Improving Patient Flow – Whole of System Transformation Dr Karyn Johnson – GP Liaison Women’s Health Jane Waite – Service Manager Women’s Health

Christchurch: February 22 nd 2011

The Gynaecology Story 2003 CWH employs a GP Liaison (GPL) to interface between primary and secondary services. –Need to decrease wait times / increase equity of access : GPL worked with the SMO’s to create gynae management and referral guidelines - these were put onto a CD and delivered to General Practitioners. –Initially the GPL struggled with delivery and GP engagement.

Canterbury Initiative (CI) August 2007: Canterbury Initiative (CI) established Redesign activities focussed on the primary/ secondary interface Bring together workgroups of GP’s and hospital specialists - solve clinical service issues Outlined the “problems” and discussed “solutions” Implements solutions by working with Planning and Funding (P&F) to shift funding, alter access to investigations, up skill GP’s, develop new support services

Engagement Engagement – by involving those working at the coal face with the process. Showed health workers the “burning platform” - Vision 2020 show case If health services not redesigned By need 2x hospital infrastructure 2 x existing health workforce

Outcomes of workgroups GP Liaison and CI team implemented solutions –Required funding changes >> CI approached management. –Pipelle biopsy subsidies implemented –Increased access to community pelvic USS –GP up-skilling/education opportunities Internet based pathways – easy access, up to date, applicable to local system, responsive “HealthPathways”

Workgroup and Health pathway stats At the end of 2011: 93 specialists, 131 general practitioners, and 15 nurses involved in health service redesign activities 350 clinical pathways in Canterbury in over forty specialties 2500 Canterbury clinicians perform 70,000 pages reads of Health Pathways per month

Implementation Increase consistency of pathway use Triage – single gateway and use of virtual FSA Struggled to keep community radiology requests within budget –Created access criteria for radiology –Triage of scans –Reasons for declines and referral back to the Health pathway –Developed further pathways to deal with most common conditions

Electronic referrals (ERM’s) Launched /130 practices using at end 2011 Integrates with patient management system referrals/ month via ERMs Can be audited for planning purposes

Results

Referral to FSA conversion rate

Key points in achieving the shared vision DHB board and leadership team that has strategic vision and provides the funds to support redesign activities Involving large numbers of primary and secondary care clinicians in work groups – valuing their time commitment with paid attendance Getting the clinicians to outline the “issues and solutions” Seeing the problems from each others point of view Clarity for GP’s and patients about what conditions will be seen or managed in the public system Providing alternative ways/ information on how to manage conditions unable to be seen

Building on Success Success Ideas resulting in action and improved outcomes for patients Trust that care will be delivered as planned, as guidelines are clear and are audited New projects considered, as the last one was successful

Using the model to reduce waiting times? GP’s and SMO’s look at conditions that could be managed in the community. SMOs look at surgery options and theatre utilisation Work out what is required to achieve this? e.g. increased USS access, guidelines. Consider private / public partnership in terms of theatre time Approach P&F with long term goal – shift of funding, if requiredImplement with education sessions and a variety of communication methodsTriage consistent with initiativeIncrease virtual FSA

Summary Management and Canterbury Initiative - looked at the big picture and worked with clinicians to break down funding silos and deliver care differently Developed trust between clinicians and managers Developed trust between primary and secondary care Engagement from the whole workforce

Whole of system transformation