Leaders need to step up to drive hospital efficiency


Health is the second largest area of government spend across Australia, and the forecasts aren’t looking great.

National costs are predicted to increase exponentially; at current rates Treasury estimates health expenditure to exceed the entire state and local government tax base by 2043.

It’s pretty clear something has to change; preventative measures are without doubt the best option, reducing the need for healthcare in the first place.

Beyond this, hospitals are the costliest element to Australia’s health system, taking up to 40 per cent of current health expenditure. With that in mind, the spotlight is well and truly on efficiency.

There’s currently a big focus on technology and the potential for increased patient predictions and improved flow. For example, in NSW hospitals have begun publishing real time queue data for emergency departments.

I wanted to explore the driving force behind these changes. As the largest employer in Australia, hospitals have a pretty significant resource at their fingertips that could drive some real change.

With a yearly increase of around 9 per cent in emergency patients, Dr Harvey Lander, Director of Medical Services at Hornsby Ku-ring-gai Health Service is no stranger to finding ways of being more efficient. Ultimately, ensuring people don’t stay in hospital longer than they need to.

Dr Lander has been working on a Clinical Engagement Strategy at Hornsby Hospital that drives mentoring and leadership, and it’s clearly working. He’s been driving a clinical engagement project at the hospital that increased NEAT targets by nearly 20 per cent year on year. He explained the role strong leadership has played:

“Many clinicians have inspired me over the years. Those who thrive on a sense of purpose and mastery of all facets of their profession. The most effective leaders can collaborate, coach, mentor and build superb teams.

“Such clinical champions are needed to affect transformational change. We need to work together to improve our relationships and collaborate to make a difference both for patients and staff.

“There’s a real potential to improve efficiencies throughout the whole process within a hospital. At the core of this change is the ability to get clinicians to the right places at the right time.

“I recently saw a need to improve our care locally, driving a collaborative approach across the whole hospital.”

The project began with a small group of clinicians at Hornsby Ku-ring-gai Health Service, developing a vision of where they wanted to go. The team, with the help of a clinical redesign team leader, developed a one pager to outline what they wanted to do. This was then used to test the project and seek feedback from others that would be involved:

“We shared and market tested with other clinicians whenever we could at clinician meetings and during VMO individual performance reviews. The intent was to make this process about involving our clinicians in a meaningful way, where our most important resource could generate ideas for improving the patient experience, care and outcomes.   We have also been conscious of involving the junior medical workforce, because they are often highlighted as a forgotten group.

“We want to create a positive culture to make things easier and better for our staff, beyond the targets and numbers everyone is used to seeing. We want our clinicians to see, feel and believe that we are supporting the work they do to provide the best patient care,” he said.

For widespread rollout to be effective, it’s safe to say there are a few obstacles. Anyone driving change will know to expect challenges. There are still large pools of people that don’t want to be a mentor. Identifying clinical champions who are willing to get involved and drive change can be challenging. It’s a matter of passion, time, volition and skills.

Dr Lander explained the key to success comes in finding the individuals that are committed, rather than focusing on the ones that aren’t:

“Our clinicians are becoming increasingly committed to driving change that’s going to make a real difference. It’s a tumbleweed effect. Supporting these individuals is vital. We try to acknowledge their ideas and act on them, and celebrate successes to make sure our staff feel valued. This can sometimes be as simple as a genuine ‘thank you’. It also means being approachable and available, recognising the effects system demands on staff, as well as the effects of reform fatigue and burnout.

“Making patients the centre of our collective action has aided us in finding a common purpose and helped inform everything we want to do. We have been encouraging clinical staff to find creative solutions that they can implement. This has encouraged clinical directors to drive a lot of important conversations, helping to set high expectations. We know that competition drives doctors; they want to be the best in their craft and won’t tolerate being left behind. We are fortunate to respect each of our roles – credibility is important. The importance of building, strengthening and even repairing relationships is integral to our improving success.”

Such an impressive increase in results has of course exposed other challenges along the way, including tension between the system and clinicians. But it has also ensured a deeper understanding of the clinician and honesty when looking at individual, collective and cultural differences to help meet expectations (both internally and externally). Dr Lander shared his seven key areas to driving success:

  • Be willing to be involved, and lead if you are so inclined;
  • Be open to inspiration and innovation, share your ideas as they are the most important;
  • Take time to understand your local culture and what drives your clinicians;
  • Be honest about where you are and what needs to be done;
  • Acknowledge any conflict and be ready to have the necessary courageous conversations, but be kind to your colleagues;
  • This is a journey, so have realistic timeframes for the change., It can take five to ten years to change a culture;
  • And look to learn from others in Australia and internationally.

Join Dr Harvey Lander during his presentation ‘Improving Patient Flow with Effective Management and Staff Engagement’ at Hospital Efficiency 2014 in July.

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