Systems need to be fixed to drive real efficiency in healthcare

Gold Coast Hospital hit the headlines last year as they rolled out their Patient Admission Prediction Tool mapping tool to predict the number of schoolies expected to hit the emergency department over summer week.

However, the benefits of the tool stretched beyond the school break with the CSIRO Australian e-Health Research Centre’s chief executive David Hansen saying* it could save Queensland hospitals up to $23 million per year through improved efficiency from being able to plan ahead with a good degree of accuracy.

The CSIRO Australian e-Health Research Centre developed the software together with Queensland Health, Griffith University and the Queensland University of Technology.

Ahead of his presentation at Workforce Efficiency in Healthcare, I recently caught up with James Lind, Former Director of Access and Patient Flow at the Gold Coast Hospital to see how tools like this fit into the bigger challenge in healthcare to drive efficiency. He explained that many hospitals are still just focusing on the individual targets rather than looking at the bigger picture.

“The hospital wasn’t performing as it should, particularly the emergency department which is why we looked to redesign in the first place.

“The predictor feature is actually just a tool which every other business uses, the accountability frameworks and the meeting structures that you integrate those tools into to get the desired behavioural results – that’s where we’ve done most of our work.

“Data is really the currency by which we argue. The interpretation is the tricky bit and the devil’s in the detail of what data is or isn’t measuring. Once you’ve got over those few hurdles, you can actually use the data powerfully to understand what the issues are.”

Impressively, the team at the GCH managed to reinforce the governance structure by securing the attendance of the CEO in a weekly operational meeting:

“The meetings are designed around using these tools so we’re able to reinforce the behaviours that need to occur. When you say it’s going to be here next week then something occurs as opposed to doesn’t occur. A lot of that comes down to accountability in governance frameworks. Having the CEO in the weekly operational meeting absolutely reinforces the governance structure. The CEO is going be made or broken by the targets, if they don’t make their targets then they’re going to be fired, so there’s a real need for them to be there too,” explained James.

There’s no doubt that the team has made some real progress:, in the two to three years since they’ve been fixing the system and following the data, there’s been a huge improvement in performance results. Last year the hospital finished within 1 per cent of the NEAT target set – quite an improvement considering Gold Coast Hospital was rated worst in the state just a couple of years ago.

Matching KPIs

A key part to the improvements has been developing a set of KPIs that encompasses the system as a whole, rather than individual figures. James broke down the key to successful measurement:

“If you say you’ve made your NEAT, NEST and budget – if you didn’t achieve another KPI it would be looked at as more of a misdemeanour, and some of them are actually contradictory.

“If you fix the system itself though, the KPIs will flow with the system. If you just try and fix a number it won’t work.

“KPIs have to be easily measurable, even ones that seem a bit trickier to measure. Take satisfaction as an example, sometimes you have to pick surrogates of that, (a surrogate of how an ED works could be the ‘did not wait’ (DNW) rate.) You’ve got to have a combination and look in different dimensions with quality indicators, performance indicators and time indicators.

“Hospitals are complex adaptive systems, if you change one variable all the others will change in turn. The problem is you never know whether it’s good or bad as all the variables aren’t always measured.”

Where next

James has now been seconded by another hospital to implement some of the work from the Gold Coast and insists there are key principles that can make a wholesale difference to efficiency:

“A lot of systems are very similar to each other. The mathematics shows that everything is uniquely the same although people will tell you they’re different, and therefore the problems and the solutions by and large have got the same sort of flavours to them, they’re in slightly different quantities and proportions, but they have the same similar makeup.

Many are still not fixing the systems – more just making a number and hoping it will all to go away.”

So where to from here? In one word, NEST. The team are currently going through their ‘myth busting’ stage, looking at the mathematics of the state to work out the simple things first. For example, long case V start case timing and Smart Scheduling.

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