2. Target Performance: Q1 = 80% Q2 = 85% Q3 = 90% Q4 = 95% We are heading in the right direction 14% Improvement since Sept 2011 Quarter 3 (to date) 87.7 % ED patients experience stay of less than 6 hours 14% Improvement since Sept 2011 Quarter 3 (to date) 87.7 % ED patients experience stay of less than 6 hours With a little help from our friends….. Partnering with ADHB With a little help from our friends….. Partnering with ADHB

3. Initial Quick Wins – Front door & Back door improvements Reduced delays for patients in ED – now seeing 95% of patients within 6-7 hrs (reduced from 11hrs *  CAPACITY & FLOW with 12 new Flex beds * Renewed focus EDD’s *  CAPACITY & FLOW with 12 new Flex beds * Renewed focus EDD’s *  ED doctors *Daily Breach analysis & action * Medicine Flow Coordinator *  ED doctors *Daily Breach analysis & action * Medicine Flow Coordinator * Escalation and Flex triggers * Telemetry access guideline * Escalation and Flex triggers * Telemetry access guideline * Discharge bed cleaning *Phlebotomy for earlier discharge * Discharge bed cleaning *Phlebotomy for earlier discharge

4. Rapid Improvement - MAPU & SSU MAPU/SSU RIE Clear streamed flow & reduced steps & delays =  LOS MAPU/SSU RIE Clear streamed flow & reduced steps & delays =  LOS 14-15 th Sept - 14 th Oct 2011 Sustained streamed flow and earlier discharge Medical ward  LOS from 6.6 days Oct to 5.9 Feb = 0.7 day reduction 100% EDD’s Gen Med Medical ward  LOS from 6.6 days Oct to 5.9 Feb = 0.7 day reduction 100% EDD’s Gen Med * * Rapid Rounding *Gen Medicine RMO’s Round on Discharge pts 1st *Nurse facilitated d/c * Rapid Rounding *Gen Medicine RMO’s Round on Discharge pts 1st *Nurse facilitated d/c

5. Rapid Improvement - Emergency Department * ED Flow Coordinator roles * Mapped & timed ED processes * Geographic teams & leadership * ED Patient at a glance boards * ED Flow Coordinator roles * Mapped & timed ED processes * Geographic teams & leadership * ED Patient at a glance boards * ED Rapid Rounding * Shorter Triage 18min - <5 mins * Breach analysis & action * ED Rapid Rounding * Shorter Triage 18min - <5 mins * Breach analysis & action 95% in 6 hrs

6. Surgical Improvement * General surgery stage 2 breaches * Pt flow mapping * WIP-Acute surg assessment (unit or team) * General surgery stage 2 breaches * Pt flow mapping * WIP-Acute surg assessment (unit or team) As at week 27/02/12 *DNM - Surg & AH flow * Define & Measure – delays Acute Operating Theatre *DNM - Surg & AH flow * Define & Measure – delays Acute Operating Theatre *Rapid Rounding 6N Orthopaedics *Plan 4surg spread *Rapid Rounding 6N Orthopaedics *Plan 4surg spread * Reviewed access criteria & operating principles for surgical short stay

7. Improving Discharge * Breaches AH & WE’s *  admit AH’s *  discharge delays AH & WE’s * Breaches AH & WE’s *  admit AH’s *  discharge delays AH & WE’s Work in Progress * Preparing for Discharge * Weekend discharges Work in Progress * Preparing for Discharge * Weekend discharges

8. Aligning demand & Capacity – all beds Simulation current & optimal flow  variation/delay Aligning demand & Capacity – all beds Simulation current & optimal flow  variation/delay Bed Management & Aligning Demand and Capacity ! 1 hr to bed RIE March *Decision to admit-bed ready <40% -78% in 1 hr 1 hr to bed RIE March *Decision to admit-bed ready <40% -78% in 1 hr WIP *IT – real time flight deck view of beds and demand WIP *IT – real time flight deck view of beds and demand

9. Using lean/six sigma methods & data to sharpen our focus Breach reason by Specialty, day of week, time of presentation, Stage (3:2:1).... Breach reason by Specialty, day of week, time of presentation, Stage (3:2:1).... *Weekly dashboard * Fortnightly poster *Weekly dashboard * Fortnightly poster * Executive leadership * Consistent method * Capability Development * Data mining & analysis * Communication of progress * Towards Service Excellence * Executive leadership * Consistent method * Capability Development * Data mining & analysis * Communication of progress * Towards Service Excellence * Learning from & with our other DHB colleagues

10. Integrated Care Collaborative From the Patients Perspective….working together & joining up the gaps

11. * General Medicine Improvement – Medical teams * Aligning Clinical resources & rosters to acute demand * Capacity –demand alignment * General Medicine Improvement – Medical teams * Aligning Clinical resources & rosters to acute demand * Capacity –demand alignment * General Surgery Acute response AH & WE’s * Aligning clinical resources & rosters to acute demand * Capacity –demand alignment * SAPU or team * General Surgery Acute response AH & WE’s * Aligning clinical resources & rosters to acute demand * Capacity –demand alignment * SAPU or team * Building sufficient improvement capability * Clinical engagement & patients perspective focus *Sustaining improvement * integrating with other improvement initiatives eg RTTC, service redesigns * Building sufficient improvement capability * Clinical engagement & patients perspective focus *Sustaining improvement * integrating with other improvement initiatives eg RTTC, service redesigns Challenges *Recruiting ED SMO’s *Aligning Resources & rosters to demand in ED * Bed spaces for assessment, treatment & flow * Time required - new models * Delays specialty review & Decision to admit *Recruiting ED SMO’s *Aligning Resources & rosters to demand in ED * Bed spaces for assessment, treatment & flow * Time required - new models * Delays specialty review & Decision to admit Reducing variation *Making flow reliable Reducing variation *Making flow reliable