CHA Nursing Symposium A Journey to Organisational Excellence

Sue O’Neill June 2013

Cabrini Health - Melbourne • 832 beds over 6 campuses plus linen and biomedical

engineering • 40 outreach programs supported • 3850 staff (1721 nurses) + 1225 Doctors • 75 000 inpatient / 43 000 operations • 23 500 ED presentations • 1900 births • $400 million annual turnover • Owners New York -Missionary Sisters of the Sacred heart

of Jesus

Clarity re Quality?

• Doing the right thing in the right way at the right time … the way the patient prefers it …

• Quality therefore has to be

everyone’s role

Excellence • Safety is the minimum expectation of

quality care • Excellence is a talent or quality which is

unusually good and so surpasses ordinary standards. It is also standard of performance that is aimed for …*

"We are what we repeatedly do . . . excellence, then, is not an act, but a habit.“ * Reference available

In the excellence paradigm leaders want to understand the issues preventing people from doing the right thing, in the right way at the right time as the patient prefers it … so their experience surpasses ordinary

standards

The Continuous Improvement Approach • Issues are then analysed to understand the

barriers • Barriers are problems that need to be solved • Solving problems is what improvement is about • Improvement requires continuous change • Change management is reliant on strong

leadership • Leadership therefore is the key to excellence

The Leader’s Job is to Develop People SPIRIT of lean thinking mentorship:

“If the learner hasn’t learned, the teacher hasn’t taught”

John Shook

The role of the leaders is to ask questions not give the answers by asking WHY, WHY, WHY, WHY and WHY,

Problem Solving • Technical (tame problems)

• a problem for which a solution already exists

• Adaptive (wicked problems)

• a problem that cannot be solved with existing know how

• Major pitfall in health care is adaptive problems have

been treated as if they are technical problems

Unit level change

Own practice

Senior management Front-line staff Unit head

Extent of change

System level change

Reduce overburden & unevenness

Remove steps

Improve the quality of each step

Clarity about Impact

Organisational Excellence Capability Framework

Reference available

100% •Right Care

100% •Staff Engagement

100% •Patient Satisfaction

Shared strategic direction

Leadership and Change Management

Coaching and learning main job as leaders

Understand Patient Value

See the Cancer patient journey presented later

today

Acute to Rehabilitation flows

Never short of issues

Process Design and Improvement

Triage

Discharge direct from ED 55%

Resuscitation

Assess

General & Specialty Medical

CCU

Medical Ward

Cardiac Medical Ward

Specialty surgical wards

4 South

ED

Lab/Deliv

Time critical

UNPLANNED

PLANNED

PlannedReview

Fast track

Consulting Suites

OR L2

Ward HDU

Ante/Post

NICU/Nurs.

OR process

Endoscopy

Day Oncology ICU

Nobb

mmm

No stay Short stay Long stay

OR process

Cath lab

CCU1 South

OR L1

Surgical/gynae 1 Central

70%

DPC

30%

Admission direct from ED 45%

Unplanned review

DOSA

Paediatrics PACU

Radiology procedure

Cabrini MalvernPatient flows February 2012

3 North

1 North

4 Central

4 North

2 Central

3 Central

1 South

3 South

Paediatric ward

General surgery

Treatment

Discharge

DischargeTo usual residence

Complex discharge –

change place of residence

Dischargeto fast/slow

stream rehabCHERS

Discharge

Adapted from FMC flow chart

2 North

CCL

200225250275300325350375400425450

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Bed

Days

Malvern Inpatient Bed Days - August 11 Actual Budget

200225250275300325350375400425450

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Bed

Days

Malvern Inpatient Bed Days - August 12 Planned Actual

+25

+50

Reduce

variation from high volume

processes

Area of Improvement From (Av) To (Av) % Var Bed clean 53 mins 29 mins 45% STEMI-Door to balloon <90 mins 57% 94% 37% CSS Wait time to procedure 90 mins 15 mins 83% Vacancy time to fill 120 days 37 days 70% ED by pass 84% 30% 64% Length of stay 5.4 4.5 16% Agency utilisation 8% 2.2% 60% Nursing staff vacancy 16% 3% 80%

No of areas increasing pt satisfaction 53% 85% 24%

Performance Measurement and Feedback

RELATIONSHIP DEVELOPMENT COACHING PERFORMANCE REVIEW

Employee Relations Industrial Relations Human Resources

Expectations

Role Clarity

Dreams

Tools Strategies &

Time

HR Policy

& Procedure

Disciplinary with HR Executive

Routine occurrence Infrequent occurrence Rare

Time

Human Relations

Effective People Skills

Knowledge capture and sharing

Developing External Partnerships

Our Philosophy on our Journey to Organisational Excellence • Patients are our focus • Staff are our assets • Leaders are the teachers • Build capability of everyone • Release the potential of our people • Right problems solved by the right people at

the right level • Integrated problem solving is the key to a

better healthcare future

21