Hospital efficiency programs

Outpatients’ reform – the Logan Hospital journey

Logan Hospital Outpatient Services The Logan Hospital Outpatient Reform journey

Overview • Logan Hospital Outpatients • Key drivers for the Logan Outpatients journey • What we did • How we did it • Lessons learned • Next steps Logan Hospital Outpatient Department Logan Hospital Specialist Outpatients provides: • • Cardiology Arrhythmia Allied Health and Nursing Services • Diabetes • Audiology • Ear, Nose & Throat • Clinical Nurse Consultants • Endocrine • Dietetics • Gastroenterology • Maternity • General Medicine • Nurse Educators • General Orthopaedics • Nurse Practitioners • General Surgery • Occupational Therapy • & • • Hepatology • Physiotherapy • • Speech Therapy • Paediatric Medicine • Paediatric Surgery • Rehabilitation Building 1, 2 and 3 • Renal • 20 FTE Nursing staff • Respiratory • 24 FTE Administration staff • Urology Key drivers for the Logan journey • 19,684 waiting for an outpatient appointment in Aug 2014 • 3/4 of these were long waits (longest wait July 2005 Gen Surg)

August 2014 waiting list 25000

20000 19,684 15000 patients 14,923 waiting 10000 long waits

5000

0 Key drivers cont: • New recognition that OPD as one of the ‘big three’ of hospital activities – NEAT – ED 4 hour rule – NEST – Elective surgery targets – Development of OPD targets • Metro South Health wide solution Local initiative • In 2014 Logan Bayside Network SOAR project and implementation plan was commissioned  How do we drive success – New role  Practice Manager single point accountability and responsibility Looked at what our key performance indicators should be Working together Key drivers cont:

Queensland Department of Health • May 2016, My health, Queensland’s future: Advancing health 2026 • An investment of $361.2 million over four years to provide more specialist outpatient services • May 2016 - Specialist Outpatient Strategy, Improving the Patient Journey by 2020 What we did and how

Purpose: A commitment to wait list reduction and patient focussed culture gets patients seen sooner

Environment: Recognition that OPD is expensive ($2m)  nursing labour, non-labour, physical resources and real estate

• Set up a robust governance structure - top down approach to reduce waiting times • Political commitment - Queensland Department of Health strategies • Designed a suite of performance measures and monthly reporting What we did and how cont: • Monthly performance reporting 10,985 removed of the wait list 11,620 removed from the long wait list (longest wait 2011 Neuro/Gastro)

Total waiting list and long waits – Jul 14 – Feb 17

25000 Wait List Total Long Waits…

20000

15000

10000

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0 What we did and how cont:

• Metro South wide solution and networking with other facilities including the Central Referral Hub

• Introduced the Practice Manager position with a Medical Services reporting structure

• Redesigned and realigned the roles of existing nursing and administration staff

• Alternative models of care Pelvic Health clinics – >800 patients seen so far • 58% cost reduction per patient in the outpatient setting • From 41% to 8% reduction in the conversion to surgery rate • $400-$1000 per patient surgery cost savings • From 39% to 11% reduction in conversion to colo-rectal surgery • $750 per patient cost savings What we did and how cont: Metro South Allied Health Specialist Outpatient Long Wait reduction clinics Initiative Other Reporting Funding known Financial period generated Staffing costs costs outcome $34,112 or Feb - Jun $78,620 $4,489 per 2016 $1,462,167 $1,349,435 (QEII) WAU $699, 943 or Jul - Dec $38, 810 $3,617 per 2016 $2,919,556 $2,180,803 (QEII) WAU

Other Allied Health conservative management teams: • Physiotherapy musculoskeletal, hand and podiatry – 1336 removed • Integrated ENT clinics – 305 removed • Dietitian-led clinics for gastroenterology - 233 removed • Allied Health paediatric service – 420 removed Learnings and take-home messages • Shifting platform and complexity around balancing demand and supply into the future • Strategising competing priorities, powerful lobbying and community needs and expectations • Culture of ‘evidence based best practice’ to support new programs/clinical initiatives that are proven to be cost effective • Embrace alternative models e.g., telehealth services, Skype • Difficult conversations around disinvestment of traditional models What’s next?

• Ongoing monitoring and management of the wait list  load sharing with other hospitals?  what to do when the waiting lists dry up?

• Appropriate clinical space for new models of care with multidisciplinary teams

• Integrated reporting and building relationships with key clinical areas such as the Division of Surgery and surgical waiting lists Our Outpatients is the best place to work

Sue MacPherson Practice Manager SOPD Logan Hospital [email protected]