department of human services welcome and overview kate harmond

Department of Human Services

Welcome and overview

Kate Harmond

Patient Flow Collaborative

House keeping

Mobile phones/Bleeps turn to silent

Rest rooms

Fire Alarms

Equipment on table

Agenda

9.00-9.15 Welcome and agenda overview

9.15 – 9.30 Overview of collaborative

9.30 – 10.00 Project or mass movement

10.00 – 10.30 Clinical champions

10.30 – 11.00 Morning tea

11.00 – 12.30 Rigorous diagnostic phase

12.30 – 1.30 Lunch

1.30 – 3.00 Team Planning

3.00 – 3.30 Afternoon tea

3.30 – 4.00 Next steps

Partnership agreementPartnership agreement

• Please remember that the patient flow collaborative is based on a partnership and is tailored to your organisational leads. There are no passengers and no dictators we are all in it together.

Questions


Overview of the Patient Flow Collaborative

Jenny Bartlett

Patient Flow Collaborative

The challenge is to revolutionise our

expectations of health care: to design a

continuous flow of work for clinicians and a

seamless experience of care for patients.

Donald.M.BerwickPresident and CEO

Institute for Healthcare Improvement

DiplopiaDiplopia

Shared vision results from a combination of good leadership and good followership. We assume the former and disregard the latter.

Why Collaborate?Why Collaborate?• Part by part improvement

- nurses improving nursing- doctors improving doctoring

- pharmacists improving pharmacy

• Working together they improve systems

• Risks of not doing this……

Issues

• Excellent innovation in pockets• Long waits in ED• Elective surgery waiting times• Inpatient delays

– Specialist Consultation– Specialist tests– Access to OR

Mirror mirror on the wallMirror mirror on the wall

How does an organisation know that its view of reality matches that of its

workforce and consumers.

Process

• Use Breakthrough collaborative Methodology with Whole system thinking

• Rigorous Diagnostics to give a base line– Matrix diagnostics to show high level constraints

• Improvement plans following the diagnostic stage• In priority order• Tested on small scale • Spread across organisation

Roll out plan

KeyOS Orientation SessionLS Learning SessionC/Call Team Conference Calls

SustainSustain

Patient Flow CollaborativeProject Plan

Feb Apr SeptJulJun

LS25 Oct

Dec

LS38-9Feb

Mar

LS419-21April

2004

Feb

2005

OS2th

April

OctMarJan Apr Jun Jul

LS519 July

Diagnostic phaseTest cycles and implementation Action phase:

Enable spread

HealthImprove-

mentSchool

Embed sustainability and mainstreamTrainingphase

Engage HealthServices

May

LS16 -7July

Celebration

Aug Nov MayJan

Site visitsC/Call

7-11 March

Site visitsC/Call

23-28 May

ActionLearningSession





9 Jun

Site visitsC/Calls

23-27Aug

ActionLearningSession6 Sep

ActionLearningSession9 Aug

Site VisitsC/Calls3-8 May

Site visitsC/Call 15-

20 Nov

ActionLearningSessionJan 04

ActionLearningSession3rd Dec

Site Visits

Nurse LeadTraining1 April

DataTraining17 Mar

PGMTraining

5 Mar

InnovationAssociates

Training30 Apr


Training29 Oct

ProjectTeam

TrainingDay 129 Mar

MainstreamAction Plan

Report


Training29 Apr

ProjectTeam

TrainingDay 227 Apr

ExecutiveTeam

Training31 Mar

Launch of the Victorian Travelling Fellowship Program


Introduction to improvement science

Kate Harmond

““Better care without delay”Better care without delay”

• Pilot site for national programme• Measurement for improvement• Whole systems approach• Local control, national steer and support• Opportunity to shine• Star ratings

What went well?What went well?

• Programme manager• PR and celebrations• Top level leadership• User and volunteers • Working with other agencies• Clinical engagement

Even better if...Even better if...

• More preparation time• Data analysis and support• Appreciation of previous success• Skills data base• Managing enthusiasm• Managing cynicism

National supportNational support

• Client power• Expertise• Openness• Tool kits• Leadership development• Workshops and learning labs

ResultsResults

• Emergency waiting times• Elective waiting lists• Cancelled operations• Medical out-liers• Better use of telephones, dispensing etc• Star ratings

Cultural changeCultural change

• Clinician champions• Media coverage• National and international presentations• Recruitment• “Feel good” factor• Inclusive learning (lunch hours)

Target practiceTarget practice

• Evidence for politicians• Measurement from Mars• Innovation from Venus• Manufacturing models and language• Clinical reality• Think big, work smart

Untapped resourcesUntapped resources

• No more patients• Self-managed care• Nurses and midwives• The clerk’s tale• Text and e-mail• Critical appraisal of current practice

Simple stuffSimple stuff

• Process mapping• SPC’s• Reports, publications, presentations• Learning programmes• Political influence• Managing up

No more projectsNo more projects

• Systems approach• Regular review and refinement• Self-assessment against national

measures• Spread and rapid roll-out• Influencing national targets• From programmes to mass movement

What next?What next?

• New consumerism• Career development• Adding value by avoiding duplication• Losing “wait”• Appreciative inquiry• Inspirational leadership


Clinical Champions

Marcus Kennedy

Why is Why is Clinical Clinical Leadership So Important?Leadership So Important?

• Have vision of what to change

–but may not know how (methods & resources)

• Understand how the system works

• Can drive progress through

–influence with managers

–clinical & professional networks

• Long term continuity

Further reading: Leading Physicians through change J Silversin, ACPE

2000 Leadership at every level J Hardacre, HSJ, 2001

Clinician Leaders (inclusive definition) - Clinician Leaders (inclusive definition) - What are the Critical Success Factors?What are the Critical Success Factors?

• Empirically:

–Frustration with status quo

–Ownership of the problem

–Passion & commitment to change

–Willingness to challenge

–Protected time

“The challenge is to bring the full potential benefit of effective health care to all… this challenge demands a readiness to think in radically new ways about how to deliver health care services.”

Institute of Medicine, USA“Crossing the Quality Chasm”

Where are we now?

Where do we

want to be?

The chasm! patient expectations public credibility outcomes access resources equity of service staff recruitment/retention funding

The gap is growing!

First order changeFirst order change

More of, or less of…….the same thing

Second order changeSecond order change

Stand back….Reframe…….See the big picture

Creating and Leading Creating and Leading Innovation at Three LevelsInnovation at Three Levels

Central truths of innovationCentral truths of innovation

• Every system is perfectly designed to get the results that it gets

• If we want different performance, we must change the system

• To change the system, we must think in fundamentally different ways

Factors That Can Drive the Business Factors That Can Drive the Business Case For InnovationCase For Innovation

• Patient/family expectations• Politician/public expectations• Competitive pressures (business environment)

• Cost containment• Technology enablers• Changing workforce• Reconfiguration and capacity change• Drive for excellence (strategic aspirations)

• Incremental approach– reduces threat (spread)

– increases ownership (sustainability)

• Better understanding – redesign methods & skills

– simple rules

• Showing tangible benefits– Benefits to patients (‘technical’)

– ‘Now I can play more golf!’ - what’s in it for me? - cultural

– Ignore the human dimensions of change and you will surely fail

Rigorous Diagnostics1. Process Maps

2. Patient flow (Programme Measures)

3. Patient and carer

experience

4. Sampling data

5. Brainstorming

Demand

system

Dimensions of innovation cultureDimensions of innovation culture

• risk taking• resources• widely shared information• specific targets• tools and techniques• rewards systems• team environment• Psychological safety

Partnerships for changePartnerships for change

“I think that people are trying to tackle initiatives too low in the organisation .…

you need a damn good project manager, a strong chief executive

and a strong lead clinician” Site visit comment

The partnership of these groups will provide a effective, dynamic team

Seven Factors ShapingSeven Factors ShapingTeam PerformanceTeam Performance

• Strong platform of understanding• Shared vision• Creative climate• Ownership of ideas• Resilience to setbacks• Network activators• Learn from experience

Source: Rickards and Monger

Team levelTeam level

Executive leads

Clinical team Clinical team Clinical team

Leadership – ‘the art of mobilising

others to want to struggle for shared aspirations’

The Leaders Third EyeThe Leaders Third Eye

• A vision that– Views the content– Ensures clarity– Projects to others (so

they can see)– Has a wide-angled lens

A new model of leadershipA new model of leadershipLeading others

• Genuine concern for others’ well-being and development

• Empowers, delegates, encourages critical and strategic thinking

• Accessible, available, approachable

Personal Qualities• Integrity, open to ideas, criticism & advice

• Transparent honest & consistent

• Decisive, charismatic & in-touch, analytical & creative thinker

Organisational Skills• Inspirational communicator, networked and achiever

• Clarifies team direction; team-orientated problem-solving

• Unites through a shared vision

• Manages change sensitively & skilfully

Alimo-Metcalfe, B. & Alban-Metcalfe, R.J. (2000). ‘Heaven can wait’, The Health Service Journal, October 12th, 26-29.

What do good leaders do ?What do good leaders do ?

• Articulating the vision & embodying values

“You must live the world you want to create.” Ghandi

• Innovation & creativity

• Working across boundaries

• Motivation

• Releasing talent

• Personal resources

Leadership at Every Level, Jeanne Hardacre, HSJ publications 2001 Workforce & development: Embodying leadership in the NHS. London; NHSE 2000

Tools and techniques for us:Tools and techniques for us:

• build on existing creative thinking and rapid cycle improvement methods

• locate natural champions for innovation and invite them to help with clinical innovation team once diagnostic completed

• past innovators to serve as coaches; beware: not all innovators are good coaches

“If you think you are going to be successful running your business in the next ten years the way you did in the last ten, you’re out of your mind. To succeed, you have to disturb the present.”

Roberto GoizuetaChief Executive, Coca-Cola

The K2 Paradox

Change something everyday to produce a stable routine of continuous evolution (improvement).

Change is inevitable, Change is inevitable, except from a vending machineexcept from a vending machine

Questions ?Questions ?


Morning tea


Rigorous Diagnostics

Lee Martin

Aim of the rigorous diagnostic phase

Overall aims• identify constraints across the patient journey• Engage key staff in the process ready to

implement change• Find any myths

Rigorous Diagnostic phase

Elements of the diagnostic Elements of the diagnostic packpack

• Program measures• Sampling data tool• Brainstorm tool• Process mapping tool• Patient, carer and relative involvement

tools• Innovation intensive tool

Program Measures Program Measures

• Patient Journey Time in ED (SPC chart)• Percentage and Number of ED Admissions waiting <12 hrs (SPC chart)• Percentage of ED Throughput <6hrs (SPC chart)• Patient Journey Time on Waiting List (SPC chart)• Patient Waiting Times for Admitted Patients from Waiting List (Pareto

chart)• Cancellations (HIPs) per 100 Admissions (Line chart)• Average Admissions & Discharges by day of week (Bar chart)• Length of Stay – Medical/Surgical/Other (Pareto chart)• Number of Unplanned Readmissions within 28 days by day (SPC chart)

Percentage of ED Admissions waiting <12 hours Percentage of ED Admissions waiting <12 hours - Chart- Chart

For the period Jul03 to Feb04 between 59% and 86% of ED patients waiting for admission to a ward could expect to wait less than 12hrs.

The average number of patients admitted within 12hrs per week was 73%, with a target of 95%.

Sampling toolSampling tool

• Two clinical areas minimum• Request staff to identify key delays• Chart delays for each patient each day• Total at end of time period

exampleexamplePILOT EXAMPLE Example of creation and process of delay tally chart

Surgical ward identified delays total numbers – Example

Day No clear

care plan Awaiting tests: MRI, CT, Bone scans

No planned discharge date

Home unit not reviewed

Boarder- not seen x unit before 0900 bed meeting

Boarder- not seen x unit before 0900 bed meeting

Late decision to discharge

Waiting for assessment

Waiting for ACAT referral

Waiting for rehab bed

Waiting for review by other unit

Waiting acute bed at another hospital

No weekend discharge plan so covering RMO says no

Monday 5 1 3 0 0 0 1 1 0 0 1 0 0

Tuesday 3 3 1 0 2 2 2 0 0 0 0 0 0

Wednesday 11 4 2 1 1 1 1 0 0 1 0 0 0

Thursday 6 3 0 0 1 1 2 0 0 1 2 0 0

Friday 9 4 0 0 1 1 1 0 0 1 1 0 0

Sunday 8 1 0 0 2 2 0 0 0 0 1 0 0

Monday 8 5 0 12 2 2 0 1 0 1 3 0 0

Tuesday 4 6 1 12 1 1 0 0 2 1 1 0 0

Wednesday 11 5 2 0 0 0 0 1 2 0 0 0 0

Thursday 10 2 3 3 1 1 1 1 2 0 0 0 0

Friday 1 3 0 0 0 0 0 1 2 1 0 0 0

Saturday 0 1 0 0 0 0 0 2 1 1 0 0 0

Sunday 6 4 3 0 0 0 0 2 0 0 0 0 0

Monday 2 4 4 0 2 2 1 1 0 1 0 0 0

Tuesday 9 7 3 0 1 1 1 0 0 1 0 0 0

Total 93 53 22 28 14 14 10 10 9 9 9 0 0

Brainstorm toolBrainstorm tool

• Brainstorm the delays that effect your patients

Brainstorming toolBrainstorming toolBrainstorm Whole system constraints tool

Order of

constraint

Description of constraint

Effect on majority or

minority of total points

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Key Minority – small number of patients affected Majority – majority of patients affected

Process mapping toolProcess mapping tool

Map minimum of two whole system patient journeys

Elective Admission to DischargeEmergency Admission to Discharge

Unnecessary complexityadds to chaos in ED

MedicalTeam‘Front door’

to ED

Minor

GP Majors

ED MajorsSurgicalTeam

MedicalBed

SurgicalBed

‘Front door’to ED

Minor

Majors

MedicalTeam

SurgicalTeam

Ideal -reduce complexity

Bed

Unnecessary complexityadds to chaos in ED


to ED

Minor

GP Majors


MedicalBed

SurgicalBed


to ED

Minor

GP Majors


MedicalBed

SurgicalBed


Minor

GP Majors


MedicalBed

SurgicalBed


Minor

Majors

MedicalTeam

SurgicalTeam


Bed


Minor

Majors

MedicalTeam

SurgicalTeam


Bed

Exam

ple

of

Pro

cess M

ap

Out patient referral process

GP/Dent/otherNew referral send by

post/courier or fax

Letter received by Appointments centre

Dated and registered (ORED)

Appointment clerk takes referrals to

consultant sec

Referral could godirect to consultant

Average5 days

GP to Acute

Some sec’s write down they have received the referral

24 hour targetfrom register

to sec

ProblemNo tracking Acute has

received referral

Exam

ple

of

Pro

cess M

ap

Ultra Sound, Breast Core Biopsy, Out Patient

10.12Patient arrives at

ultra sound

10.20Patient shown cubicle andasked to change into gown

10.24Patient sits back down in

waiting area

10.26Patient called into examination

room by nurse,Patient asked to make herselfcomfortable on the couch andthe Radiologist explains the

procedure and that the processwill take about 20 minutes

10.28Examination starts, ultrasound gel is applied, the

radiologist checks theultrasound screen

10.29Radiologist checks

patients past ultra soundimages, the lump is deeper

than he had anticipated

10.30 Radiologist explains that the

lump looks benign, that hewill measure its size and

reassures the patient that he would be surprised if it was a

. Explains to patient thatthe biopsy sample will give

the definitive answer

10.32Radiologist marks area for core biopsy

gun to penetrate. Explains that the needlewill be inserted briefly, but will give ptLA first, pt is concerned about 2 needles

being used, asks if she can be repositioned,and asks if lump is cancer or cyst.

Radiologist explains that it is probably afibramoma (a bristly type lump which arefairly common). Patient says she does not

want surgery. Radiologist says that she candiscuss this with MS Shah

Exam

ple

of

Pro

cess M

ap

This is the first part of a three part process map of which in its entirety was too detailed to successfully display.

A high level patient processA high level patient process

Patient feels unwell

Sees GP

Referral letter sent

Prioritised by consultant

Appointment sent

Patient attends OP clinic

Added to waiting list

TCI letter sent

Patient attend POA

Patient attends for operation

Diagnostic tests

Review in clinic

‘transfer’ home

Added to OP pending list

General medical ward round - Monday 28th of April 2003

MAU9.00-9.08 2 patients

Cuckmere ward9.14 - 9.17

1patient

Berwick ward9.17-9.302 patients

Wilmington ward11.23-12.209 patients

Folkington ward10.40-11.156 patients

East Dean ward9.37-10.227 patients

Summary:Duration of ward round = 3 hours and 20 minsWards visited = 6Patients seen = 26

Patient,carer and relative Patient,carer and relative involvementinvolvement

• Small test cycles to gain consumer input

• Use the tools one to one with patients

Intensive innovation toolIntensive innovation tool

• Pre-plan 6 weeks in advance• One day event for individual health

service• Book early!• Not needed for completing the rigorous

diagnostic phase

Completion of diagnostic Completion of diagnostic phase phase

• Review all of the 5 tools together and priorities the constraints that are causing the most disruption to the larges patient group.

• Identify the clinical area team that is needed to carry forward the innovations from the diagnostics

Review meetingReview meeting

• Collaborative team wish to be involved • Feedback at the first learning session

Handy hintsHandy hints

• Share the work • Gain as many views as you can• Use this phase to find the constraints

and test assumptions• Enjoy the focus on patient process• Have fun

Questions


Lunch


Team planning time

Aim of team planning time

• Dedicated time for team planning together

• Chance to network with other organizations

• Practice mapping before real event

TasksTasks

• Confirm team structure and contact details

• Allocate tasks for the rigorous diagnostic phase against the time planner

• Process map

Where to startWhere to start

How to get going How to get going

• Discuss tasks and what needs to be completed today

• Look through the templates • Agree time for tasks to be completed

today• Remember to think about how to use

these tools to unfreeze environment that are going to innovate in the next phase

Equipment and TemplatesEquipment and Templatesfor team planning for team planning

• Health service project team structure• Program measures• Brainstorm exercise• Patient relative and carer involvement• Sampling data • Process mapping equipment

Process mapping exerciseProcess mapping exercise

• Whole system map • Agree a patient

i.e. Mrs Smith – fractured Neck of femur• Map the process from admission to

discharge

Process and flow rateProcess and flow rate

Remember you could Remember you could Photograph the processPhotograph the process

Delays amount to 58 hours 5 minutes in Delays amount to 58 hours 5 minutes in HistopathologyHistopathology

Specimenarrives in

department

Numberallocated tospecimen

Specimenentered ontolaboratorydatabase

Specimencut up

Blockschecked

Sectionsmounted

under coverslips

Sectionsstained

Blocks cut & sections placed on

glass slides

Blocksembedded

and checked

Blocksimpregnated

Slides micro-scopically

quality controlled

Slideslabeled

Casesbooked outon database

Cases placedin pathologist

trays

Slides areviewed and a

report dictated

Reports taken to pathology

post room

Reports areplaced in envelopes

Reportsare signed

Reports are printed

Reports aretyped

6 61

5

69 974 528 26

11 2 282

393

60

3 2

169491105346

Fixation occurs while the steps take place and varies between 10 min and 24 hours depending upon the specimen type size and subsequent techniques needed

Requestarrives in dpt.

Requestarrives in dpt.

Consultant requestsCT

Result leavesdpt.

Patient receives the result

Reportleavesdpt.

1

3

5

2

4

1 Portering batches + handoffs

2 Booking appointments > 680 different appointment types backlog 1658 at end of July 2000

3 Getting the patients to scannerdelays waiting for contrast injection

4 Reporting carved out capacitybatches

5 Portering batches + handoffs

1 Patient (someone) takes request to department

2Appointment types• 3 types of scan• quickies, middlies and longies

3 Getting the patients onto scanner• venflon on ward

4Reporting• instant reporting• reports sent out to secretaries every day

5 Portering• patient leaves with report

Ideas being tested and changes implemented

Task: Map a process you know really Task: Map a process you know really well: well: goinggoing to work each morningto work each morning

where does it start ?

where does it end ?

•where are the main bottle necks?•how do you manage the bottlenecks?•what are the 10 -15 ‘high’ level process steps

A B

Patient processes cross many boundaries

C D E

organisational/departmental/professional boundaries

outp

ut

Whole system patient journey

First Process Map for Taking Blood Samples and Receiving results

Bloods taken by nurses at start ofday shift

CC co-ordinator ensures all bloods inbag and on shelf ready for collection

Unit Co-ordinator telephones porter“bloods ready to collect”. Informs

other CC staff

Porter arrives and collects samples

Porter takes samples to lab on foot

Bloods deposited in the collectionbay

Secretaries arrive and take samplesinto lab

Samples separated into Biochemistryand Haematology

Biochemistry

Samples booked in

Samples processed

U&Es(20 MINS)

Check levels(45 mins)

Sample authorised

Result on computer

Haemotology

Sample centrifuged

Processed

Sample authorised

Results on Computer

8.00am

8.15am

8.15am

8.30am

8.35am

Not before9.00am

20 to 45minutes

5 mins

By 10.15am but11am in practice

10-20 mins

Should be by 10.00ambut after 11.00am in

practice

May get diverted

Flow Chart A

Revised Process Map for Taking Blood Samples andReceiving results

Bloods taken by nurses at end ofnight shift

CC co-ordinator ensures all bloods inbag and on shelf ready for collection

Unit Co-ordinator telephones porter“bloods ready to collect”. Informs

other CC staff

Porter arrives and collects samples

Porter takes samples to lab on foot

Bloods deposited in the collectionbay

On-call team take samples into lab

Samples separated into Biochemistryand Haematology

Biochemistry

Samples booked in

Samples processed

U&Es(20 MINS)

Check levels(45 mins)

Sample authorised

Result on computer

Haemotology

Sample centrifuged

Samples Processed

Sample authorised

Results on Computer

6.30am

6.45am

7.00am

7.00am

7.05am

20 to 45minutes

5 mins

By 8.30am

10-20 mins

By 8.30am

May get diverted

Flow chart B

Initial pathway for blood samples

Flow chart C

Patient 1 Patient 2

Patient blood taken andsent at 8.30am

Results received at11.06am as ward round

was happening

After ward round – lowHB established at

11.30am

Prescription actioned for 2units of blood at 11.36am

Patient given 1st unit ofblood at 12.15pm

Discharge arranged between12.00pm and 12.30pm

Time taken from blood taken totreatment and discharge arranged3.5 to 4 hours

Patient blood takenand sent at 8.30am

Results received at11.00am as wardround happening

At ward roundidentified that K+

level was low

K+ prescribed at11.45am

K+ administered at12.45pm

Time taken from blood taken totreatment 4 hours 15 minutes

Revised pathway for blood samples

Patient 3Elective admission

Patient 4

Patient blood taken andsent by 7.00am

Results received at8.30am

Low Hb level of 7.7established

(normal range 13 – 16.5)

SHO prescribed 2 units ofblood at 8.45am

Blood retrieved from theatre(kept for 48 hours post op)

First unit given at 10.00am,second unit at 11.20am

Time taken from blood taken totreatment and discharge arranged

3 hours

Patient blood takenand sent by 7.00am

Results received at8.45am

Low level of K+ level3.4 identified

(normal range 3.6 – 5)

K+ prescribed at9.30am

K+ administered at9.50am prior to ward

round

Time taken from blood taken totreatment 2 hours 50 minutes

Discharge arranged duringadministration of 1st unit

and report on before start ofward round at 11.00am

RESULTDischarge arranged before ward

round, staff lunch breaks andbusier time of the day

RESULTPatient received more timely

treatment and team achieved anefficient delivery of care

DELAY DELAY 5 HRS 30 MIN

3HR 30MIN

7:30 11:00 12:00 16:00 17:00 17:30Nurse identifies

patient ready to discharge

Enquiry made about bed availability

Advised that bed available and ward ready to accept patient.

Doctor made decision to

discharge

Patient ready to leave unit

Patient left unit

DELAY 8HR 30 MIN

Discharge delay

Any questions?

Once Completed - Identify on Once Completed - Identify on Your Map the FollowingYour Map the Following

• Number of steps for the patient• Number of times hand off’s occur• Time between each step• Total time for process• Queues in the process• Steps that add value to the process• Steps that add value to the patient• Look for batching – tasks that are left to build up• Identify constraints on people and equipment• Identify other processes that affect this process

Good luck!!Good luck!!


Next steps

Rochelle Condon

Next steps

KeyOS Orientation SessionLS Learning SessionC/Call Team Conference Calls

SustainSustain

Patient Flow CollaborativeProject Plan

Feb Apr SeptJulJun

LS25 Oct

Dec

LS38-9Feb

Mar

LS419-21April

2004

Feb

2005

OS2th

April

OctMarJan Apr Jun Jul

LS519 July

Diagnostic phaseTest cycles and implementation Action phase:

Enable spread

HealthImprove-

mentSchool

Embed sustainability and mainstreamTrainingphase

Engage HealthServices

May

LS16 -7July

Celebration

Aug Nov MayJan

Site visitsC/Call

7-11 March

Site visitsC/Call

23-28 May






9 Jun

Site visitsC/Calls

23-27Aug

ActionLearningSession6 Sep

ActionLearningSession9 Aug

Site VisitsC/Calls3-8 May

Site visitsC/Call 15-

20 Nov

ActionLearningSessionJan 04

ActionLearningSession3rd Dec

Site Visits

Nurse LeadTraining1 April

DataTraining17 Mar

PGMTraining

5 Mar


Training30 Apr


Training29 Oct

ProjectTeam

TrainingDay 129 Mar

MainstreamAction Plan

Report


Training29 Apr

ProjectTeam

TrainingDay 227 Apr

ExecutiveTeam

Training31 Mar

For the learning sessionFor the learning session

• Story board or display of your results from rigorous diagnostics

• Presentation 15 mins to show other team what you achieved

• Project coordinators to feedback what their team would like on the agenda next learning session


Questions and close

Jenny Bartlett

Questions and Close

• Any questions for Kate, Marcus, Rochelle, Lee or myself

• Evaluation forms• Remember about the travel fellowship awards• Contact the team to start the work together

and build the relationships

Thank you to Kate Harmond and Nina Willis

See you all on 6-7 July for the Celebration event

Have a safe trip home

Thank you

department of human services welcome and overview kate harmond

Documents

continuous flow of work

good followership

improvement nurses

combination of good

seamless experience

expectations of health

learning labsresultsemergency

national steer