcomes • New processes embedded in the organization. • Innovative approach to address access issues. • Outcomes reflect change strategies that support system integration. Future Plans • Spread implementation success to remaining three urgency bands, second referral site and other services within RHA. • Department of Health and Community Services, Access and Clinical Efficiency Division. • Centre for Research in Healthcare Engineering (CRHE). • Central Health Regional Waitlist Committee. • Newfoundland & Labrador Provincial Endoscopy Advisory Committee. WAIT TIMES: THE CENTRAL HEALTH CONTEXT IMPROVING ACCESS SYSTEM ENGAGEMENT AND PROCESS CHANGE Inspire people Build a guiding team Develop a shared vision Communicate for buyin Empower acWon: Don't let up CHALLENGES IMPACTING WAIT TIMES Defining Demand Referring Physician prac0ces Standardized form and process Screening Quality of referral informa9on Central Intake Triage based on new urgency Bands Retriage old referrals Recording and repor0ng data Pending wait list Repor9ng Wait Times Clinic Accessibility Capacity Booking / Scheduling Staffing Physicians (Endo) Capacity 2 room model 0 100 200 300 400 500 600 Monthly Procedures Completed at CNRHC 2012 Actual Goal 0 50 100 150 200 250 Wait Time (Days) Wait Times for Urgent Colon CNRHC 2012 50th 90th 83 211 46.5 72 9 33 0 50 100 150 200 250 50th Percen9le 90th Percen9le Wait Time (Days) Wait Times for Urgent Colon CNRHC 2012 March April May OUTCOME MEASURES Referral Rates (Urgent & NonUrgent Combined) 2011 2012 Number Waiting for Colonoscopy 1139 864 Number of Colonoscopy Referrals 14 43 Accessibility Rates (Urgent) 2011 2012 Colonoscopies 50 th percentile 30 18 Colonoscopies 90 th percentile 237 29 ACKNOWLEDGEMENTS Dec. Dec. Dec. Dec. Principles of Change Management
Transcript of Leadership and Sustainable Change: Process mprovement ... · Leadership and Sustainable Change:...
Leadership and Sustainable Change:A Process Improvement Initiative in Endoscopy
The Newfoundland and Labrador (NL) Provincial Colorectal Cancer Screening Program wasannounced in the spring of 2010. The Department of Health andCommunity Services (DoHCS)announced a Provincial Wait Time Management Strategy to look at wait times and improve access to Endoscopy services.
Central Health Regional Endoscopy Waitlist Management Working Group was formed to assist in the development of a regional waitlist management strategy for endoscopy to improve access to Endoscopy services.
The Goals:
• Standardized provincial referral form for all Endoscopy services.
• Explore methods to utilize capacity, improve access and reduce wait times.
• Define and measure the demand for Endoscopy services.
• Define key performance indicators and measure outcomes.
• Early engagement of key stakeholders was central in implementing change and achieving goals.
• Communication strategies focused on all key stakeholders.
• Action plans and process maps were developed outlining key changes.
• Strong and committed leadership at provincial, regional, and facility level.
• Bottlenecks and inefficiencies existed with no process to validate current waitlist.
• Significant system redesign was needed to improve overall efficiency and manage growing waitlists.
• Existing capacity underutilized; 1 Room vs. 2 Room Models.
• Lack of standardized referral form.
• Lack of Central Intake.
• Late starts and early finishes.
• Demand surpassing throughput.
• By implementing Central Intake the RHA was able to better evaluate referral practices and measure referral volumes.
• True demand for service was determined through validating the waitlist.
• Standardizing the referral form and process based on established guidelines.
• Improving access by redesigning patient flow and implementing 2 room model (2 physicians, 2 rooms).
• Decision-makers and staff took ownership and implemented and evaluated recommendations thoroughly.
Taming the Queue DRAFT Poster Presentation Page 4
Referral • Lack of standardized form (including urgency bands) • Inconsistent booking prac;ces • Waitlist valida;on required
Endoscopy Consult • No standard process of receiving referrals • No consistency in HOW referrals were triaged among 5 physicians • Waitlists varied, months to > 2years
Endoscopy Department • Late starts and early finishes (underu;lized capacity) • 2 rooms, 1 physician (increased idle ;me) • No ability to increase recovery beds • Aging reprocessors, 56 minute machine reprocessing ;me
To improve accessibility and reduce existing wait times, several options were presented to the Regional Endoscopy Waitlist Committee. The following options for increasing clinic capacity were evaluated:
• Increase physician capacity: Impact of adding three physicians to the Endoscopy service and implementing the 2 room model.
• Redesign patient flow to prep patients in waiting room and walk to procedure room to eliminate patients admitted to “bed” prior to procedure.
• Process to book all Urgents as referral is received.
Key Performance IndicatorsCentral Health-CNRHC
Key performance indicators were developed by the DoHCS in collaboration with the RHA to measure efficiency, accessibility, and effectiveness.
• All referrals (excluding Urgents) are entered into a pending list and booking process occurs from pending list (Meditech).
• Booking for new patients accommodates referral volume by type, next available, and physician specific requests.
• Wait times are calculated from electronic scheduling module based on timely entry of referrals.
• Physicians (Endo) screen all referrals based on standardized urgency bands.
• Significant improvements in Urgent Colonoscopies in both the 50th and 90th percentiles.
Organizational Outcomes
• New processes embedded in the organization.
• Innovative approach to address access issues.
• Outcomes reflect change strategies that support system integration.
Future Plans
• Spread implementation success to remaining three urgency bands, second referral site and other services within RHA.
• Department of Health and Community Services, Access and Clinical Efficiency Division.
• Centre for Research in Healthcare Engineering (CRHE).
• Central Health Regional Waitlist Committee.
• Newfoundland & Labrador Provincial Endoscopy Advisory Committee.
WAIT TIMES: THE CENTRAL HEALTH CONTEXT IMPROVING ACCESS
SYSTEM ENGAGEMENT AND PROCESS CHANGE
Taming the Queue DRAFT Poster Presentation Page 2
The Goals:
~ Standardized provincial referral form for all endoscopy services
~Explore methods to utilize capacity, improve access and reduce wait times
~ Define and measure the demand for Endoscopy services
~Define key performance indicators and measure outcomes
System Engagement and Process Change
~ Early engagement of key stakeholders was central in implementing change and achieving goals
~ Communication strategies focused on all key stakeholders
~ Action plans and process maps were developed outlining key changes
~ Strong and committed leadership at provincial, regional, and facility level
Inspire people
Build a guiding team
Develop a shared vision
Communicate for buy-‐in
Empower acWon: Don't let up
Change Management Principles
CHALLENGES
IMPACTING WAIT TIMES
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Impacting Wait Times
§ By implementing Central Intake the RHA was able to better evaluate referral
practices and measure referral volumes. § True demand for service was determined through validating the wait list. § Standardizing the referral form and process based on established guidelines. § Prioritization for booking, based on appropriateness and urgency. § Improving access included improving clinic capacity by redesigning patient flow
and implementing 1 room model. § Decision-makers and staff took ownership and implemented and evaluated
recommendations thoroughly.
Defining Demand
Referring Physician prac0ces
-‐Standardized form and process
Screening -‐Quality of referral
informa9on
Central Intake -‐ Triage based on new urgency
Bands
-‐ Retriage old referrals Recording and
repor0ng data -‐Pending wait
list
-‐ Repor9ng Wait Times
Clinic Accessibility -‐Capacity -‐ Booking /Scheduling -‐Staffing
Physicians (Endo) -‐Capacity
-‐2 room model
Trends
Actual GoalMarch 255 330April 239 300May 248 330June 250 315July 303 315August 480 345September 366 400October 474 440
0
100
200
300
400
500
600
Monthly Procedures Completed at CNRHC 2012
Actual
Goal
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0
50
100
150
200
250
Wait Time (Days)
Wait Times for Urgent Colon CNRHC 2012
50th
90th
83
211
46.5 72
9 33
0
50
100
150
200
250
50th Percen9le 90th Percen9le
Wait Time (Days)
Wait Times for Urgent Colon CNRHC 2012
March
April
May
OUTCOME MEASURES
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Outcome Measures
Key Performance Indicators
Central Health-‐CNRHC
Key performance indicators were developed by the DoHCS in collaboration with the RHA to measure efficiency, accessibility, and effectiveness.
Referral Rates (Urgent & Non-‐Urgent Combined) 2011 2012 Number Waiting for Colonoscopy 1139 864 Number of Colonoscopy Referrals 14 43
Accessibility Rates (Urgent) 2011 2012 Colonoscopies 50th percentile 30 18 Colonoscopies 90th percentile 237 29
§ All referrals (excluding Urgents) are entered into a pending list and booking process occurs from pending list (Meditech).
§ Booking for new patients accommodates referral volume by type, next available, and physician specific requests.
§ Wait times are calculated from electronic scheduling module based on timely entry of referrals.
§ Physicians (Endo) screen all referrals based on standardized urgency bands. § Significant improvements in Urgent Colonoscopies in both the 50th and 90th percentiles. Organizational Outcomes: •New processes embedded in the organization. •Innovative approach to address access issues. •Outcomes reflect change strategies that support system integration. Future Plans
§ Spread implementation success to remaining three urgency bands, second referral site and other services within RHA
ACKNOWLEDGEMENTS
Taming the Queue DRAFT Poster Presentation Page 1
Leadership & Sustainable Change: A Process Improvement Initiative in Endoscopy
Wait Times: The Central Health Context
The Provincial Colorectal Cancer Screening Program was announced in the spring of 2010. Subsequently, a Provincial Wait Time Management Strategy was announced to look at wait times and improving access to endoscopy services. Newfoundland and Labrador’s current state assessment of endoscopy services in 2010 identified issues of inefficiencies such as late starts and early finishes and backlogs which if addressed could increase capacity for endoscopy services. The Department of Health Community Services engaged Centre Research Healthcare Engineering (CRHE) of the University of Toronto during the summer of 2011 to work with Central Health (CH) to identify opportunities to increase capacity and improve the efficiency of the two endoscopy suites in the region. Central Health Regional Endoscopy Wait List Management Working Group was formed to assist in the development of a regional wait list management strategy for Endoscopy and to develop a plan of action to implement and evaluate this strategy and improve access to appropriate Endoscopy services.
Dec.
Dec.
Dec.
Dec.
Principles of Change Management
