Victorian Maternity Record Victorian Maternity Record (VMR) Pilot – a Change (VMR) Pilot – a Change

Management projectManagement projectLeanne HolmesLeanne Holmes

2525thth HIMAA National HIMAA National ““SEE- CHANGE” conferenceSEE- CHANGE” conference

Four Points by Sheraton HotelFour Points by Sheraton HotelGeelong July 28Geelong July 28thth 2005 2005

MISSION

project planproject plan

Plan/ Document

Design Consult Pilot

Disseminate / Train

Establish/Manage

Secure host Dec04

Establish project team & management

strategiesMar – Aug 04

Establish Reference

GroupMay –Aug 04

M1

M2

M3

Write project plan

Apr – Aug 04

Progress Reports

Ongoing

M4

M5

Initial design criteria written

& approvedApr 04

M6

Initial Design Options

May 04

M7

Methods approved

May – Aug 04

Complete pre Pilot

consultation Jun - Dec 04

Consultation during Pilot

Feb 05 – Dec 05

M11

M12

Communication Strategy Written

& ApprovedFeb 06

Dissemination

strategy developed &

approvedFeb 06

M20

M21

Sites Agreed & Approved

Apr 04 – Nov 04

M14

Survey/ process

evaluation completed

Jun 05 – Feb 06

Pilot methods

agreed @ sites

Jun - Dec 04

M15

Pre PilotNov - Dec 04

M16

PilotJan 05 – Dec 05

M18

Preliminary site visits

Feb 05

M19

M17

Final DraftDec 05

Pilot RecordDec 04

EHR PlanFeb 06

M8

M9

M10

M13

Consultation with women -Consultation with women -Consumer WorkshopsConsumer Workshops

• Women carry it Women carry it • Women read itWomen read it• Women keep itWomen keep it• Consumer- friendly Consumer- friendly

language language • 78% of participants 78% of participants

agreed it would be agreed it would be useful to carry a useful to carry a hand held recordhand held record

Using the Generic information Using the Generic information booklet with the VMRbooklet with the VMR

• Even non English Even non English speaking women speaking women thought including thought including booklet about medical booklet about medical tests was usefultests was useful

Consultation with clinicians Consultation with clinicians -Scenario workshop-Scenario workshop

• Clinicians test Clinicians test the VMRthe VMR

• Identify Identify strengths and strengths and weaknessesweaknesses

• Hospital and GP Hospital and GP will takes copies will takes copies for their recordsfor their records

Information Information bookletbooklet

Carry WalletCarry Wallet

VMR VMR Page 1-4Page 1-4

Women can Women can write in the 1write in the 1stst four pages : four pages :

• DemographicsDemographics• Appointment Appointment

detailsdetails• Birth Birth

preferencespreferences

VMR VMR Instructions Instructions for clinician for clinician and womenand women

• Women must Women must consent to consent to carry itcarry it

• Frequently Frequently asked asked questions questions includedincluded

..

Clinician notes p 5 - 14Clinician notes p 5 - 14• Maternity History Maternity History

and Examinationand Examination• Tests and Tests and

InvestigationsInvestigations• Progress through Progress through

pregnancypregnancy• Labour & BirthLabour & Birth• Baby SummaryBaby Summary• Discharge and Discharge and

Going Home Going Home • Glossary of clinical Glossary of clinical

termsterms

Progress through pregnancyProgress through pregnancy

• Giroform high Giroform high quality carbonless quality carbonless paperpaper

• ISO 9001 compliantISO 9001 compliant• NCR copies in NCR copies in

ttriplicateriplicate• WOMEN KEEP THE WOMEN KEEP THE

ORIGINAL!ORIGINAL!

Labour & Birth SummaryLabour & Birth Summary

Baby summaryBaby summary

Going homeGoing home

Additional Additional NotesNotes

• Use as progress Use as progress notes notes – antenatal in ERantenatal in ER– post natal in wardpost natal in ward– GP rooms GP rooms

• Pads of 50 in Pads of 50 in triplicatetriplicate

• Use writing guardUse writing guard

VMR posterVMR poster

• Display on Display on doctors/clinic doctors/clinic waiting room waiting room wallswalls

• Reminder to Reminder to women to bring women to bring their VMRtheir VMR

pilot processpilot process7 sites Sunshine, Mercy, Angliss, Mildura, Orbost, Kyneton, Seymour

1000+ health & other professionalsmidwives, obstetricians, GPs, paediatricians, managers, health information, emergency staff, allied health, interpreters & translators, graphic designers, packaging experts, change management and group facilitation consultants, medico legal, policy/DHS/MSAC, project managers, IT experts, software designers, students, clinical educators, public relations, RANZCOG, ACMI, GPDV, consumer reps

5000+ women

P

ilot

pla

nP

ilot

pla

n

EstablishPrepare

Begin Monitor

Close

Establish pilot

management strategiesDec 04 - Feb 05

P2

Schedule & timelines

Nov 04 - Feb 05

Select Pilot sites Dec 04

P1

Set aims and measuresJan – Mar 05

P4

Design Processes

Jan – Feb 05; Ongoing

P5

Introduce VMR

Feb - May 05

P6Process

EvaluationFeb 05 – Dec 05

P10

Final

RecommendationsApr05 - Feb 06

P12

Survey staff Dec 05 – Feb 06

P11

P3

Collect dataMar - Dec 04

P7

Consult & informFeb 05 – Dec 05

P9

Identify and act on issuesMar - Dec 04

P8

Process mapping-Process mapping- what stays what stays & & what goes?what goes?

Pre-pilot Map 1 Pre-pilot Map 1 prior to VMR prior to VMR

Pilot Map 2 Pilot Map 2 changes after VMRchanges after VMR

Post Pilot Map 3 Post Pilot Map 3 final changes final changes afterafter using using

the VMR the VMR over timeover time..

2. Antenatal care arrangementwith Shared Care

Antenatal Carewith GP or

Obstetrician/midwife

Antenatalappointment

Documentantenatal care

on Medicaldatabase

Pathologyresults

Correspondence

Radiologyresults

Medical Directoretc database

If patient represents tohospital in labour, GP will seewoman. If complicated the on

Call obstetric doctor iscontacted

Go to Labourand Admission

DS Ward Clerkfiles all faxed

results in woman'srecord

NOTE: If woman isbooked and no results are

available, midwife willtelephone the doctor’s

room and request copiesof all blood results etc.

Woman carriesVMR

NOTE: GP’s vary in how to document antenatalcare, some are continuing to use medical

databases, some are starting to use the VMRexclusively. Some are trialling a combination of

both.

Document antenatalcare in VMR. Use

generic booklet andchecklist fordiscussions.

VMR progressvisits 1-3 etc areseparated onlyafter page is

complete

when to separate the NCR visits, inexperimental mode at present.

NOTE: Sharedcare cards arenow obsolete and/or

Separate NCR copiesat regular intervals

throughout antenatalcare

Some GPsare scanning

VMR copyand shredding

paper copy

2nd copy kept in GProoms

Woman keeps 1st

copy in VMR

3rd copy is sent tohospital and filed

in record inDelivery Suite

Arrange copies ofinvestigations/

correspondencefor hospital

Fax copies ofinvestigations/

correspondence tohospital

Provide copies forwoman to insert in

VMR pocket

and/or

Action ResearchAction Research

• This This Pilot Pilot isis based on based on what is known as an what is known as an ““action researchaction research”” improvement method improvement method..

• The strength of action research is The strength of action research is its its responsiveness and the ability to turn responsiveness and the ability to turn unpromising beginningsunpromising beginnings into into effective effective endingsendings by converging on an appropriate by converging on an appropriate outcome over time.outcome over time.

• The VMR is encouraging pilots to innovate The VMR is encouraging pilots to innovate and change their current work practicesand change their current work practices

Plan, Do, Study and Act Plan, Do, Study and Act cycle (PDSA)cycle (PDSA)

The pilot sites are encouraged to apply PDSA The pilot sites are encouraged to apply PDSA cycles to their processes to assist them with cycles to their processes to assist them with learning learning and and reflectionreflection. People identify issues . People identify issues and actions. and actions.

• Site teams respond with a plan of action Site teams respond with a plan of action (PLAN).(PLAN). • The plan is actioned for a period of time The plan is actioned for a period of time (DO).(DO). • This may involve measuring or observing. They This may involve measuring or observing. They

study and reflect on the effects study and reflect on the effects (STUDY).(STUDY). • They act again. They act again. (ACT).(ACT). • PDSA cycles are built around issues identified PDSA cycles are built around issues identified

from the ‘floor’, and from the routine from the ‘floor’, and from the routine measurement of progress towards aims. measurement of progress towards aims.

Example of an issue:Example of an issue:“The VMR is taking longer to “The VMR is taking longer to

complete” could mean???complete” could mean???

• It takes longer but it is worth it. It takes longer but it is worth it. • Consultations were too short prior to the VMRConsultations were too short prior to the VMR• Documentation was lacking previouslyDocumentation was lacking previously• It takes longer because people are still getting It takes longer because people are still getting

used to it. When familiar it will take less time.used to it. When familiar it will take less time.• It takes longer because women are asking It takes longer because women are asking

questionsquestions• It takes longer because the midwives are It takes longer because the midwives are

repeating what the doctor/GP has done. repeating what the doctor/GP has done. POSSIBLE SOLUTIONPOSSIBLE SOLUTION: : Change toChange to appointment timesappointment times

““Change is complicated by the fact that Change is complicated by the fact that organizations are organizations are social systemssocial systems whose whose participants have identities, participants have identities, relationships, communities, routines, relationships, communities, routines, emotions and differentiated powers. emotions and differentiated powers. Thus managers must be alert to how a Thus managers must be alert to how a change will conflict with existing social change will conflict with existing social systems and routines.” systems and routines.” Harvard Business Essentials, Managing Change and Harvard Business Essentials, Managing Change and Transition 2003Transition 2003

ChangeChange

““The primary difficulty with The primary difficulty with change…change…

• is that it is 10% logical/physical and 90% is that it is 10% logical/physical and 90% social/emotional. social/emotional.

• No matter how much we try to justify our No matter how much we try to justify our proposed change with logic...or resources, proposed change with logic...or resources, change is tough because it is primarily change is tough because it is primarily cultural cultural in nature. in nature.

• Cultures are primarily Cultures are primarily emotionalemotional, not , not logical. logical.

• Those of us who value logic like to explain Those of us who value logic like to explain our preferences from a sensible framework our preferences from a sensible framework but when it all boils down, but when it all boils down, emotion runs emotion runs deepdeep.”.”

Future impact on Health Future impact on Health Information Services?Information Services?

Women carry VMR Women carry VMR reduction in clinic reduction in clinic preparation timepreparation time

Women keep VMRWomen keep VMR reduction in filing spacereduction in filing space

Women read their Women read their VMRVMR

less FOI requestsless FOI requests

Standard forms Standard forms designdesign(Statewide)(Statewide)

reduction in forms reduction in forms design responsibilities design responsibilities for HIM’sfor HIM’s

NCR Copies kept in NCR Copies kept in medical recordmedical record

need to review medico need to review medico legal legislationlegal legislation

Leading Change with the VMRLeading Change with the VMR

THE VMR project is about leading changeTHE VMR project is about leading change

The VMR project provides an opportunity to The VMR project provides an opportunity to change and innovate in the workplacechange and innovate in the workplace

The VMR project identifies staff resistance but The VMR project identifies staff resistance but also staff readiness also staff readiness

The VMR project provides an opportunity for us to The VMR project provides an opportunity for us to step back and look at the way we do things!step back and look at the way we do things!

The VMR has the promise of new vision, The VMR has the promise of new vision, streamlining structures and provides a catalyse streamlining structures and provides a catalyse for people towards a common goal – provision for people towards a common goal – provision of better health care for our women.of better health care for our women.

The VMR has changed my The VMR has changed my thinking!thinking!

Initially I thought :Initially I thought :• that this was a forms design project – WRONG!that this was a forms design project – WRONG!• that that onlyonly an electronic health record would solve all our an electronic health record would solve all our

paper record problems – WRONG!paper record problems – WRONG!• Women felt empowered in their decision making when Women felt empowered in their decision making when

having a baby – WRONG!having a baby – WRONG!I now know:I now know:• there is a lack of there is a lack of CONSISTENTCONSISTENT information available for information available for

women about maternity carewomen about maternity care• HIM’s should review their role as forms design experts and HIM’s should review their role as forms design experts and

custodians of medical records. custodians of medical records. • HIM’s should embrace the notion that there is a place for HIM’s should embrace the notion that there is a place for

personal hand held records in the future!personal hand held records in the future!• change requires greater consideration of the change requires greater consideration of the social social

influences influences within ourselves and our organisation rather than within ourselves and our organisation rather than just the logical influences. just the logical influences.

Evaluation and findingsEvaluation and findings

• This pilot is well underway across 7 sites. This pilot is well underway across 7 sites. • 1,500 women are carrying the VMR so far.1,500 women are carrying the VMR so far.• 95% of woman are consenting to carry it95% of woman are consenting to carry it• No lost records were reported in May or June.No lost records were reported in May or June.• A final evaluation will be undertaken in February A final evaluation will be undertaken in February

2006.2006.• Only after feedback is received from all Only after feedback is received from all

consumers and staff will a decision be made consumers and staff will a decision be made about whether to implement state-wide.about whether to implement state-wide.

Watch this space!!Watch this space!!

Thank you:Thank you:

Jo Campbell (03) 8345 0430Jo Campbell (03) 8345 0430jo.campbell@wh.org.aujo.campbell@wh.org.au

Leanne Holmes (03) 8345 1685Leanne Holmes (03) 8345 1685leanne.holmes@wh.org.auleanne.holmes@wh.org.au