Case for Change In 2015, 2.5 times as many patients attended the Ryde Hospital Fracture Clinic compared to 2012

The Ryde Hospital Fracture Clinic is getting busier. This high demand impacts the delivery of patient care to other areas of the hospital, due to redirection of staff working on the wards to the clinic during busy times, and the large numbers of clinic patients requiring x rays.

Patients and their carers previously have had to endure long waiting times in uncomfortable waiting rooms to get an x ray, then see the doctor, and sometimes the nurse and physiotherapist. This has resulted in some patients being unhappy with the service and making complaints. The situation also affects staff, who feel less enthusiastic about working in the clinic.

The #Fixit project was started to make positive changes; to put the patient first and improve their experiences by redesigning how the clinic is run. Without these changes, and with ever increasing demand, the situation would become worse. Patients and staff would become unhappier with the service and the reputation of Ryde hospital would be placed at risk.

Diagnostics

Solutions

# Fixit Ryde Hospital Fracture Clinic Redesign Project

Cayley Smith, Emily Bucknell, Christian Ghan Ryde Hospital; Royal North Shore Hospital; NSW Agency for Clinical Innovation

Goal To improve the experience of patients and their carers by providing more timely access to care at the Ryde Hospital Fracture Clinic.

Objectives 1. Reduce the waiting times at the Fracture Clinic by 20%, from 81

minutes to 65 minutes, by June 2016.

2. Increase patient and carer satisfaction with the Fracture Clinic by 25%, from 45% to 59% of the patients and carers being very satisfied’ with the service, by June 2016.

Method

The project was carried out using the redesign methodology developed by the ACI’s Centre for Healthcare Redesign. This methodology consists of five sequential phases, outlined above.

The project commenced on 1 August 2015 and is scheduled to conclude on 31 December 2016.

Next Steps

Contact

Project Initiation & Start-up

Diagnostics

Solution Design

Implementation Planning Implementation

Checkpoints Implementation

Planning

Evaluation Sustainability

Knowledge Sharing

Diagnostics

“A waiting room should be a waiting room, not a corridor..” - Patient A range of activities were carried out to gather information about the clinic. These included: patient interviews and “tag alongs”, questionnaires for both patients and staff, process mapping, timing parts of the patient journey, and analysing data around clinic attendance in the past. The project uncovered three major sources of patient dissatisfaction.

1. Poor environment - for both staff and patients. 37% of staff and 100% of patients interviewed reported this as a major reason for dissatisfaction.

2. Long waiting times – to get an x ray, see the doctors, nurse and physiotherapist.

3. No explanation of processes – patients felt clinic processes were not explained clearly to them.

The diagnostic activities revealed what the major problems were. In coming up with solutions, a variety of techniques were used. These included: researching what other organisations facing similar issues had done; brainstorming with diverse groups of stakeholders including management, administration, radiology, clinicians and allied health; and performing root cause analysis on the major causes of dissatisfaction. The solutions were prioritised and the following were approved for implementation, with a staggered approach.

1. Improve waiting room comfort and fix clinic equipment

Simple things like providing patients with water and replacing broken equipment improve the experience for patients and staff.

2. Provide patients with more information An information sheet telling patients what the clinic is for, what to expect, and the names and contact numbers of the specialists.

3. Introduce a clinic concierge To greet patients, direct patients to where they need to be and answer any questions.

4. Implement a streaming system A sequence of steps for the patient’s next visit.

5. Optimise the booking process Electronic booking process optimised to prevent bottlenecks.

6. Improved governance and management Drives positive change from the top down.

Results

So far results have been very positive. 100% of patients are now going through the optimised streaming process and receiving patient information sheets. Since the improvements to the waiting room and the clinic concierge began, patients are reporting better experiences. As not all solutions have been implemented yet, waiting times are still quite unpredictable, but heading in the right direction.

Clinic concierge,

Peter

The #Fixit project has been a success so far, and more solutions will be rolled out in the coming months and before the year’s end.

1. Refurbishments The outpatient clinic area will undergo some refurbishment, meaning patient satisfaction should improve even further. There is also a proposal for a major refurbishment to refurbish the entire outpatient clinic area to create a new Ambulatory Care Centre.

2. Improved governance An ambulatory care manager will be appointed, who will oversee the day to day running of outpatient clinics and further improve clinic coordination and patient flow.

Cayley Smith, Acute Physiotherapy Team Leader Ryde Hospital Cayley.Smith@health.nsw.gov.au

Brian Bonham, Director of Nursing & Midwifery, Ryde Hospital Brian.Bonham@health.nsw.gov.au